Cardiac ablation, also known as catheter ablation, is a procedure to treat heart rhythm disorders (cardiac arrhythmias), a range of problems with the heartbeat’s rate or rhythm. Heart ablation involves guiding a catheter (a small and flexible wire) through the veins and/or arteries into the heart. The electrodes at the end of the catheter diagnose and correct problematic heart tissue.
Catheter ablation treats a variety of heart rhythm abnormalities. There are many types of cardiac arrhythmias. Some are benign, while others can be life-threatening. Arrhythmias that may be treated with catheter ablation include:
A careful evaluation by a heart rhythm specialist (cardiac electrophysiologist) can help determine the type of heart rhythm and the treatment options for it. 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 cardioverter defibrillator (ICD).
Catheter ablation may be curative, making the need for medications unnecessary.
Cardiac ablation involves a catheter ablation procedure to destroy the areas causing the abnormal heart rhythm. The two main types of cardiac ablation are:
During a cardiac ablation 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 the heart.
These electrodes are connected to monitors that tell the cardiologist what area(s) of the heart is interfering with the heart rhythm. Once the source of the problem has been found, one of the catheters is used to send radiofrequency energy or cryo to the 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 the abnormal electrical signals or reroute the electrical signals that are causing the abnormal rhythm.
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 Cardiac Arrhythmia Service 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.
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.
Catheter ablations may take less than an hour but can be a longer procedure that lasts from three to five hours. During the procedure, the heart will be closely monitored. Most people do not feel pain during the procedure, but sometimes experience a mild discomfort in the chest. After the ablation is over, the doctor will remove the catheters.
Before the Ablation Procedure
A cardiac ablation procedure requires only one day at the hospital. Typically, a patient will be asked to stop eating and drinking the night before the procedure. Your doctor will also discuss the potential need to discontinue medication ahead of your procedure.
The Day of the Ablation Procedure
Upon arrival, blood tests will be performed, and you and your family will be brought to the cardiovascular recovery room for preprocedural preparation. This will include placing an intravenous line (IV) and shaving your groin area (and chest, if needed). Your procedure will be reviewed with your care team. This is an opportunity for you and your family to ask any final questions.
You will then be brought back to the electrophysiology laboratory. You will be closely monitored throughout the procedure by many electrodes, and you will wear a blood pressure cuff. 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 cardiac ablation procedure, you will recover with the support of 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.
After Cardiac Ablation
Cardiac ablation recovery begins immediately after the procedure. Once you are home, you may experience soreness for up to a week, and you will need to avoid soaking in water for five days to allow time to heal. Your doctor will likely prescribe medication to prevent blood clots that may need to be taken for up to two months.
After about a week or two, the heart tissue will heal, and you can return to your normal lifestyle.
No, the use of a catheter for the ablation is a minimally invasive procedure that allows the patient to avoid surgery.
While complications with cardiac ablation are rare, every procedure comes with risks. They include:
Undergoing multiple cardiac ablation procedures throughout the course of treatment is not uncommon. An initial heart ablation procedure may not have recognized all the misfiring electrical signals and new issues may crop up following a procedure, making additional procedures necessary.
Doctors recommend avoiding caffeine for at least 24 hours before an ablation procedure and may advise avoiding it for a time following the procedure.
The most common catheter insertion point is via a large vein or artery in the groin. In some situations, based on the patient's condition, a doctor may discuss alternative locations, such as the arm or neck.
Cardiac ablation is generally considered to be safe procedures. Complications after catheter ablation are rare.
The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from Brigham and Women's main 75 Francis St. 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.
The Cardiac Arrhythmia Service of the Brigham and Women’s Hospital 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). We 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 our Cardiac Arrhythmia Service.
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.
The goal of our team is to provide the most accurate diagnosis in partnership with our patients. It is important that patients understand their diagnosis, what it means and the treatment options. We will work with you to determine the best approach for you.
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.
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