What to Expect From Catheter Ablation
Your electrophysiologist can tell you what to expect along with potential risks to help you decide if catheter ablation is appropriate for you.
Evaluation to determine if you are a candidate for catheter ablation may include some of the following tests:
- Electrocardiogram (ECG)
- Echocardiogram
- Transesophogeal echocardiogram (TEE)
- Computed tomography (CT)
- Holter monitor tests
- INR/Protime test (if on anticoagulants)
- Other blood tests or lab work
If you are on anticoagulants, your INR must be an appropriate reading. Starting a few days before the procedure, you will stop anticoagulants such as warfarin or Coumadin®. You should discuss with your doctor whether to continue or stop your other medications.
During the evening before your procedure you won't take any food or liquid after midnight.
During Catheter Ablation
Your procedure will be done in the electrophysiology (EP) lab. You will get hooked up for an IV that will deliver medications and fluids, and by IV you will get some medication that will put you to sleep. You'll also be hooked up to a variety of monitors and equipment, including:
- Defibrillator/cardioverter/pacemaker, which will speed up the heart and deliver energy
- Electrocardiogram (EKG)
- Blood pressure monitor
- Mapping system, which helps the doctor locate the source of irregular electrical impulses
- Ablation machine to deliver the energy for creating lesions, which may be radio radiofrequency, cryotherapy, microwave, or ultrasound
- Fluoroscopy X-ray machine, which helps the doctor monitor the catheters
- Intracardiac ultrasound, also called Intracardiac Echocardiogram (ICE), to help the doctor locate structures of the heart and gain access to the left atrium, and to determine where to place the catheters and how much energy to use for ablation (important in preventing pulmonary vein stenosis and other complications).
Once you're hooked up to all the equipment, and are drowsy or asleep, the doctor inserts the catheters into large veins in the groin, neck, or arm. They are directed toward the right atrium, and a needle carries the catheters through the septum, the wall between the left and right atrium, and into the left atrium.
The pacemaker speeds up the heart by sending electrical impulses to it. When the source of your irregular heartbeat is located, the doctor will use the catheter to apply energy from the ablation machine to produce a scar that blocks electrical impulses from the pulmonary veins, shutting down the abnormal rhythms and preventing afib.
When the procedure is complete, the doctor will check the heart's electrical signals by viewing them on the monitor and ensure that the heart rhythm is correct. As you might guess with so much equipment to hook up, this overall procedure isn't fast, and can last for three to eight hours.
What should you expect to feel? When the doctor injects medication, you may feel a burning sensation, and may also feel burning or discomfort when the energy is applied. You may also feel your heart speed up or pulse when the pacemaker increases the heart rate.
After Catheter Ablation
After the procedure, the doctor will remove the catheters and apply pressure to avoid bleeding at the catheter insertion site.
To prevent bleeding, you'll stay still for up to 6 hours, though with the impact of anesthesia, you may still be out the whole time. You'll be hooked up to a telemetry monitor that uses EKG-like patches and displays your heart rhythm. You will likely have to stay in the hospital overnight.
Expect to be tired, even out of it, with some chest discomfort for a day or two. You may experience afib or skipped heartbeats, but they will subside once your heart heals.
You can expect to be on anticoagulants to prevent blood clots for at least three months after the procedure, and to be on an antiarrhythmic drug for two months to manage any afib episodes.
Your doctor will likely tell you to avoid baths and swimming and to avoid lifting for up to a week following the procedure.
Follow-up visits after the procedure will generally involve many of the same tests as before the procedure, such as:
- Electrocardiogram (ECG)
- Echocardiogram
- Transesophogeal echocardiogram (TEE)
- Computed tomography (CT)
- Holter monitor tests
- INR/Protime test
- Other blood tests or lab work.
To learn more about additional procedures for curing atrial fibrillation, see Can Afib Be Cured?
