What is Catheter Ablation

Catheter ablation is a non-surgical technique where a thin electrode catheter (a specially insulated electrical wire) is used to localise the abnormal site in the heart causing the arrhythmia (electrical disorder of the heart). Radiofrequency energy is then delivered via the catheter to ablate (or destroy) it. It is an extension of the electrophysiological study (EPS).

Preparations before the procedure

Some medications, which can affect the EPS, should be stopped about 3-5 days before admission. You need to fast for about 6 hours before the procedure. Sedation will be given before the procedure.

Following the injection of local anesthetic, the catheters will be inserted usually via the left subclavian vein (near the left shoulder) and either femoral veins (at the both groins). The catheters are positioned in the heart by the operators using X ray imaging guidance. During the study, the patient may feel a rapid heart rate due to the pacing or the induction of the tachycardia. The EPS gives an electrical map of the heart and determines the cause of the arrhythmia (electrical malfunction). The exact site is then localized by the electrical signals obtained from the tip of the catheter. Once the abnormal site is precisely localized, radiofrequency energy is then delivered via the tip of the catheter to destroy or “burn” (temperature of 60 to 70°C only) the abnormal tissue. The size of the "burn" is very small and is usually about 5 mm in diameter only and hence very precise localization is necessary for it to succeed. Radiofrequency energy is delivered for usually 30-60 seconds, to ablate the abnormal focus. The procedure usually takes about 1 2 hours. After the ablation, the patient waits for another 15-30 minutes in the lab to ensure that there is no immediate recurrence.

After the procedure

The nurse will instruct you to rest in bed for about 8 to 12 hours. You can have food and drinks, on returning back to the ward. The nurse will monitor the pulse rate hourly and blood pressure 4 hourly for 24 hours. A telemetry (ECG monitoring device) will be put on when necessary. An intravenous drip may be started and oral medication may be given on return to the ward. Call the nurse or doctor if there is bleeding from the groin.

How successful is the procedure and is it safe

In experienced centres, and depending on the type of arrhythmic, the success rate is about 95-98% and the recurrence rate is < 5%. The risk of the procedure for any serious complication is <1% (bleeding, heart block, death). Patients are usually discharged the next day after the ablation procedure.

Most patients can return to normal activities within a day or two. You may find a small bruise or lump under your skin where the catheter was inserted. This is common and should go away within a few days. Avoid strenuous physical exercise for about 2-4 weeks but after full physical and normal activities can be resumed.

Who is it for

Patients with cardiac arrhythmias may be at risk for sudden cardiac death, have recurrent attacks of arrhythmia or may need life long drug therapy and its potential side effects.. Radiofrequency catheter ablation is able to cure some of these patients by ablating the abnormal focus of arrhythmia.