Catheter Ablation

Ablasi Kateter

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Catheter ablation is used to treat certain types of arrhythmias (irregular heartbeats) that cannot be controlled by medicine or if you have a high risk for ventricular fibrillation, sudden cardiac arrest, or atrial fibrillation.

Cardiologists will perform catheter ablation in a hospital. You will remain awake, but you will receive medicine through an intravenous (IV) in your arm to calm you down during the procedure. The machine will measure your heart activity.

All types of ablation require cardiac catheterization to place a flexible tube, or catheter, inside the heart to create the scars in your heart tissue. Your doctor will clean and numb the area on your arm, groin or upper thigh, or neck before making a small hole in a blood vessel. Your doctor will insert a series of catheters through your blood vessel to the right place in your heart. An x-ray imaging method called fluoroscopy will allow your doctor to see the catheter as it is being moved into your heart. Some catheters have wire electrodes that record and locate the source of abnormal heartbeats. Your doctor will direct the tip of a special catheter at the small area of ​​heart tissue. A machine will send RF waves, extremely cold temperatures, or laser light through the catheter to create a scar called ablation lines. This scar forms a barrier that prevents electrical impulses from crossing between the damaged heart tissue to the surrounding healthy tissue. This will stop the abnormal electrical signals from spreading throughout the heart and causing arrhythmias.

After catheter ablation, your doctor will remove the catheter and close and bandage the opening on your arm, groin, or neck. You may experience bruising and pain where the catheter was inserted. You will need to stay in the hospital for a few hours or overnight. During this time, your heart rate and blood pressure will be monitored. Your movement will be restricted to prevent bleeding in the area where the catheter was inserted. You will need someone to drive your home after the procedure because of the medicine or anesthesia you received.

Catheter ablation has several risks, including bleeding, infection, blood vessels damage, heart damage, arrhythmias, and blood clots. There could also be a very small risk of developing cancer from the radiation used during catheter ablation.

Talk to your doctor and the technicians who perform the tests about whether you are or may be pregnant. If the procedure is not urgent, they may have to wait until after your pregnancy. If it is indeed urgent, the technicians will take extra steps to protect your baby during catheter ablation.

What Is Catheter Ablation?

Catheter ablation is a medical procedure used to treat certain types of arrhythmias. An arrhythmia is a problem with the rate or rhythm of the heartbeat. 

During catheter ablation, a series of catheters (thin, flexible tubes or wires) are inserted into a blood vessel on your arm, groin (upper thigh), or neck. The tubes are guided into your heart through the blood vessel.

A special machine transmits energy to your heart through the ablation catheter. The energy destroys a small area of ​​heart tissue where abnormal heartbeats may cause an arrhythmia to start.

Catheter ablation often involves radiofrequency (RF) energy. This type of energy uses radiofrequency current to generate heat that destroys heart tissue. Studies have shown that RF energy functions safely and effectively. 

Overview

To understand catheter ablation, it is necessary to learn how the heart works. The heart’s electrical system controls the rate and rhythm of your heartbeat.

Normally, with each heartbeat, an electrical signal travels down from the top of your heart. As it travels, the electrical signal causes your heart to contract and pump blood. This process repeats itself with each new heartbeat.

Problems with any part of this process can lead to arrhythmias. Catheter ablation is one of several arrhythmia treatments. Your doctor may recommend ablation if:

  • The medicines you take do not control your arrhythmia.
  • You cannot tolerate the medicines your doctor has prescribed for your arrhythmia.
  • You have certain types of arrhythmia.
  • There is abnormal electrical activity in your heart that increases your risk of ventricular fibrillation (v-fib) and sudden cardiac arrest (SCA). V-fib is a life-threatening arrhythmia. SCA is a condition when your heart suddenly stops beating.

Catheter ablation has several risks. Bleeding, infection, and pain may occur at the catheter insertion site. More serious problems include blood clots and puncture of the heart. Your doctor will explain the risks to you.

Cardiologists (heart specialists) sometimes perform ablation during open heart surgery. This method is as common as catheter ablation – which does not require surgery to open the chest.

Catheter ablation procedure does not always restore a normal heart rate and rhythm. You may require other treatments. It may be necessary for some people who undergo the procedure to do it again. This may happen if the first procedure does not completely resolve the problem.

Who Needs Catheter Ablation?

Your doctor may recommend catheter ablation if:

  • The medicines you take do not control your arrhythmia.
  • You cannot tolerate the medicines your doctor has prescribed for your arrhythmia.
  • You have certain types of arrhythmia.
  • There is abnormal electrical activity in your heart that increases your risk of ventricular fibrillation (v-fib) and sudden cardiac arrest (SCA). V-fib is a life-threatening arrhythmia. SCA is a condition when your heart suddenly stops beating.

What to Expect Before Catheter Ablation

Before you have a catheter ablation, your doctor may review your medical history, perform a physical exam, and recommend tests and procedures.

Your doctor may want to know what medicines you are taking. Certain medicines may interfere with catheter ablation. If you are taking any of these medicines, your doctor may advise you to stop taking them prior to the procedure.

Your doctor may also ask if you have diabetes, kidney disease, or other conditions. If so, he or she may need to take extra steps during or after the procedure to help you avoid complications.

Before catheter ablation, you may have tests such as:

  • ECG (electrocardiogram). This simple, painless test records the electrical activity of your heart. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
  • Echocardiography. This is a painless test that uses sound waves to create a moving image of your heart. The image shows the size and shape of your heart. The images also show how well your heart chambers and valves are working.
  • Stress test. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During a stress test, you exercise to make your heart work hard and beat fast while a heart test is done. If you are unable to exercise, you may be given medicines to increase your heart rate.

It is not in many cases that your doctor may recommend cardiac catheterization, coronary angiography, or a test to rule out an overactive thyroid (an arrhythmia can be a symptom of an untreated overactive thyroid.)

If you are pregnant, tell your doctor before having catheter ablation. This procedure involves the use of radiation that can harm the fetus. Talk with your doctor about whether the benefits of this procedure outweigh the risks.

If you are a woman of childbearing age, your doctor may recommend a pregnancy test before catheter ablation to make sure you are not pregnant.

After the procedure is scheduled, your doctor will tell you how to prepare for it. You may have to stop eating and drinking by midnight before the procedure. Your doctor will give you specific instructions.

Some people would go home the same day as the procedure. Others may have had to stay in the hospital longer. Driving after the procedure may not be safe. Your doctor will tell you if you need a ride back home.

What to Expect During and After Catheter Ablation

Catheter ablation is performed in a hospital. Doctors who perform this procedure have special training in cardiac electrophysiology (the heart’s electrical system) and ablation (destruction) of diseased heart tissue.

Before the Procedure

If you are a woman of childbearing age, your doctor may recommend a pregnancy test before catheter ablation to make sure you are not pregnant. This procedure involves the use of radiation that can harm the fetus. If you are pregnant, talk to your doctor about whether you should proceed with the procedure or wait. 

Before the procedure, you will be given medicine through an intravenous (IV) line that is inserted into a vein in your arm. The medicine will help you relax and possibly make you sleepy. You will also be connected to several machines that will check your heart’s activity during the procedure.

After you are sleepy, the doctor will numb an area on your arm, groin (upper thigh), or neck. A needle will be used to make a small hole into your blood vessel. Then, your doctor will insert a tapered tube called a sheath through this hole.

Next, the doctor will thread a series of catheters (long, thin, flexible wireless) through the sheath and into your vein. It will push the wire to the right place in your heart.

An imaging method called fluoroscopy will help your doctor see the cable as it travels to your heart. Fluoroscopy uses real-time x-ray images.

During the Procedure

The electrodes at the tip of the catheter stimulate your heart and record its electrical activity. This will help your doctor know where the abnormal heartbeat begins in your heart.

After your doctor locates the source of the abnormal heartbeat, he or she will aim the tip of the catheter to a small area of ​​heart tissue. A special machine will send energy through the catheter to create the ablation line.

The ablation line  will create a barrier between the damaged heart tissue and the surrounding healthy heart tissue. This will stop abnormal electrical signals from spreading throughout the heart and causing arrhythmias.

What You May Feel During The Procedure

You may sleep during the procedure. You generally will not feel anything other than:

  • A burning sensation when your doctor injects numbing medicine into the area where the catheter will be inserted
  • Discomfort or burning in the chest when the energy is applied
  • A faster heart rate when your doctor stimulates your heart to find out where the abnormal heart rate begins

This procedure lasts 3-6 hours. When the procedure is completed, your doctor will remove the catheter and sheath. The blood vessel puncture site will be bandaged. Pressure will be applied to this site to help prevent major bleeding.

What to Expect After Catheter Ablation

After catheter ablation, you will be transferred to a special care unit where you will lie still for 4-6 hours of recovery. Lying down prevents bleeding from the catheter insertion site.

You will be connected to a device that measures the electrical activity and blood pressure of your heart. The nurse will regularly check this monitor. The nurse will also check to make sure that you do not experience bleeding from the catheter insertion site.

Returning Home

Your doctor will decide if you need to stay overnight in the hospital. Some people may go home on the same day as the procedure. Others may require longer hospital stays.

Before you go home, your doctor will tell you:

  • Which medicines you need to take
  • How much physical activity you can do
  • How to care for the catheter insertion site
  • When to schedule follow-up care

Driving after the procedure may not be safe. You will need to have someone to drive you home after the procedure.

Recovery and Recuperation

Recovery from catheter ablation is usually quick. You may feel stiff and sore from lying still after the procedure.

Also, small bruises may form at the catheter insertion site. The area may feel sore or tender for about a week. Most people are able to return to their normal activities within a few days.

Your doctor will tell you about signs and symptoms to watch for. Let your doctor know if you have problems such as:

  • A constant or large amount of bleeding at the catheter insertion site that you cannot stop with a small bandage
  • Pain, swelling, redness, or other unusual signs of infection at or near the catheter insertion site
  • Strong, fast, or other irregular heartbeats
  • Fainting

You may be prescribed with medicines after the procedure. 

What Are the Risks of Catheter Ablation?

Catheter ablation has several risks. This procedure may cause:

  • Bleeding, infection, and pain at the catheter insertion site.
  • Blood vessel damage. In rare cases, the catheter may scratch or poke holes in a blood vessel when pushed toward the heart.
  • Leaky heart valve
  • Heart damage that might cause you to require a permanent pacemaker. A pacemaker is a small device that is placed in the chest or abdomen to help control abnormal heart rhythms. 
  • Blood clots – which can lead to stroke or other problems.
  • Narrowing (stenosis) of the blood vessels that carry blood from the lungs to the heart. 

Catheter ablation also involves the use of radiation. Therefore, this procedure may increase the risk of cancer. 

As with any procedure involving the heart, complications can be fatal in some cases. However, this rarely occurs with catheter ablation.

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