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Ablation

What is a radiofrequency catheter ablation (also called ablation)?
When a heart rhythm disturbance is caused by a fast rhythm, an ablation may be the treatment of choice. Ablation stands for "elimination" or "removal". An ablation is performed at the same time as an electrophysiological study. A specially trained Inova cardiologist, or electrophysiologist, performs this procedure at the Inova Heart Center.

Specifically, an ablation procedure begins with the insertion of a catheter that is guided into the heart to map or locate abnormal tissue causing the irregular heart rhythm. Then the catheter passes radiofrequency energy into the heart at the precise area that contains the abnormal tissue. This destroys the tissue causing the irregularity and, in most cases, a normal heart rate is restored.

Ablation is performed to treat fast heart rates such as supra ventricular tachycardia or ventricular tachycardia.

Catheter ablation is designed to prevent a return of the fast heart rhythm, but ablating some parts of the heart can cause a slow heart rate. In such cases, a permanent pacemaker may be needed. Your Inova Heart Center Electrophysiologist will discuss this in detail if it is applicable to you.

What are the risks?

The risks of an ablation are low and are outweighed by the benefits from the treatment Risks include bleeding, blood clots, heart block, perforation of the heart muscle or of a blood vessel, stroke or heart attack (very rare), and death (extremely rare). Click here to read more about the Inova Heart Center's outcome indicators regarding ablation.

Preparing for the procedure

• This procedure is completed in the hospital. Most patients go home the day of the procedure. Some patients are admitted to the hospital the day before or the day of the procedure and go home the next day.
• Your Inova cardiologist will order lab work, blood tests, an EKG, possibly a chest x-ray, and possibly an echocardiogram. Some of these may be completed in the physician's office and others will be completed at the hospital. These tests should be completed a few days before the radiofrequency catheter ablation.
• If you are already a patient in the hospital, your physician will determine the type of tests you will need and when they will be completed. An anesthesiologist will interview you about your health the day before the procedure.
• Do not eat or drink anything after midnight the night before the procedure.
• You may brush your teeth the day of the procedure and take any physician-approved medicines with as little water as possible.
• You should arrange for a family member or friend to drive you to the hospital and to pick you up if you are able to go home that evening. Your family members are welcome to stay with you before and after the procedure.
• You will change into a hospital gown, and a nurse will ask you questions about your health, take your blood pressure and check your temperature. The nurse will start intravenous fluids flowing through a needle inserted in your hand or arm. A nurse and a doctor will discuss the procedure and the possible risks associated with the procedure with you. You may ask questions any time and you will be asked to sign consent forms for the procedure.

During the procedure

• The radiofrequency catheter ablation usually takes 3 to 6 hours. You will be brought to the lab and asked to lie down on a thin table. The room will be cool and dimly lit. Cold monitor patches and EKG stickers will be placed on your back and chest. An oxygen monitor will be taped to one of your fingers, and a blood pressure cuff will be put on your arm.
• You will be given general anesthesia through your IV, this will help you to fall asleep.
• Your arms will be tucked in at your sides with sheets so they do not slip off the table when you get sleepy. You will need to lie still during the procedure.
• After you fall asleep, a catheter will be inserted into your bladder to monitor your fluid status (urine output) during the procedure. This will also help prevent problems with urination when you are confined to bed after the procedure is complete. The catheter will be removed when you start getting out of bed.
• There will be a large circular piece of equipment around the table. It holds the X-ray in position above your chest and below the table. There are several TV monitors in the room so that the electrophysiology team can monitor you and watch as they work. Thin tubes will be inserted into the blood vessels in your groin (at the top of your leg) or upper chest.
• Special catheters are then placed into your heart through the thin tubes to track the electrical activity as it moves through the heart. This electrophysiology study provides an electrical map of your heart. The ablation can than be performed as the mapping identifies the location that requires ablation.
• When the procedure is over, the tubes in your leg and upper chest will be removed and the lab staff will apply pressure over the sites for 10-20 minutes.
• After the bleeding has stopped, a Band-Aid or heavier dressing will be placed on your groin and upper chest sites.
• You will then be taken to a recovery area to fully wake up (this usually takes about one hour). A chest x-ray may be completed in the recovery room. After you are fully awake, you will be moved to your room. Your family and friends may wait to speak with the physician in the csath/ep lab waiting room. After they speak with the physician, they may wait for you in your assigned room.

Path of cardiac catheter

After the procedure

• You will have to remain flat in bed for 4 to 6 hours, with the head of the bed raised 30 degrees or less. You must keep your leg straight while on bed rest, and a sandbag will be placed on the insertion site (to keep it from bleeding).
• If you cough, sneeze, laugh, move in bed, or use the bedpan or urinal you will need to hold pressure over the site with your hand. The nurse will assist you with this.
• If you have increasing pain at the site; feel something warm, wet, sticky, or swollen at the groin site; or have numbness, tingling, or pain to the foot, hold pressure and call your nurse immediately. Notify your nurse immediately if you experience any angina or chest discomfort.
• You will be asked to drink lots of fluid.
• After 4-6 hours you will allowed to use the bathroom and sit in a chair while you are monitored for bleeding. If your pulse and blood pressure remain stable and there is no more bleeding after you have been up for an hour, you will be allowed to go home (or if admitted you will be allowed up in the room on your own).
• Family or friends are welcome to help monitor the bed rest and assist in encouraging you to drink and eat.

While in the hospital

• Ask your nurse for pain medication if you experience any discomfort.
• Notify your nurse immediately if you experience any angina or chest discomfort. If you have increasing pain at the site; feel something warm, wet, sticky, or swollen at the groin site; or have numbness, tingling, or pain to the foot, hold pressure and call your nurse immediately.

The day after your procedure

• You can expect a small amount of bruising at the catheter insertion site, along with a small, marble-sized knot. If you feel additional discomfort, notice a large knot or bleeding from the site, don't hesitate to tell your nurse or physician.
• Your Inova electrophysiologist will review the results of the procedure with you.

Do's and don'ts after your procedure

• Do not lift anything heavier that 15 pounds.
• Limit stair climbing for the first 48 hours.
• Do not operate heavy machinery for several days.
• You may take acetaminophen (such as Tylenol) for pain; however, do not take aspirin or ibuprofen for 3 days unless your physician says you can.
• Do not shower or bathe the evening after your procedure. You may take a shower the next day.
• You should be able to return to work a few days after your procedure.

Notify your Inova cardiologist if any of the following symptoms occurs after you go home:

• Oozing from the insertion site.
• Body temperature (fever) greater than 100 degrees.
• Angina or chest pain.
• Call 911 if the knot at the insertion site becomes larger, or if bleeding occurs. If you are bleeding, lie down and apply direct pressure to the site until you receive emergency care; this pressure will help stop the bleeding.
• Call 911 or have someone take you to the nearest emergency department if you lose feeling in an arm or leg.