Catheter Ablation

Catheter ablation, also known as cardiac ablation, is a procedure used to treat abnormal heart rhythms. Ablation involves guiding a catheter (small and flexible wire) through the veins and/or arteries and into the heart. The electrodes at the end of the catheter are used to diagnose and then correct heart rhythm disorders (arrhythmias), a problem with the heartbeat’s rate or rhythm. Radiofrequency (RF) energy (heat) or cryoablation (freezing) can be applied to the abnormal heart tissue through the tip of the catheter. This is done to ablate (destroy) areas that are causing the abnormal heart rhythm.

Catheter ablation can be used to treat a variety of heart rhythm abnormalities and may be an alternative to medications. Arrhythmias that may be treated with catheter ablation include: atrial fibrillation, atrial flutter, supraventricular tachycardias (SVTs or arrhythmias involving the upper chambers of the heart) and ventricular tachycardia (VT or arrhythmias involving the lower chamber of the heart). In many cases catheter ablation may be a curative procedure. 

The Heart Rhythm Disorders Program of the Brigham and Women’s Hospital (BWH) Heart & Vascular Center is devoted solely to the care of patients with irregular heart rhythms, heart palpitations and rapid heartbeat conditions. Treatment is provided by some of the world's most experienced physicians in cardiac electrophysiology (the study of the heart’s electrical system). They perform more than 3,000 procedures annually, utilizing the latest medications, devices and innovative care approaches. Many of the most complex patients from around the country and the world are referred to the Heart Rhythm Disorders Program.

With 47,000 outpatient visits each year, the Heart & Vascular Center is one of the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.

Catheter Ablation Topics

Why Have an Ablation?

There are many types of heart rhythm disorders. Some are benign, while others can be life threatening. A careful evaluation by a heart rhythm specialist (cardiac electrophysiologist) can help determine what type of heart rhythm problem you have and what the treatment options are. While some abnormalities require no treatment, others may require taking medication or the implantation of an electronic cardiac device, such as a pacemaker or implantable cardiovertor defibrillator (ICD).

Catheter ablation may be a treatment option that can cure an arrhythmia, making the need for medications unnecessary, or an adjunct to device therapy, to prevent recurrent shocks from an ICD, for example. You can find out the best treatment options for your abnormal heart rhythm by consulting with a heart rhythm expert, such as those found at the Heart Rhythm Disorders Program of Brigham and Women’s Hospital. Our team is highly experienced at performing these procedures, and in many cases were the pioneers in developing them.

The goal of our team is to provide the most accurate diagnosis in partnership with our patients. It is important that patients understand what their diagnosis is and what it means, and what the treatment options are. We will work with you to determine what the best approach is for you.   

What Happens During an Ablation?

During the procedure, catheters are inserted into a blood vessel. The physician uses live X-ray images (fluoroscopy) and ultrasound to carefully guide the catheter into the heart. Catheters with small electrodes on their ends are placed in different areas of your heart.

  • These electrodes are connected to monitors that allow the cardiologist to tell what area in your heart is causing problems with your heart rhythm. Usually, there are one or more specific areas.
  • Once the source of the problem has been found, one of the catheters is used to send radiofrequency energy (heat), or cryo (freezing) to the problem area to destroy or “ablate” it. This area is usually quite small, about one-fifth of an inch.
  • This is done to either eliminate the source of abnormal electrical signals or reroute electrical signals that are causing the abnormal rhythm.   

Catheter ablation procedures are done in a hospital laboratory by specially trained staff. This includes a cardiac electrophysiologist, technicians, nurses and sometimes a cardiac anesthesiologist (depending on the type of ablation). The setting is safe and controlled to make your risk as low as possible.

Catheter ablations may take less than an hour but can be a long procedure that may last three to five hours. During the procedure your heart will be monitored closely. Most people do not feel pain during the procedure but you may sense mild discomfort in your chest. After the ablation is over, your doctor will remove the catheters.

 

The Day of the Ablation

The day of your procedure you will be asked to refrain from eating past midnight. After arriving at the hospital, blood tests will be performed and you and your family will be brought to the cardiovascular recovery room (CVRR) for preprocedure preparation. This will include placement of an intravenous line (IV), and shaving of your groin area (and chest if needed). Your procedure will be reviewed and consent obtained. This is an opportunity for you and your family to ask any additional questions.  

You will then be brought back to the electrophysiology laboratory (EP Lab). You will be closely monitored throughout the procedure and many electrodes and a blood pressure cuff will be placed. Depending on the type of ablation, your sedation may be provided by an experienced nurse or you may receive general anesthesia by a cardiac anesthesiologist. Every effort will be made to keep you comfortable and anxiety-free during the procedure. The areas in the groin where the catheters are placed will be “numbed” with local anesthesia. If not under general anesthesia, you may feel your heart race from time to time as we diagnose the abnormal heart rhythm. During ablation you may feel a slight burning feeling in your chest. At the end of the procedure, the catheters will be removed and pressure will be applied to where they were inserted to prevent bleeding

After your procedure, you will recover in the CVRR where you will receive comprehensive care by an experienced surgical and nursing staff. You will have to lie flat for four hours to allow the blood vessels to heal. You may go home the same day or stay overnight in the hospital for monitoring depending upon the type of ablation.

Read more about catheter ablation.

What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

Prior to your procedure, you will likely be scheduled for a visit to the Watkins Clinic in the Shapiro Cardiovascular Center for pre-operative information and tests.

During your procedure, family and friends can wait in the Shapiro Family Center where staff members will provide surgery updates.

Multidisciplinary Care

In addition to our cardiac electrophysiologists, patients also benefit from the teamwork of interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiovascular disorders. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn about the Watkins Clinic in the Shapiro Cardiovascular Center.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

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