Radiofrequency ablation (RF ablation) is a procedure in which ultrasound current is used to selectively destroy tiny areas of heart muscle (electrical pathway) involved in a rhythm disturbance. It can also be used to disconnect an abnormal electrical pathway between the upper chambers (atria) and the lower chambers (ventricles) of the heart. The type of ablation performed depends upon the type of arrhythmia. Radiofrequency catheter ablation is considered the safest and most effective therapy for a variety of arrhythmias. It often follows an electrophysiology study (EPS).
Along with the wires used to map the electrical pathways of the heart, one special wire (electrode catheter) is inserted in an artery or vein and placed on the heart tissue responsible for the arrhythmia. Ultrasound energy is delivered to the tip of this catheter to heart tissue, causing the tip to be heated. The heat creates scar tissue on the tissue cells that abnormal electrical impulses cannot pass through. The abnormal pathway is now destroyed.
Why did my doctor order radiofrequency ablation for me?
Usually a doctor will order this for one or more of the following reasons:
- You may have symptoms associated with your arrhythmia which interfere with your lifestyle. These symptoms may include: palpitation, feelings of chest pressure, dizziness or shortness of breath.
- Medications have not successfully managed your arrhythmia.
- You are unable or unwilling to make a commitment to taking medications for the rest of your life.
- You have developed side effects from anti-arrhythmia medications.
- You are a woman of childbearing age and medications could cause potential problems during pregnancy.
- This procedure has fewer risks than the surgery commonly used to treat arrhythmias.
Sometimes during a routine EPS, it becomes clear to the doctors that radiofrequency ablation is the treatment of choice. For this reason, it is practical for your doctor to ask for your consent to the ablation treatment at the time you give consent for the EPS. Then, if necessary, the treatment procedure can be performed promptly, without requiring you to schedule another visit to the hospital.
What happens before the RF ablation procedure?
Before the ablation, a heart doctor will examine you and review your medical history, drug allergies and diagnostic tests. He will explain the procedure and its risks and benefits. Do not hesitate to ask questions and voice your concerns.
Usually you will have blood tests, and an EKG taken prior to the procedure.
Discuss your medications with your doctor well in advance of (at least 5 days before) the ablation. You may be asked to stop certain medications such as aspirin or Coumadin for a few days before the procedure. If you are diabetic, remind the doctor and ask about your diabetic medications (pills or insulin).
Do not eat or drink after midnight on the night prior to your procedure. You may take the approved medications with small sips of water.
Empty your bladder prior to the test. You may receive sedatives to help you relax. Most people sleep through the procedure. Bring someone to drive you home.
What happens during the RF ablation?
This procedure takes place at the EP (electrophysiology) lab.
Before the test begins, a nurse will start an IV line so you can receive medications and fluids during the procedure. You will be given a medication through your IV to relax you and make you drowsy. 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.
In the lab you will find TV screens, heart monitors, a blood pressure machine and other various instruments and devices. You will lie on an X-ray table and a camera will be placed near but not touching your body. Electrodes will be applied to your chest and back to monitor your heart rhythm at all times. A blood pressure cuff will be laced on your arm to monitor your blood pressure. After you become drowsy, you will be shaved and cleansed with antiseptic solution in the areas where the catheters will be inserted. These steps are taken to prevent infection. You will be covered with sterile sheets.
The doctor will inject a local anesthetic into the skin to numb the insertion areas. You will feel an initial burning sensation and then it will become numb. Then a small incision will be made in the skin. The doctors will use a special needle to puncture the blood vessel (vein or artery), into which the catheter will be introduced. You will feel some pressure but no pain. If you do feel pain, please let the doctor know, so more numbing medication can be given to you.
The catheters are then guided into your heart. You will not feel the catheters inside your body. After the catheters are in place, the doctor will look at the monitor to assess your heart’s conduction (electrical) system. Then the doctor will use a pacemaker to give the heart electrical impulses to increase your heart rate. You may feel your heart beating faster or stronger when you are paced. The doctor will then move the catheters around your heart to see which area your arrhythmia is coming from. Once the doctor finds the area, energy is applied. During the actual ablation (application of heat), you may feel some minimal chest pain. This lasts for less than a minute. If you are awake, let the doctor know how you feel.
When the procedure is completed, the doctor will remove the catheters and apply firm pressure on the insertion site for 10-20 minutes to stop the bleeding. A light dressing is then applied to the catheter site.
How long does the procedure take?
The procedure, including preparation and ablation, will take 2 to 6 hours. After the procedure, you will be taken to a bed where you will rest with your head slightly elevated for 4 to 5 hours. You must lie flat in the bed and keep your legs straight. You may roll onto your side, but don’t bend your knees. You can wiggle your feet and toes to avoid stiffness. After the procedure, you will be able to eat and drink.
Results of the procedure will be given to you and your family after the test. Your doctor will also discuss when you can resume activities and how often you will need to visit your doctor.
How long will I stay in the hospital?
Usually you will stay overnight in the hospital for observation and monitoring of your heart rhythm. Before you are discharged, you may have a repeat echocardiogram. If you were on Coumadin you may have to stay for a few days after the procedure.
Wound site care
- No stitches are needed
- You will have a small sterile dressing on your wound. It may be removed the next day.
- Keep the area clean and dry.
Call your doctor if you notice any redness, swelling or drainage at the incision site.
Many individuals feel extra heartbeats on and off for a few weeks. Sometimes you may also feel as if your abnormal heart rhythm is starting, but then it stops. These sensations are normal and you should not be alarmed. But if your abnormal heart rhythm reoccurs and lasts, call your doctor.
What should I do when I get home?
You may be advised to take one aspirin every day for 6 weeks. Do not strain or lift heavy objects. Your doctor or nurse will tell you when you can shower. It is common to see a temporary bruise or small lump at the insertion site.
Call your doctor if you have a fever or if the insertion site is painful or warm. Call her if you have palpitations, dizziness, chest pain or shortness of breath. You can usually stop taking your heart rhythm medications after a successful ablation. You will probably be able to resume your normal activities within a day or two at home.