What happens during a cardiac ablation?

Atrial fibrillation is a very common type of irregular heartbeat. If medications aren't enough to keep people in a safe rhythm, another option is a procedure called an ablation. For an ablation, doctors use catheters inside the heart to find certain areas where atrial fibrillation typically comes from. They can burn, and in some cases, freeze around those areas to try to disconnect them electrically from the rest of the heart. Doctors use an x-ray system that provides 3D mapping, similar to a GPS, inside the heart. They also simultaneously use an ultrasound system to look at multiple different images. Most importantly, this procedure can correct the problem without other devices or a lifetime of medications.

The goal of an atrial fibrillation ablation is, by restoring normal rhythm, to provide you with symptomatic relief and to do so in a safe and comfortable fashion.
Catheter ablation is a procedure used to selectively eliminate (damage or get rid of) the heart cells causing heart rhythm disturbances ("arrhythmias").

A team of specialists including Electrophysiologists, one or more nurses, an Electrophysiology (EP) technologist, and a radiology technologist will perform your ablation. The members of the team will check you throughout the procedure to monitor your condition. Please do not hesitate to ask them any questions.

The procedure sites (both groin areas and sometimes the right side of your neck) will be shaved and washed with an antiseptic soap. You will then be covered from your neck to your toes with a large sterile sheet that helps to prevent infection. The Electrophysiologists will wear masks, gowns, and gloves in order to maintain sterile conditions during the procedure. The lighting in the EP lab will be dimmed during most of the procedure to allow the physicians to view the heart monitors and x-ray screens more clearly.

A local anesthetic will be administered at the sites chosen for insertion of the catheters (small, thin tubes). You may feel a temporary sting or slight pressure as the area is anesthetized, in addition to some pressure as the catheters are inserted. If you experience undue discomfort, please let the physician or nurse know so they can provide you with additional medicine. Once the catheters are in position, you should feel comfortable.

Before the actual ablation can be performed, the physicians must first identify the area where your abnormal rhythm is coming from. They will record the electrical activity of your heart during your abnormal rhythm to create a "map" of the precise area of heart muscle responsible. During this time you may experience some palpitations, but otherwise you will be resting quietly.

Once the physicians have identified the mechanism of your abnormal rhythm, they will insert a special catheter. The catheter tip will be positioned against the inner surface of the heart muscle as close as possible to the site of origin of your abnormal rhythm. Radiofrequency current is then passed into the area through the tip of the catheter in order to cauterize (burn) and silence the cells responsible for your abnormal heartbeat.

If you experience any chest discomfort or pressure, be sure to inform the staff during the procedure. The length of the procedure is variable, but most commonly ranges between three and four hours.
Typically, a cardiac ablation procedure takes 1 to 2 hours. A combined procedure (EP and cardiac ablation) may take 3 to 4 hours or longer. You will sleep through the procedure.

The first step in an EP study is inserting one or more catheters.
  • Anesthesia: First, medication will be given so you go to sleep and sleep through the procedure.
  • Preparation: A nurse will prepare each patch of skin where a catheter will be inserted.
  • Monitoring: You will have monitoring devices attached to check your heart rate, breathing, and other information.
  • Inserting catheters: Your  doctor will first insert a sheath (a short plastic tube) into a blood vessel. Each catheter will be put into the sheath and threaded through the blood vessel to the heart. Guidance is provided by x-ray imaging techniques.
  • Finding the abnormal heart tissue: An EP study confirms the location of the tissue that is causing the rhythm problem.
  • Placing the ablation catheter: An ablation catheter connected to a specialized device is placed next to the abnormal tissue.
  • Ablation of the abnormal cells: Precisely focused radiofrequency energy or liquid nitrogen is sent from the catheter to the abnormal tissue cells. This ablates the cells, or in other words, creates a tiny scar. This prevents the abnormal cells from interfering with the heart’s normal electrical pathway.
  • Removing the catheter(s): Numbing medication will be applied to the catheter sites. Each catheter will be threaded back through the vein and removed. Then the sheath will be removed.
  • Sealing the catheter site: A doctor or nurse will apply pressure to the site to prevent bleeding, and a bandage or pressure bandage will be placed on the site.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.