Ablation
What is a radiofrequency catheter ablation (also called ablation)?
When a heart rhythm disturbance is caused by too fast a heart rhythm, an ablation may be the treatment of choice. Ablation stands for "elimination" or "removal." An ablation is performed at the same time as an electrophysiological study. A specially trained Inova cardiologist, called an electrophysiologist (who also has training in pediatric cardiology), performs this procedure at the Inova Heart Center.
Specifically, an ablation procedure begins with the insertion of a catheter that is guided into the heart to map or locate abnormal tissue causing the irregular heart rhythm. Then the catheter passes radiofrequency energy into the heart in the precise area that contains the abnormal tissue. This destroys the tissue that causes the irregularity.
Preparing for the procedure
Other diagnostic studies will have been conducted prior to the procedure (such as an EKG, and an echocardiogram). Many times the arrythmia needs to be recorded on a monitor called an event/recorder or a holter monitor. The electrophysiologist may request specific blood tests to be sure the child does not have any kidney problems or is not anemic. The child will not be allowed to eat for a specific period of time before the procedure. Upon arrival at the hospital, some children will have an IV started. Before the procedure begins, the child will receive medicine to make him or her sleepy. This medicine can be given by mouth or through an IV.
During the procedure
The radiofrequency catheter ablation usually takes 3 to 6 hours. Once in the Electrophysiology Lab, the child is placed on a narrow x-ray table. He/she will be asleep for the entire procedure. An anesthesiologist will provide general anesthesia and monitor your child throughout the procedure. An IV will be started after your child is asleep if it was not started earlier. Monitoring equipment is attached. Special catheters are guided into the child's heart to track the electrical activity as it moves through the heart. This electrophysiology study provides an electrical map of the heart that identifies the location requiring ablation (removal). When the ablation is completed, the catheters are removed.
After the procedure
Any time an intravenous catheter is placed in a big blood vessel, there is a period of observation to watch for bleeding where the catheter was inserted. The child's heart rate, blood pressure and breathing will be watched also. Depending on a variety of circumstances (the time of day of the procedure, type of sedation used, risk for complications, child's overall health status and complexity of the case), the child may go home the day of the procedure or the next day.
After discharge
After the child is discharged, instructions include the following:
- Quiet play the day of the procedure
- No baths or swimming until the access site scab is healed. Showers are OK.
- No strenuous activity for one week after the procedure. No gym class. No heavy lifting such as bookbags or weights.
- Many children are asked to take an aspirin every day for about a month after the procedure.
- If there is any bleeding from the insertion site, apply direct pressure immediately for 10 minutes (while the child is lying down). Do not remove the pressure. If bleeding continues, call 911 for immediate assistance while continuing to hold pressure on the site.
- Follow-up with the electro physiologist at their office in one month.
