Treating Heart Arrhythmias With Ablation
How Should I Prepare for Ablation?
The ablation preparation may vary, depending on whether you're having surgical or nonsurgical ablation. These are general guidelines; your doctor or nurse will give you specific instructions.
To prepare for ablation, there are several steps you should take. Among them:
- Ask your doctor which medications you should stop taking and when to stop them. Your doctor may ask you to stop certain drugs (such as those that control your heart rate or blood thinners, including aspirin products) one to five days before your procedure. If you are diabetic, ask your doctor how you should adjust your diabetic medications.
- Do not eat or drink anything after midnight the evening before the procedure. If you must take medications, drink only with a small sip of water.
- When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.
What Can I Expect During Nonsurgical Catheter Ablation?
During nonsurgical catheter ablation, the following things will occur:
- The procedure will take place in a special room called the EP (electrophysiology) lab. Before the test begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV (intravenous) line in your hand or arm. This is so the doctors and nurses can give you medications and fluids through your vein during the procedure. You will be given a medication through your IV to help you relax. Depending on the type of ablation you have, you may or may not be awake during your procedure. If you are awake, you will be asked to report any symptoms, answer questions, or follow instructions given to you by your doctor. If you are uncomfortable or need anything, please let your nurse know.
- The nurse will connect you to several monitors.
- After you become drowsy, your groin area will be shaved and your neck, upper chest, arm, and groin will be cleansed with an antiseptic solution. Sterile drapes will be placed to cover you from your neck to your feet.
- The doctor will numb the insertion site by injecting a medication. You will feel an initial burning sensation, and then it will become numb. Then, several catheters (special wires that can pace the heart and record its electrical activity) will be inserted through a small incision into a large blood vessel(s) and/or artery (in your groin, neck, or arm) and advanced to your heart. If you are awake, it is important that you remain still and resist the temptation to raise your head to see what the doctor is doing while the catheters are being placed.
- After the catheters are in place, the doctor will look at the monitor to assess your heart's conduction system.
- Then, the doctor will perform the ablation procedure.
- During traditional ablation, the doctor will use a pacemaker-like device to send electrical impulses to the heart to increase your heart rate. You may feel your heart beating faster or stronger when the pacemaker delivers the impulses. If your arrhythmia occurs during the procedure, the nurse will ask you how you are feeling. It is very important to tell the doctor or nurse the symptoms you feel. The doctor will then move the catheters around your heart to see which area(s) your arrhythmia is coming from. Once the doctor finds the area of your arrhythmia, energy is applied. You may feel some discomfort or a burning sensation in your chest, but you must keep very still and avoid taking deep breaths. If you are feeling pain, tell your doctor or nurse and ask them to give you more medication.
- During pulmonary vein ablation (for atrial fibrillation), the doctor delivers energy through a catheter to the area of the atria that connects to the pulmonary vein (ostia), producing a circular scar. The scar will then block any impulses firing from within the pulmonary veins, thus preventing atrial fibrillation from occurring. The process is repeated to all four pulmonary veins. In some cases, ablation may also be performed to other parts of the heart such as the subclavian veins and coronary sinus. The catheter is a special "cool tip" catheter. Fluid circulates through the catheter to help control the intensity of the temperature.
- Once the ablation is complete, the electrophysiologist will use monitoring devices to observe the electrical signals in the heart to ensure that the abnormal heart rhythm was corrected.
The procedure usually takes about four to eight hours, but may take longer.