What to Expect During Catheter Ablation
Your catheter ablation procedure will be done by an electrophysiologist in the electrophysiology (EP) lab. You will be hooked up for intravenous delivery of medications and fluids. You will receive medication for anesthesia because your movement will need to be minimized for the ablation procedure. The most commonly used method of anesthesia is deep sedation or general sedation, which puts you to sleep. Another option less commonly used is conscious sedation, which puts you in a fog.
You’ll also be hooked up to a variety of monitors and equipment, which may include:
- Pacing device, which will speed up the heart
- Electrocardiogram (ECG)
- Blood pressure monitor
- Mapping system to help the EP locate the source of irregular electrical impulses
- Ablation machine to deliver radiofrequency, cryo, laser energy, or ultrasound energy for creating scar tissue
- Fluoroscopy X-ray machine to help the EP monitor the catheters
- Intracardiac ultrasound, also called intracardiac echocardiogram (ICE), to help the EP 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).
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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. Then, they are directed toward the right atrium. Next, a needle carries the catheters through the septum, the wall between the left and right atrium, and into the left atrium.
First, a mapping catheter is inserted. Electrodes at the catheter tip provide tiny electrical impulses to activate and identify the abnormal heart tissue causing your arrhythmia. Then, when the source of your irregular heartbeat is located, the EP will insert an ablation catheter. It will apply energy from the ablation machine to produce a scar that blocks electrical impulses from the pulmonary veins and other left atrium areas. This shuts down down the abnormal rhythms and prevents afib. In the last few years, catheters that can perform both mapping and ablation have been put into use.
What should you expect to feel? This may depend on the kind of anesthesia you receive. When the doctor injects medication, you may feel a burning sensation. You may also feel burning or discomfort when the energy is applied. In addition, you may feel your heart speed up when the electrode catheter activates the abnormal tissue causing your arrhythmia. However, many afib patients report feeling nothing at all, having slept through the procedure.
The EP will check the heart’s electrical signals and ensure normal heart rhythm when the procedure is complete. The catheters are removed. Pressure may be applied to the catheter insertion site to prevent bleeding, or more commonly today, a collagen patch may be used to avoid bleeding. As you might guess, with so much equipment to hook up, the overall procedure typically lasts for several hours.
To learn what to expect during recovery, see What to Expect After Catheter Ablation.
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