Treating AFib with Catheter Ablation
Quick facts about catheter ablation:
- Catheter ablation is used to treat abnormal heart rhythms (arrhythmias) when medicines are not effective or compatible with a person’s lifestyle.
- Medicines help to control the abnormal heart tissue and pulmonary vein tissue that causes arrhythmias. Catheter ablation blocks the pathway so the erratic contraction signals cannot control the heart and cause the arrhythmias.
- Catheter ablation is a procedure that is successful for many people with AFib, although the success rates can vary widely.
- This procedure takes place in a special hospital room called an electrophysiology (EP) lab or a cardiac catheterization (cath) lab.
What is a catheter ablation and why is it used to treat atrial fibrillation?
Medicines to treat rapid and irregular heartbeats work well for many people. But they don’t work for everyone, and they may cause side effects in some people. In these cases, doctors may suggest catheter ablation. Catheter ablation is also used to help control other heart rhythm problems such as atrial flutter. Catheter ablation aims to block the signals that trigger the erratic activity controlling the heart without damaging the rest of the heart.
It may be helpful to know that although many AFib patients are understandably reluctant to undergo invasive procedures, recent studies indicate an encouraging number of people are able to achieve long-term symptom relief from catheter ablation, but many only after having the procedure more than once. If you’re considering this route, it is important to realize that a follow-up ablation may be necessary to achieve the desired results.
How does a catheter ablation work?
Special cells in your heart create electrical signals that travel along pathways to the chambers of your heart. These signals make the heart’s upper and lower chambers beat in the proper rhythm and sequence or keep your heart in “normal sinus rhythm.” Abnormal cells in the heart or pulmonary veins may create disorganized electrical signals that cause irregular or rapid heartbeats called arrhythmias. When this happens, your heart may not pump blood effectively and you may feel faint, short of breath and weak. You may also feel your heart pounding.
Before an ablation procedure, electrical mapping of the heart is performed. An electrically sensitive catheter is used to map the heart muscle and the origins of the “extra” electrical activity throughout the heart. The map tells the physician which areas of the heart are creating problematic electric signals that interfere with the proper rhythm.
How is an ablation performed?
Summary of the Procedure: A catheter (thin, flexible tube) is inserted into the patient’s blood vessels and is gently guided to the heart. The physician carefully creates a conduction block (an interruption in the electrical signals) using the catheter to deliver energy (such as radiofrequency, cryo or laser) to scar the problematic areas. The goal is to eliminate the abnormal signals reaching the heart. If successful, the heart will return to a normal rhythm. This minimally invasive procedure usually has a short recovery period. Patients may be placed on a short course of anti-arrhythmic drugs while the procedure takes full effect.
Are there different types of ablation for AFib?
Yes, the more common AFib ablation procedure is called a pulmonary vein isolation ablation, but sometimes an AV node ablation is still performed today.
- Pulmonary vein isolation ablation (PVI ablation or PVA).
- In some AFib patients, fibrillation is triggered by extra electrical currents in the pulmonary veins. During this procedure, the catheter tip is used to block the erratic signals to the tissue and, in most cases, normal heart rhythm returns.
- To learn more about varying types of ablation techniques and procedures, visit the StopAfib.org Catheter Ablation pages.
What are the risks of catheter ablation?
There are few risks. Fewer than 5 percent of people who have the procedure develop complications. The most common problems result from the use of the catheters, the long, thin tubes doctors insert into your arteries or veins. Inserting the tubes can occasionally damage your blood vessel or cause bleeding or infection. There are a few other risks to consider, but these problems are rare. (Further reading available on StopAfib.org.)
Before Checking In: How should I prepare for catheter ablation?
- Your doctor will tell you what you can eat and drink during the 24 hours before the procedure.
- Usually, you’ll be asked not to eat or drink anything for at least 6 to 8 hours before the procedure.
- Tell your doctor about any medicines you take. He or she may ask you not to take them before your catheter ablation. Don’t stop taking your medicines until your doctor tells you to.
- Leave all your jewelry at home.
- Arrange for someone to drive you home after your procedure.
What happens during catheter ablation?
A doctor with special training performs the procedure along with a team of nurses and technicians. The procedure is done in a hospital EP or cath lab.
- Clot Prevention and Visual Inspection: The hospital staff will likely perform some diagnostic imaging before prepping you for the procedure to verify the plan and safety of the procedure for you. (More about diagnostics and prepping here.)
- Sedation for The Procedure: A nurse will put an IV (intravenous line) into a vein in your arm so you can get medicine (anesthesia) to prevent pain. In most cases, general anesthesia is recommended although a few doctors use a milder form of sedation.
- Infection Prevention: The nurse will clean and shave the area where the doctor will be working. This is usually in your groin.
- Accessing Your Heart Tissue for Treatment: The nurse will give you a shot — a local anesthetic — to numb the needle puncture site.
- The doctor will make a needle puncture through your skin and into the blood vessel (typically a vein, but sometimes an artery) in your groin. A small straw-sized tube (called a sheath) will be inserted into the blood vessel. The doctor will gently guide a catheter (a long, thin tube) into your vessel through the sheath. A needle carries the catheter through the septum, the wall between the left and right atrium, and into the left atrium.
- A video screen will show the position of the catheter. You may feel some pressure in your groin, but you shouldn’t feel any pain.
- Locating Cells and Performing Ablation: To locate the abnormal tissue causing arrhythmia, the doctor sends a small electrical impulse through the catheter. When the source of your irregular heartbeat is located, the doctor will use the catheter to apply a mild, painless, energy-–radiofrequency (similar to microwave heat), cryo (freezing), or laser-–to produce a scar that blocks electrical impulses from the pulmonary veins and other areas of the left atrium, shutting down the abnormal rhythms and preventing afib.
- Recovering and Going Home: Catheter ablation usually takes three to six hours, but occasionally more time is needed. If you have more than one area of abnormal tissue, the procedure will take longer. In general, you can expect an overnight stay.
What happens after catheter ablation?
You’ll be moved to a recovery room. The sheath usually stays in your leg for several hours after catheter ablation. During this time, you have to lie flat.
After the doctor or nurse removes the sheath:
- A nurse will put pressure on the puncture site to stop the bleeding.
- You should keep your leg straight for 6 to 8 hours after the doctor or nurse removes the sheath. The nurse will tell you when you can get out of bed.
- The nurse will watch you carefully and check your heartbeat and vital signs (pulse and blood pressure).
- Tell your doctor or nurse right away if you notice any swelling, pain or bleeding at the puncture site, or if you have chest pain.
- Before you leave the hospital, the nurse will give you written instructions about what to do at home.
What happens after I get home?
Follow the instructions your nurse or doctor gave you. Most people can return to their normal activities within a few days after they leave the hospital.
- Make sure you understand how long you should wait before you drive. You will be instructed not to drive for at least 24 hours after you leave the hospital.
- Ask your doctor how long you should expect to be off work. Typical time frames may be up to a week.
- You will need to avoid strenuous physical activity for a while following the procedure. Ask you doctor when you can return to strenuous exercise.
- A small bruise at the puncture site is normal. If the site starts to bleed, lie flat and press firmly on top of it. Have someone call the doctor or hospital.
Call 9-1-1 if you notice:
- The puncture site swells up very fast.
- Bleeding from the puncture site does not slow down when you press on it firmly.
Call your doctor if:
- Your leg with the puncture becomes numb or tingles, or your foot feels cold or turns blue.
- The area around a puncture site looks more bruised.
- The spot begins to swell, or fluids drain from it.
- You feel pain or discomfort in your chest that moves into your neck, jaw or arm.
- You feel sick to your stomach or sweat a lot.
- You have a fast or irregular heartbeat.
- You feel short of breath.
- You feel dizzy or lightheaded enough to have to lie down.
How can I learn more about catheter ablation?
Talk with your doctor. Here are some good questions to ask:
- Why do you think catheter ablation will help me?
- Are there other treatments we should consider?
- How did I get this arrhythmia?
- Will I need to take medicine or have another procedure after I have catheter ablation?