Introduction

Ablation is used to treat abnormal heart rhythms. It can be performed both surgically and non-surgically.

Non-surgical ablation is performed in a special lab called the electrophysiology (EP) laboratory. During this non-surgical procedure a catheter is inserted into your heart and then a special machine is used to direct energy to the heart muscle. This energy either "disconnects" or "isolates" the pathway of the abnormal rhythm (depending on the type of ablation). It can also be used to disconnect the electrical pathway between the upper chambers (atria) and the lower chambers (ventricles) of the heart.

For those that require heart surgery, ablation can be performed during coronary artery bypass or valve surgery.

In addition to re-establishing a normal heart rhythm in people with certain arrhythmias, ablation therapy can help control the heart rate in people with rapid arrhythmias, and prevent blood clots and strokes. The maze and surgical pulmonary vein isolation.

There are two types of surgery that can be used to treat the abnormal heart rhythm, atrial fibrillation. These procedures are often combined with other surgical therapies such as bypass surgery, valve repair, or valve replacement. They include:

• The Maze procedure. The surgeon makes small cuts in the heart to interrupt the conduction of abnormal impulses and to direct normal sinus impulses to travel to the atrioventricular node (AV node) as they normally should. When the heart heals, scar tissue forms and the abnormal electrical impulses are blocked from traveling through the heart.
• Surgical ablation. The surgeon creates controlled lesions on the heart and ultimately scar tissue to block the abnormal electrical impulses from being conducted through the heart and promote the normal conduction of impulses through the proper pathway. This procedure involves a single incision into the left atrium. One of three energy sources may be used to create the scars: radiofrequency, microwave or cryothermy (cold temperature).

The type of ablation performed depends upon the type of arrhythmia and the presence of other heart disease.

Why Do I Need Ablation Therapy?

Doctors recommend ablation therapy to treat:

• Atrial fibrillation and atrial flutter
• AV Nodal reentry tachycardia (AVNRT)
• Accessory pathways
• Ventricular tachycardia

How Should I Prepare for Catheter Ablation?

• Ask your doctor which medications you should stop and when to stop them. Your doctor may ask you to stop certain medications (such as those that control your heart rate or aspirin products) one to five days before your procedure. If you are diabetic, ask your doctor how you should adjust your diabetic medications.
• Do not eat or drink anything after midnight the evening before the procedure. If you must take medications, drink only with a small sip of water.
• When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.

What Can I Expect During Catheter Ablation?

• The procedure will take place in a special room called the EP (electrophysiology) lab. Before the test begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV (intravenous) line. This is so the doctors and nurses can give you medications and fluids through your vein during the procedure. You will be given a medication through your IV to help you relax. Depending on the type of ablation you have, you may or may not be awake during your procedure. If you are awake, you will be asked to report any symptoms, answer questions or follow instructions given to you by your doctor. If you are uncomfortable or need anything, please let your nurse know.
• The nurse will connect you to several monitors.
• After you become drowsy, your groin area will be shaved and you neck, upper chest, arm and groin will be cleansed with an antiseptic solution. Sterile drapes will be placed to cover you from your neck to your feet.
• The doctor will numb the insertion site by injecting a medication. You will feel an initial burning sensation, and then it will become numb. Then, several catheters (special wires that can pace the heart and record its electrical activity) will be inserted into a large blood vessel(s) and or artery (in your groin, neck or arm) and advanced to your heart. If you are awake, it is important that you remain still and resist the temptation to raise your head to see what the doctor is doing while the catheters are being placed.
• After the catheters are in place, the doctor will look at the monitor to assess your heart's conduction system.
• Then, the doctor will perform the ablation procedure.
• During traditional ablation, the doctor will use a pacemaker to give the heart electrical impulses to increase your heart rate. You may feel your heart beating faster or stronger when you are paced. If your arrhythmia occurs, the nurse will ask you how you are feeling. It is very important to tell the doctor or nurse the symptoms you feel. The doctor will then move the catheters around your heart to see which area(s) your arrhythmia is coming from. Once the doctor finds the area of your arrhythmia, energy is applied. You may feel some discomfort or a burning sensation in your chest, but you must stay quiet, keep very still and avoid taking deep breaths. If your pain is extreme, tell your nurse or doctor and they may give you more medication to help you.
• During pulmonary vein ablation (for atrial fibrillation), the doctor delivers energy through a catheter to the area of the atria that connects to the pulmonary vein (ostia), producing a circular scar. The scar will then block any impulses firing from within the pulmonary vein, thus preventing atrial fibrillation from occurring. The process is repeated to all four pulmonary veins. In some cases, ablation may also be performed to other parts of the heart such as the subclavian veins and coronary sinus. The catheter is a special "cool tip" catheter. Fluid circulates through the catheter to help control the intensity of the temperature. Once the ablation is complete, the electrophysiologist will use monitoring devices to observe the electrical signals in the heart and evaluate if the signals are coming from areas around the pulmonary veins or are originating, as they should, from the sinus node.

The procedure usually takes about four to eight hours, but sometimes longer.

What Happens After Catheter Ablation?

• The doctor will remove the catheters from your groin and apply pressure to the site to prevent bleeding. You will be on bed rest for one to six hours. Keep your legs as still as possible during this time to prevent bleeding.
• After your procedure, you will be admitted to the hospital. You will be taken to your room and a special monitor, called telemetry, will be used to follow your heart rate and rhythm. Telemetry consists of a small box connected by wires to your chest with sticky electrode patches. The box causes your heart rhythm to be displayed on several monitors on the nursing unit. The nurses will be able to observe your heart rate and rhythm. In most cases, you will be able to go home the next day after the catheter ablation procedure.
• You and your family will receive the results of the procedure after the procedure. Your doctor will also discuss when you can resume activities and how often you will need to visit your doctor.
• Temporarily, many individuals experience heart palpitations on and off for a few weeks after the procedure. Sometimes you may also feel as if your abnormal heart rhythm is returning, but then it stops. These sensations are normal and you should not be alarmed. But, if you feel as if your abnormal heart rhythm has recurred, call your doctor.
• You may be required to take medications to treat or control your abnormal rhythm after the procedure until the scars created in the heart heal. Healing after surgery takes 6-8 weeks.

If you have any other questions, please ask your doctor or nurse. Ask your health care provider how often you will need to go for follow-up appointments.

How Should I Care for the Wound Site?

You will have a small sterile dressing on your wound. It may be removed the next day. Keep the area clean and dry.

Call your doctor if you notice any redness, swelling or drainage at the incision site.

Reviewed by the doctors at The Cleveland Clinic Heart Center.
Edited by Charlotte E. Grayson, MD, June 2004, WebMD.

Portions of this page © The Cleveland Clinic 2000-2004

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