Catheter Ablation

The information on theis page is for patients having 'catheter ablation' which is a treatment of the heart. It explains what it is for, what is involved and any significant risks that there may be.

What is catheter ablation for?
It is a treatment to selectively destroy 'short circuits' within the heart that cause abnormal rhythms. it is very effective with a success rate of over 90%. Usually heat is used to destroy the short circuits, but occasionally freezing may be used instead. An ablation follows on immediately after an electrophysiology study (EPS) which has identified the problem short circuit.

What preparation do you need for an ablation?
The preparation is the same as for an EPS.

On the day of the ablation
An ablation often follows on directly after an EPS and this may mean a stay overnight so it is best to come prepared with an overnight bag. A specialist doctor will explain the examination and ask you to sign a consent form to confirm you understand the procedure and agree to go ahead with it. You may be given medication before your examination to relax you. You will also be given a hospital gown to change into. A nurse will take you to the cardiac suite for the procedure.

What does it involve?
It is similar to an EPS but involves inserting another catheter to target the short sircuit identified by the EPS. The tip of the catheter destroys a tiny target area to break the short circuit. It is performed under x-ray so the the doctor can direct the catheter accurately.
You will be lying on a table which can be moved around. Mounted above is an x-ray machine. You will have a local anaesthetic to numb the groin; you may also have a sedative injection to relax you. One or more wire catheters are passed into a blood vessel in your groin. A wire catheter with a special tip (ablating wire) is then inserted along the guide catheter into the heart to target the short circuit within the heart. The tip of the catheter can then be heated or cooled for at least 30 seconds. This damages a very small target area. One or more of these may be needed to destroy the short circuit.
What do you feel? You may be aware of the feeling of heat in your chest, and some patients feel some temporary discomfort. Do tell the doctor this who can give you someting to relieve it. Finally the doctor will do another EPS to test whether the treatment is successful. The whole procedure may take between 1 and several hours.

After the procedure
The doctor or nurse will stop any bleeding from the groin by pressing on the site for a few minutes and a bandage may be applied. You will then go back to the ward and stay in bed for a few hours to make sure that the bleeding stops. You may need to stay in hospital overnight. Painkillers will be given if you need them. After more time out of bed and moving around you should be able to go home.

Going Home
You will usually be allowed home about two to three hours after the procedure. You can take your normal painkillers if you experience any pain from the bruising around the groin site. A friend or relative must collect you and take you home and stay with you for the first 24 hours. You can bath after 24 hours. You can go back to work 24-48 hours after the procedure. You may not drive for a week.

What are the benefits and risks?
Ablation is a very successul (over 90%) and safe treatment. The majority of patients who have successful treatment should not need to take drugs to control the heart rhythm again. However, the success rate and risk of complication may vary for different types of short circuits. There are some risks from ablation; these are increased in patients over 65, and may lead to a longer stay in hospital than planned. They include;

• The need for a permanent pacemaker due to damage of the heart's natural electrical system (1%).
• Bleeding around the heart (1%), this can cause pain and breathlessness but can be treated with painkillers; occasionally the blood has to be removed with a needle while in the cardiac suite. The risk is increased if you are on anti-clotting drugs.
• Bleeding or bruising, around the groin site (1%) where the catheters were inserted. This can be made worse of you are on anti-clotting drugs.
• There is a very small risk of a small tear of the heart or lungs.
• Strokes (0.2%). These occur only very rarely: blood thinning drugs are used to reduce the risk.
• The risk of death (0.3%)is also very low but is greater for those who have an exsiting life threatening heart problem.

Please speak to your specialist dactor before your opperation if you have any worries.