Show AllRadiofrequency ablation or cryoablation would be recommended after consulting with an electrophysiologist, a cardiologist who specializes in the treatment of arrhythmias of the heart.
Further testing may be ordered to determine if an ablation procedure is necessary. These may include an electrocardiogram (ECG or EKG), a Holter monitor, event recorder, exercise test or an electrophysiology study (EP study).
If not done beforehand, the doctor will perform an electrophysiology study, along with the ablation, to determine the abnormal part of the heart's electrical system that is causing the arrhythmia.
If the patient's symptoms from arrhythmia are minor, or well-controlled with medication, the doctor may not recommend ablation.
However, if a patient's symptoms are more persistent, resistant to medication or if he / she suffer from side effects of medication, the electrophysiologist may recommend ablation.
The doctor may strongly recommend radio frequency ablation if arrhythmia is considered life-threatening.
Patients are admitted to the hospital through Same Day Surgery early on the morning of the radio frequency ablation.
While in Same Day Surgery, a patient history and physical examination is completed by a cardiology fellow. Any tests that need to be done before the procedure are also done at this time.
The electrophysiology study and ablation procedure are performed in Cincinnati Children's Cardiac Catheterization Laboratory.
Once in the lab, an intravenous (I.V.) line will be placed so sedation can be given to make the patient drowsy. In some cases, general anesthesia maybe recommended.
Once sedated, the team prepares the patient by placing numerous ECG patches used to help monitor heart rhythm during the procedure.
A blood pressure cuff is placed on the patient's arm and a pulse oximeter probe is wrapped around one of the fingers. Both will also be used for monitoring.
Large patches will also be placed on the patient's chest and back; they are used to convert the heart rhythm to normal, if necessary, during the procedure.
The patient's groin area is cleaned and draped for the sterile procedure. The area will then be numbed with a local anesthetic for a pain-free catheter insertion.
Catheters may also be inserted into veins under the collarbone or in the neck after these areas have also been cleaned and draped. The catheters are guided by x-rays through the blood vessels and into the heart, and positioned to give the best intracardiac signals.
The electrophysiology study is done first to provide an electrical "map" of the patient's heart. The "mapping" identifies the area of inappropriate conduction or rhythm and the ablation catheter is then positioned at this spot to deliver energy that will destroy the tissue.
Once this has been successful, a 60-minute monitoring period begins. The procedure is considered successful when multiple attempts to induce an abnormal heart rhythm fail.
This procedure is not painful, but the patient can have some back discomfort from lying on his / her back during the test. All catheters are removed when the procedure is completed, and small bandages are placed on the catheter insertion sites.
The patient is then moved to a monitoring area (Post Anesthesia Care Unit or PACU) until he / she is fully awake. Parents can visit at this time.
In most cases, patients are discharged home from Same Day Surgery on the day of the procedure, though sometimes overnight observation in the hospital may be recommended.
Radiofrequency ablation or cryoablation has the same risk as any procedure entering the vascular system. Patients could have bleeding at the insertion site of the catheters resulting in some swelling and bruising.
More serious -- but rare -- complications include infection at the puncture site, damage to blood vessels, and blood clots.
There is also a possibility that normal conduction system of the heart could be damaged if the abnormal area being ablated is close to the normal conduction system. This could result in a loss of conduction between the upper and lower chambers of the heart. If this were to occur, a permanent pacemaker could be required.
Because it is important to be able to reproduce the arrhythmia during the procedure, it is generally necessary to be off medications used to treat the arrhythmia for the test. The doctor will indicate how to stop them before the procedure so that he can start the arrhythmia during the procedure.
Some medications can just be stopped a few days to a week beforehand, while others must be weaned off over a longer period of time.
If the ablation procedure is successful, patients usually no longer need the medications. The electrophysiologist will talk explain this after the procedure.
The doctor will provide individualized instructions before leave the patient leaves the hospital; however, in general, patients can return to school or work the next day.
To protect the catheter insertion sites, patients are restricted from swimming or bathing 48 hours after the procedure. Patients can take showers.
The doctor will usually want to see patients 2 weeks after the procedure, and additional follow-up will be discussed at that time.
