Catheter ablation is an established procedure that has eliminated atrial fibrillation (Afib or AF) for many patients and reduced Afib symptoms for many others. Before your doctor recommends catheter ablation for you, your care team will need to confirm that you are a good candidate for the procedure. If it is determined that you are likely to benefit from catheter ablation and you decide to go forward with the procedure, your care team will review how you should prepare for the procedure, what will happen during the procedure and what to expect during recovery. Here we review some general information about catheter ablation.
Testing Before Catheter Ablation
Before you undergo a catheter ablation procedure, your doctor and medical team will order tests to check on your overall health and how your heart is doing. These tests may include:
- Blood Tests: Your care team can learn a lot about your health by studying the results of blood tests. Learn more about blood tests here.
- Chest X-ray: A chest X-ray is a painless test that produces an image of the inside of your chest. It shows the bones, heart and blood vessels. Learn more about chest X-rays here.
- Cardiac CT Angiography or Cardiac MRI: Both CT angiography and cardiac MRI tests provide doctors with images of the blood vessels in and around your heart. A CT angiography scan uses X-rays and a computer to create detailed images of the blood vessels and the blood flow inside them. A cardiac MRI (magnetic resonance imaging) uses magnetic fields and energy radio-waves to produce two- or three-dimensional images of the heart and blood vessels.
- Echocardiogram: This test uses sound waves to create a moving picture of your heart. The information provided by this test can help your doctor see the heart’s chambers, walls, muscles and valves. Learn more about how an echocardiogram works here.
- Transesophageal echocardiogram (TEE): This special type of echocardiogram is performed by placing an ultrasound probe down your throat. The ultrasound images provide excellent images of the left atrium, so that your doctor can be sure no blood clots are present before the procedure is performed. You can learn more about TEE here.
Depending on your overall health and risk factors, your doctor may recommend other tests as well.
About Your Catheter Ablation Procedure
Before your catheter ablation procedure, your care team will review all of the details about what to expect before, during and after the procedure. Your information will be tailored to you and your condition and will likely include guidelines about the following:
- What you may or may not eat or drink in the 24 hours before the procedure.
- Whether you should continue taking any medications before your procedure. As always, make sure your doctor has a full list of your medications, including prescriptions, over-the-counter medicines and supplements.
- Whether you will be spending the night in the hospital after the procedure. This will depend on the type of procedure you are having, your overall health and other factors.
- Whether you will need to arrange for someone to drive you home. Most people are not allowed to drive for at least 24 hours after a catheter ablation procedure. You will also want a family member or friend to be available to help you at home during the first few days after the procedure because your activities will be limited.
All catheter ablation procedures are performed in a hospital setting. Before your procedure, you will probably be given a sedative to help you relax. You will be taken to the electrophysiology laboratory, where your care team, including your electrophysiologist, will be waiting for you. They will use a medication to numb the area on your upper leg where the thin tubes (catheters) will be inserted into your blood vessels. Between the sedative and the numbing medication, you will not feel the procedure taking place.
What Happens During a Catheter Ablation Procedure?
As the procedure begins, your electrophysiologist will insert one or more catheters through your blood vessels and into your heart. Once the catheters are in place in your heart, your electrophysiologist will identify the tiny “hot spots” in your heart muscle that are sending the abnormal electrical impulses that are causing your heartbeat to be irregular.
For most patients, the electrophysiologist delivers a tiny pulse of painless, low-level energy to each “hot spot.” This energy kills the tissue that is causing the atrial fibrillation or other arrhythmias. It is possible that your electrophysiologist could instead use a catheter that has a cold tip. This device is used to freeze the problem tissue (cryotherapy).
Whether your team uses hot or cold energy to treat the problem heart tissue, the intended result is the same: the tissue that is causing the problem will die and in its place, scar tissue will form. Scar tissue cannot transmit or react to electrical signals, which means that it cannot cause atrial fibrillation.
A catheter ablation procedure is focused on very small areas of heart tissue. Your heart does not need this tissue to do its job pumping blood to your body. In fact, most people are allowed to go back to their normal activities once their care team has determined the catheter ablation procedure was successful. After the procedure, you do need to wait for your doctor to advise you on when to start exercising and how much exertion is right for you.
In some cases, people who have catheter ablation also receive a pacemaker – a small, battery-powered device that is implanted in the upper chest to monitor the heartbeat and help the heart keep beating as it should. Your doctor will let you know before the procedure if a pacemaker will be necessary. You can learn about pacemakers here.
Most catheter ablation procedures take two to four hours, sometimes longer, especially if a pacemaker is also being implanted. When the entire procedure is completed, you will be moved to a recovery room. You will be asked to remain in bed and to hold your leg that received the catheters straight for a few hours. This is to allow the area where the catheter was inserted (known as the access site) time to begin healing.
Back at Home: After Your Catheter Ablation Procedure
Most people who have catheter ablation stay in the hospital overnight.
When you are discharged from the hospital, you will not be allowed to drive until your doctor confirms that you have fully recovered from the procedure. You will also have to avoid strenuous exercise and any heavy physical activity until your doctor has given approval to return to these activities. When you are making plans for your catheter ablation, it is important to make sure a family member or friend will stay with you for a few days after the procedure. They can drive you home from the hospital and to your follow-up appointments. They can also help with activities that require lifting or exertion.
Your doctor may want you to keep track of your pulse for several days after the procedure. You may be asked to take your pulse yourself or to wear a Holter monitor, which will continuously record your heart’s activity.
Some people experience palpitations while the heart is healing from ablation. This may feel like the heart is racing or beating very fast. After ablation procedures, doctors sometimes prescribe an antiarrhythmic medication for a few months to help keep the heart beating in a normal rhythm.
Your care team will also provide you with a list of typical side effects and possible complications from the procedure. They will tell you what to do if side effects or complications develop. Read this information carefully, keep it handy and make sure you check it often enough to recognize various stages of your recovery, as well as any possible complications. You may want to have a family member or friend read this list, too, so they can help you monitor your recovery.
Life After Catheter Ablation
No matter how well your catheter ablation procedure worked, the most important factor in your continued good health is you. A heart-healthy lifestyle will provide your heart with optimal conditions for good health, and will allow the procedure to have its maximum beneficial effect.
Talk to your doctor about the following:
As always, you should have good communication with your doctor and your medical team. Ask all of your questions – even questions you might think are trivial or embarrassing. Your care team will be on hand to help you through not just the procedure but also your recovery and long-term journey toward heart health.
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