Sunday, July 20, 2014

What to Expect Before and After a Radiofrequency Catheter Ablation

The Radiofrequency catheter ablation procedure is an attempt at correcting an irregularly fast heart rhythm. Typically this procedure corrects forms of tachycardia which is when your heart beats at a very rapid and sometimes irregular pace. This condition is something people are usually born with. The procedure itself involves one or more catheters being fed into the heart, and the cardiologist attempts to recreate the abnormal rhythm. If this is successful, the doctor will determine whether or not he can destroy the extra electrical pathway that is causing the issues. Where this pathway is located is what determines the outcome.
Consulting with an electrophysiologist cardiologist is the first step towards preparing for this procedure. Your doctor will explain the procedure to you, inform you of the risks and will tell you whether or not an ablation procedure could potentially work for you. Some forms of tachycardia are harder to recreate during this procedure and factors like age and overall health can affect whether or not you are a candidate. Routine blood work will let your doctor know if you are in appropriate health to undergo this procedure and an echocardiogram will determine if the heart is physically healthy enough. An EKG can also give some background information to the doctor before going in for the procedure.
You will be scheduled for your ablation at one of the hospitals that your cardiologist is affiliated at. You will be instructed to stop taking any medication you are on for your condition (Beta blockers in the bloodstream can prevent the cardiologist from recreating your tachycardia) at least 2 days prior and you will not be allowed to eat or drink anything for at least 6-8 hours prior to your arrival time at the hospital. You should anticipate being sore and a little groggy after the procedure so it's wise to take along a family member or friend who can help you get home and get comfortable afterwards.
When you arrive at the hospital on your ablation day you will need to check in. Then you will be taken to a part of the hospital where they will get your prepped and in a bed. You will be required to undress completely and wear a hospital gown. You can keep a pair of socks on- bring something warm because the operating room is usually kept very cold. One of the cardiologist's staff members will explain the procedure to you, answer any questions you have and talk to you about your health history. You will be hooked up and have your heart monitored for a little while prior to your procedure and you will be given anti-nausea medication (to prevent you from getting sick during the procedure) as well as aspirin to help prevent clots.
When it is time for your procedure you will be taken into the operating room and you will be asked to transfer onto an operating room table. Various leads and pads will be stuck onto your chest and back. A couple of these are defibrillator pads in case of an emergency and the others are to help monitor your heart during the procedure. Someone will cover you up to keep you warm and they will begin the medication that sedates you. Ablations are typically performed under conscious sedation which means you're not completely knocked out from anesthesia. You are basically asleep and extremely relaxed. If you begin to wake up at any point during the procedure you will be very calm and can communicate to the staff. They will likely give you more medication at that point. The procedure itself is painless so even if you are partially awake it won't bother you one bit. Expect to be sedated however and if you're extremely nervous communicate that to the staff- they will help get you relaxed and comfortable however they can.
Once the sedation begins to kick in the area(s) in your groin where the catheters are going to be inserted will be prepped. The entire area is cleaned and you are draped with sterile cloth. The staff monitors you for about 30 minutes to see how you are reacting to the medication and to make sure your vitals are stable. At that point x-ray equipment is placed over your chest area. Catheters are inserted into veins in one or both groins and the staff makes sure these are stable. The catheters are fed up the body and into the heart using real time x-ray technology. The cardiologist is in control at this point and will position a catheter somewhere around one of your sinus nodes (Where the electric current of your heart initiates). He will use his equipment to fire an impulse into your heart that will mimic an extra heart beat. He may need to do this a few times in order to get the timing right, but if he does, the goal is to recreate an irregular rate and rhythm. If this occurs, the doctor studies where in the heart the impulse is getting stuck- this is an extra electrical pathway that should not be there. If the pathway is in an easily accessible part of the heart the cardiologist will feed one of the catheters into the pathway and will use radiofrequency energy to cauterize the spot. This will cause scar tissue to form and the goal is to kill the unnecessary pathway.
Once the spot has been ablated, the cardiologist will try again and attempt to recreate your tachycardia. If he can initiate it again he will further ablate the pathway and follow this process again until he is sure the pathway has been cut off. There is also the possibility that there may be one or more extra pathways which results in ablated more than one spot. This determines how long the procedure will actually take. When the cardiologist feels he has done his job, you will be administered epinephrine which will mimic adrenaline in your body. This will put your heart under the type of stress you would normally feel from working out or physically exerting yourself in some way. This confirms whether or not the ablation was successful as most people experience tachycardia after some form of physical activity when the heart rate increases.
The catheters are then removed from your groin area and pressure is placed to stop the bleeding. You will be bandaged at that point. Usually no stitches or staple are necessary to seal off the area. You will be taken off the sedation medication and then taken back to a recovery area. Slowly you will begin to wake up and may not remember anything for the next couple of hours as you will be in and out of sleep depending on how much medication you have received. Shortly after the cardiologist will come and speak to you and your family or friends to inform you of what happened during the procedure. He will explain if you need to go home on medication or not and he will alert you of what to expect and when you should see him next in his office.
You will be required to lay flat for the next couple of hours to prevent any pressure on your groin. This allows the areas to heal properly. Fluid may begin to build up slightly in the areas which is normal and sometimes your nurse will apply aggressive pressure to help alleviate the swelling. This will help your overall recovery even though it may be slightly uncomfortable. Eventually you will be allowed to sit up, and then walk to the bathroom or around the room. Often times one or both of the areas will begin to bleed upon standing and you will be required to lay back down if this occurs. Once you have been checked numerous times and your nurse is confident you will not bleed any more you will be given your discharge information and taken downstairs in a wheelchair to be sent home.
When you arrive home you should expect to be very sore. Tightness and a pulling feeling may occur in the groin areas as you heal. You may experience an increase in palpitations for up to two weeks or so because of the procedure itself and this is completely normal. If your procedure was successful the palpitations should not lead to any form of tachycardia so there's no need to worry. If your ablation was not successful, you have likely been sent home on the appropriate medication that will control your symptoms. You will likely be very tired because of the medication you were given and should expect to go home and head straight to bed. You may feel this way for another day or two. Most patients feel much better within a couple of days and can resume work by that point. It's directed to avoid exercise for at least two weeks and this is to ensure the groin heals properly. You will likely need to see your cardiologist in approximately four weeks to follow up.
A radiofrequency catheter ablation is a relatively newer procedure however it has developed into a very successful and safe procedure. At one point the only option for correcting an issue such as this was undergoing open heart surgery. An ablation is very non-invasive and has very little recovery time. The success rate is very high (About 90% according to the American Heart Association) and while risks can occur (blood clot, stroke, bleeding and puncture of vein walls, need for a pacemaker) they are very unlikely if the procedure is performed by a reputable doctor. In very rare instances the pathway that was ablated can grow back but this occurs in about 1% - 3% of patients.
In October of 2009 I underwent a catheter ablation for episodes of SVT that I had since I was about 14 years old. I was 26 years old at the time of the procedure. My ablation was a success and my recovery time was very easy. I was back on my feet within a day or so and only experienced some soreness and bruising which lasted a couple of weeks. The first couple of days I experienced a few palpitations but they felt as though they began, hit a wall and fizzled out. While I have also been diagnosed with an abnormally high heart rate, to date I have not experienced another episode of SVT.

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