Before Your Procedure: Testing
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.) Please also follow these instructions:
- Do not drink any caffeine 24 hours before the scan.
- Remove all metal objects (such as glasses, jewelry, belts, or clothing with zipper).
- Fill out a pre-screening form.
Remember to dress comfortably. We will also ask you to 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 any allergies to iodine or shellfish (contrast allergies).
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. We will put a cushion under your knees and giving you a ball that you can squeeze in your hand. The ball will alert the technician, who runs the MRI machine, if you are feeling too uncomfortable or having any problems.
The MRI machine itself is loud. We will give you headphones so you can hear the technician who runs the machine. The technician will also use the headphones to 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 can’t have a cardiac MRI, they may schedule you for a cardiac computed tomography (CT). This is also a non-invasive, painless test.
Implantable Pacemaker or Defibrillator
Note that even if you have an 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, and does not involve radiation. This sonogram allows your doctor to record images of your heart from inside your esophagus (food pipe).
This test looks for blood clots in your heart. It needs to be done 24–48 hours before your ablation procedure, but may instead be done as part of the ablation itself. If we find a clot in your heart, we will reschedule your ablation procedure.
Plan for the TEE 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. We will then take you 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. We lubricate the tube is 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 (This 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. The catheter drains urine during the procedure and recovery.
Your nurses will shave your groin area and neck so they can insert the catheters. (A catheter is a thin, narrow, flexible wire.) We will also place multiple patches on your chest and back. These patches will 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. We will put 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 clean, we will cover your body 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. For some ablations, you will be under general anesthesia and on a breathing machine temporarily; for others you may be only lightly sedated and more awake. 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 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. Then 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.
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 we place them will depend on the type of ablation procedure you're having.
The mapping catheter locates where the abnormal signals are coming from in your heart. It marks those places on our 3D-mapping computer system. This helps us find the areas inside your heart tissue that need to be ablated (destroyed).
The ablation catheter delivers radiofrequency heating energy (or freezing energy) to create lesions. These lesions disrupt 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, we may ask you 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. They will put pressure on the areas where we inserted catheters. You will need to stay flat for two 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 stay at the hospital overnight 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).
What To Expect After Your Cardiac Ablation
Common Symptoms After Ablation
The ablated (or destroyed) areas of tissue inside your heart may take up 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 heartbeat
- Faster heartbeat
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
Recovery Guidelines
After your procedure you need to carefully return to your normal activities. These are general guidelines, but your doctor may modify them to suit your particular situation:
- 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 exercise for one week.
- Don’t have sex for one week.
The evening of your procedure, we will ask you to start walking. In most cases, you can return to office work in two to three days.
