Catheter Ablation Procedure
What to Expect
A CT scan can show details of the heart, coronary arteries and veins.
You and your family should take as much time as you need to decide about whether ablation is for you. You can ask us any questions you may have.
We will send you a letter with instructions about where to go, when to arrive, what medicines to stop and other details. Please call us if there is any missing information you need or if you have questions. We can help you find nearby hotels offering discounts if you or your family want to stay close to the hospital before and after the procedure.
Preparing for the Catheter Ablation Procedure
Before the ablation, you may go through the following steps:
- We may need to be certain that you have atrial fibrillation (AF). If there is no recent EKG or other recording of your arrhythmia, you may be given a monitor to take home to record an AF episode
- You’ll have a CT scan or MRI to image the left atrium. The CT will help us see how many pulmonary veins you have, how big they are and where they attach to the atria
- You may need to stop some of your medicines before the procedure. This instruction will be different for each patient and for his or her particular medication
- Warfarin (Coumadin) or other anticoagulation pills are usually stopped for three days before the procedure. Most people will take one regular (adult) aspirin daily instead. If you have special risk factors, you may need to take injections of short-acting blood thinners between stopping and restarting the warfarin
- You’ll be asked to not eat or drink anything for eight hours before the procedure
- You’ll be asked to sign paperwork acknowledging you’re aware of the procedure risks, benefits and alternatives. You can have the procedure reviewed with you and ask any questions
- You will be admitted to a private room and asked to change into a hospital gown, then an intravenous (IV) line will be started and blood work sent for analysis
- Your history will be reviewed to update it and a physical exam will be done. Your family can wait with you in this private room until it is time for you to come to the procedure suite
During the Ablation
The actual procedure will take three to six hours during which time you will be sleeping (under anesthesia). We have experienced anesthesiologists who work with us to keep you comfortable. A breathing tube may be placed in your windpipe and the anesthesiologist will monitor every breath.
You may have a tube placed in your bladder (urinary catheter) to drain urine because you will be getting fluids through your IV all throughout the procedure.
The catheters (long, flexible, softly coated wires) will be placed into your blood vessels after you have had sedation. You should not feel any discomfort, restlessness or anxiety during the procedure as the anesthesiologist will be administering medications while you sleep.
Your family can stay nearby in the admission area or in the room you will go to after the EP procedure. We will keep them updated about what is happening, either in person if they are nearby or by telephone. There are TVs in the area.
Procedure
Thin, coated wires called catheters are placed through large veins into the heart chambers. The catheters connect to computers that detect and display electrical activity of the heart. We examine these signals and other information to locate sites of abnormal electricity that is likely related to AF. Controlled energy is sent down the catheter touching the area to ablate (erase) the abnormal electrical activity with the goal of stopping the AF.
How Do the Catheters Get to the Heart?
Before we put any catheters in, we’ll prepare you for the procedure by connecting you to medical monitors to watch your blood pressure, oxygen levels and heart rhythm. You’ll have had an intravenous (IV) line placed so we can give medicines for sedation or pain, and for testing your heart. Usually an anesthesiologist will be at your side for the entire procedure, helping us keep you comfortable and safe. We prefer to have you sleeping under general anesthesia throughout the entire procedure. This means you’ll have a tube placed into your windpipe so a machine can manage your breathing.
Catheters are placed into veins at the top of your legs (femoral veins) or at your neck (internal jugular vein) using a technique like placing the intravenous line. After the areas are washed (and shaved if necessary), a tiny needle is used to reach the vein. We replace this needle with a flexible tube that the catheter can slip through. Your doctor steers or guides the catheter to your heart while looking at the fluoroscopy (X-ray). Several catheters are placed this way to monitor your heart's electricity. A special catheter is used to deliver energy and ablate. The catheters do not interfere with blood moving about the body.
What are the Risks of the Catheter Ablation Procedure for AF?
Any invasive procedure carries some risk. Please ask questions about the risks if you do not understand them.
Possible complications include heart attack, stroke, blood vessel injury, allergic reactions, arrhythmias, blood loss with need for transfusions, bleeding around the heart, need for a permanent pacemaker and death. Possible complications of ablation in the left atrium include injury to the pulmonary veins causing narrowing, injury to the food pipe (esophagus), and injury to the diaphragm (breathing muscle). Emergency surgery may be necessary to repair one or more of these injuries. These have a likelihood of occurring once in every thousand procedures.
Each of the possible risks is rare but the risks are real and cannot be underemphasized. You need to weigh these risks against the risks and discomforts of continuing in the AF.
There may be other risks that we cannot foresee.
After the Ablation
After the procedure, the catheters are removed and pressure is applied to the entry areas. Your anesthesia will be "reversed" and you will wake up. When there is no bleeding from the sites, you will be transferred from the EP suite to your hospital room. You may feel a slightly sore or dry throat. You will be able to drink and eat as soon as you are alert. We may leave your urinary catheter in place until you can get up and use the bathroom.
You will rest in bed for at least six hours to prevent any bleeding. Generally, you will go home next day or the day after. You will often have an echocardiogram before you leave to check for any complications.
You will get discharge instructions before you go home. The nurse and the physician will discuss these with you and give you a copy of the written instructions. You may still feel tired with some muscular aches. It may be best if someone drives you home.
Some of the instructions will include:
- Make an appointment with your doctor for four to six weeks after the procedure
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You will be given a list of medications to be taken:
- Warfarin (Coumadin) will almost always be prescribed after the procedure. Your doctor will decide when it can be stopped. Get a blood test for Coumadin effect in three to five days
- Other medications may be continued or new medications may be started after the procedure. In some instances, these medications may be stopped after a few weeks or months
- Avoid lifting or exercising for one to two days after the procedure
- You may return to work two to seven days after the procedure
Call us for:
- Drainage, bleeding or swelling, fever or signs of infection at the ablation catheter or IV sites
- Abnormal or increased shortness of breath or excessive weight gain, dizziness or fainting, rapid heart beats or palpitations
- Unusually sore throat
You may be given a heart monitor soon after you get home and then at three and six months following the procedure to assess for any recurrence.
Expect to feel some irregular heart rhythms during the next six weeks to six months. This is normal. Random occasional skips or palpitations, or some shift in your normal pulse rates can be normal. Treatment for these will be on a person-to-person basis determined by the results of the monitoring and the severity of any symptoms.
Continue your blood thinner (Warfarin, Coumadin or other anticoagulation medicine) and continue to have regular blood tests to monitor and regulate the dose of the blood thinner.
Some patients feel quite well after their ablation. Other patients feel tired for a few days or also feel aches and pain. Usually these discomforts are short lived. Muscle aches are usually related to having been very still, immobile, during the ablation procedure. It is unusual for anyone to lie absolutely still, even in sleep. Some of this muscle tension can be relieved by simple steps to help you relax, like taking a warm bath or shower.
Outcomes
Most patients who have the procedure improve, with half of them able to be free of heart rhythm medications. The doctor will talk to you about your chance of success during your pre-procedure visit.
Some patients have found they have fewer episodes and those episodes are easier to tolerate, or that medication can now prevent or control episodes even if the same medication was not helpful before the procedure.
Some patients will continue to have and feel some extra heartbeats. These feelings may have occurred with AF in the past, but these extra heartbeats felt after the procedure do not usually start AF up. If you are aware that this can happen, it will be easier to manage the sensations without feeling anxiety. It is common to have some sensations of irregular heartbeats after the procedure due to healing.
We cannot guarantee that the procedure will be a success for any single person. We know that people who have AF continuously for years will have less chance of success while people whose AF comes and goes, on its own or with help, have a better chance of success.
We understand that treating AF is a process, not a simple fix and may take some time or repeat procedures. We may not be able to eliminate all of your symptoms as some may be related to your other conditions. We will work with you to seek the best options and best choices for you.
Read about Atrial Fibrillation in our booklet, What You Need to Know about Atrial Fibrillation (PDF, 1.3 MB).