Overview

What Is a Cardiac Ablation Procedure?

What Is a Cardiac Ablation Procedure?

Cardiac ablation is a minimally-invasive procedure that involves inserting catheters into your blood vessel and threading wires up into your heart. Your doctor will then use catheters with tiny electrodes attached to the end to destroy (ablate) small areas of your heart tissue that aren’t using electrical signals correctly. Read more about cardiac ablation.

What to Expect Before Your Cardiac Ablation

Testing

You may need some tests before your ablation procedure. Your doctor will let you know which tests you will need, if any. Testing requirements will vary for each patient.

Tests that you may need include:

  • Cardiac stress test,
  • Cardiac MRI or CT,
  • Transesophageal echocardiogram (TEE), and
  • Blood work.

Cardiac MRI: What Is Cardiac Magnetic Resonance Imaging?

Magnetic resonance imaging (MRI) is a safe, non-invasive test that creates detailed images of your organs and tissues by using radio waves and magnets. Cardiac MRIs give doctors valuable information about your heart.

Cardiac MRIs give doctors baseline images of your heart before a procedure. Doctors also use cardiac MRIs to rule out post-procedure complications. With cardiac MRI, we evaluate your anatomy and see how much scarring you have in areas we might target for ablation. We can also use the MRI images to integrate into our computer mapping system, a tool that helps doctors see your heart more clearly. Doctors also use cardiac MRIs to rule out post-procedure complications.

Before Your MRI

Before your MRI we will draw blood. This blood helps us see if your kidneys are healthy and working the way they should. (Your will need your blood drawn one month before your MRI).

  • Do not drink any caffeine 24 hours before the scan.
  • You must remove all metal objects (such as glasses, jewelry, belts, or clothing with zippers.) Remember to dress comfortably.
  • You must fill out a pre-screening form.
  • You will change into a hospital gown.

After those things are done, an MRI tech will place an IV in your arm (possibly two). Please tell your doctor if you have contrast allergies (allergies to iodine or shellfish). You will need a 13-hour medication treatment before the MRI. Also tell your doctor if you are claustrophobic or if you get anxious in tight spaces. 

During MRI

During the MRI, you will be lying on your back. We will try to make you as comfortable as possible by putting a cushion under your knees and giving you a ball that you can squeeze in your hand, which will alert the tech if you are feeling too uncomfortable or having any problems.

The MRI machine itself is loud. You will be given head phones so you can hear the technician who runs the machine and so that they can give you instructions on how to breathe during certain parts of the scan (breath in, breath out, hold).

If you are cold, we can get you a blanket.

If your physician decides you are unable to have a cardiac MRI, they will schedule you for a cardiac computed tomography (CT). This is also a non-invasive, painless test.

It's important to note that even if you have an implantable pacemaker or defibrillator, we can often still safely perform an MRI at University of Utah Health. However, the quality of the imaging may be lower than usual. We evaluate this on a case-by-case basis.

Transesophageal Echocardiogram (TEE): What is TEE?

A transesophageal echocardiogram is a sonogram that allows your doctor to record images of your heart from inside your esophagus, or food pipe. This test looks for blood clots in your heart and needs to be done 24-48 hours before your ablation procedure.

If there is a clot found in your heart, we will reschedule your ablation procedure. Plan for the procedure to take one to two hours.

Before Your TEE

  • Make a list of all your medications and check with your doctor to see if you can take them before the test.
  • Don’t eat or drink for six hours before the test (this includes drinking water).
  • Tell your doctor if you have ulcers, a hiatal hernia, or problems swallowing. Also, let him or her know of any allergies to any medications or sedatives.
  • Plan for someone to drive you home after the exam.

During Your TEE

When you arrive for you TEE, you will change into a hospital gown and then be taken to the testing room. Once in the room, we will spray your throat with an anesthetic to numb it. We may also give you a mild sedative through an IV in your arm to help you relax. (You could also be given oxygen.). Then we will ask you to lay on your side.

The doctor will gently insert a probe into your mouth. As you swallow, your doctor will slowly guide the tube into your esophagus. The tube is lubricated so that it will slide easily. You may feel the doctor moving the probe, but it shouldn’t hurt or interfere with your breathing.

A nurse will monitor your heart rate, blood pressure, and breathing. The test usually takes 20-40 minutes.

After the Test 

If your TEE is the day before your ablation procedure, you can eat and drink again as soon as your throat isn’t numb. You will need someone available to drive you home after the test.

 

Preparing for Your Catheter Ablation Procedure

The Night Before

Do not eat or drink anything after midnight on the night before your ablation.

The Day Of

  • Take only medications your doctor has told you to take with a small sip of water.
  • Remove makeup and fingernail polish.
  • Do not wear perfume or lotions with any fragrance.
  • If you wear glasses, contacts, or dentures, bring a case to store them in.

Things to Bring With You to Your Cardiac Ablation

  • Work release form (if needed).
  • Any heart medical records.
  • List of current medications or current medication bottles. (List should include the drug name, dose, and how often you should take it.)
  • Any questions you may have.
  • Your insurance card(s) and ID picture.

Day of the Procedure

Once you arrive at the hospital, a nurse will insert an IV into your arm to give you any medications and fluids that you will need during the procedure. Because you will be receiving fluids from an IV, your nurse will sometimes place a Foley catheter into your bladder to drain urine during the procedure and recovery.

Your nurses will shave your groin area and neck as needed so they can insert the catheters. A catheter is a thin, narrow, flexible wire. We will also be placing multiple patches on your chest and back to monitor your heart rhythm.

From here, your nurses will take you into the procedure room and move you onto to an X-ray table. The room will be cold but we will do everything possible to make you comfortable and place some warm blankets over you to keep you warm.

The patches on your chest and back will be connected to a machine. We will also monitor your blood pressure and oxygen level.

To keep the catheter insertion sites sterile (clean), your body will be covered with a sterile drape (cloth). Another sterile cloth will rest on your head, allowing you to still see the nurse. Only the area where the catheters are inserted will be exposed.

Your nurse or anesthesiologist will then give you sedation medication through your IV to help keep you comfortable. Many patients are sleepy but not unconscious. This means you will still be awake. 

However, depending on which ablation procedure you have, you may be under total, general anesthesia. Your doctor and anesthesiologist will determine the best type of anesthesia to give you during your procedure.

The Cardiac Ablation Procedure

For some patients, doctors can perform an ablation without inducing your arrhythmia (changing your heart's rhythm). However, more commonly, your doctor will use several catheters to cause your heart to beat quickly. This will help your doctor create an electrical map of your heart. This map helps your doctor identify what type of arrhythmia you have and where the problem is so they can find and ablate (or destroy) damaged cells inside your heart.

After ablating (destroying) the cells that are causing problems inside your heart tissue, your doctor will prompt your heart to start beating quickly again. If your heartbeat is regular and slower, then the ablation was successful. If your heart starts beating quickly and irregularly again, you may need more ablation.

You can read more about what happens during cardiac ablation.

Inserting the Catheters 

To insert the catheters into your skin, your doctor will use a local anesthetic to numb your skin so you won’t feel pain. However, you will feel a little pressure. Your doctor will use a small needle to make punctures in your veins or artery. If at any time you feel pain in the groin area, let the doctor or nurse know so they can inject more numbing medication.

Your doctor will then insert multiple catheters (or wires) through these puncture sites and guide them into your heart with the help of X-ray monitors.

How many catheters you have and where they are placed will depend on the type of ablation procedure you're having.

The mapping catheter locates where the abnormal signals are coming from and marks those places on our 3D mapping computer system so we can find the cells inside your heart tissue that need to be ablated (destroyed). The ablation catheter delivers radiofrequency heating energy (or freezing energy) to create lesions, disrupting the abnormal electrical signals inside your heart. You may feel some discomfort during this part of the ablation, depending on where in the heart it is.

Often, doctors will use an intracardiac echocardiography (sonogram) through a special catheter from within the heart. The total ablation procedure takes two to six hours, but the length of surgery depends on many factors.

During your procedure, you may be instructed not to move or take deep breaths while your doctor is ablating. This is important so your doctor can make sure she is ablating the right areas.

After Your Procedure

When the procedure is finished, your doctor will remove all the catheters and put pressure on the areas where your catheters were inserted. You will need to stay flat for four to six hours to make sure any bleeding has stopped and that your incisions (cuts) are healing well. Most patients will not need sutures (stitches).

After your procedure, you may be admitted to the hospital overnight. You will need to stay in the hospital for at least 23 hours after your procedure so hospital staff can watch you.

Your doctor may give you a prescription before you leave the hospital. You may fill prescriptions at your regular pharmacy or the hospital pharmacy. If you would like to fill your prescriptions at the hospital, please remember to have your insurance card(s) with you as well as some form of payment.

Ablation Risks

The chances of having health problems after a catheter ablation are fairly low. Still, it’s important to discuss any possible problems you may have with your doctor before the procedure.

Possible problems may include bleeding from or damage to the blood vessels where catheters were inserted; damage to the heart itself; damage to the heart’s working electrical system; additional arrhythmias; irritation around the heart; stroke or heart attack; or collateral (associated) damage to nearby structures such as the esophagus, pulmonary veins, and nerves that supply the diaphragm (phrenic nerve).

Depending on the ablation type, we may give you a cardiac MRI the day after your procedure to look for any collateral or associated damage (especially to your esophagus).

What to Expect After Your Cardiac Ablation

Common Symptoms After Ablation

The ablated (or destroyed) areas of tissue inside your heart take about six to eight weeks to heal. You may still have arrhythmias (irregular heartbeats) during the first few weeks after your ablation. During this time, you may need anti-arrhythmic medications or other treatment. You may experience the following symptoms:

  • mild chest aches
  • skipping heart beat
  • faster heart beat

Contact your doctor if you experience any of the following:

  • increased bleeding
  • bruising or pain where your catheter was inserted (insertion sites)
  • shortness of breath or chest pain
  • coldness, swelling or numbness in your arm or leg near the insertion site
  • a bruise or lump that’s larger than a walnut close to where your catheter was inserted
  • a fever of 100 F
  • symptoms of your arrhythmia
  • confusion
  • stroke symptoms

Activity Guidelines:

  • Don’t drive for two days.
  • Don’t lift more than 10 pounds for one week. (A gallon of milk is about 10 pounds).
  • Don’t have sex or exercise for one week.
The evening of your procedure, we will ask you to start walking. In most cases, you can return to work in two to three days.