What is catheter ablation?

Catheter ablation is a nonsurgical procedure used to treat an abnormal heartbeat (arrhythmia). An arrhythmia can make your heart beat too fast or in an irregular pattern. During the procedure, a doctor guides a flexible tube (catheter) into your heart, often through a vein in the groin. The catheter is placed near the small area of heart tissue that may be causing your abnormal heartbeat. Once there, heat (radiofrequency), cold energy (cryoablation), or pulse field ablation energy is used to destroy the tissue.

Why might you need catheter ablation?

You may need catheter ablation if you have an arrhythmia. An arrhythmia is a problem with the rhythm of your heartbeat. Your heart may beat too fast. Or you may have an irregular heartbeat.

Catheter ablation can improve or even cure an arrhythmia. It can be an alternative to long-term or lifelong medicine use. It is also a choice when medicine has failed to control your heart rhythm problem.

What are the risks of catheter ablation?

Risks of catheter ablation include:

• Bruising or bleeding at the catheter insertion site.

• Infection.

• Blood clots including stroke.

• Injury to the blood vessels or heart, that may need an emergency procedure.

• Injury to nearby tissue, such as the esophagus or nerve to the diaphragm.

• New arrhythmias.

• Slow heart rate that may need a pacemaker.

• Problems with anesthesia.

• Death, very rarely.

How do you get ready for catheter ablation?

To get ready for catheter ablation:

• Tell your doctor about all prescription and over-the-counter medicines you take. This includes herbs, supplements, and vitamins. If you are allergic to any medicines, tell your doctor.

• Have any advised tests, such as blood tests.

• Follow any directions you are given for not eating or drinking before the procedure.

What happens during catheter ablation?

Catheter ablation typically lasts 1 to 2 hours or longer, depending on the type of arrhythmia being treated and other factors. It is done in an electrophysiology lab by a cardiac electrophysiologist. This is a cardiologist with special training in treating abnormal heart rhythms. 

During the procedure:

• You will be given IV (intravenous) medicine to help you relax. Some people even fall asleep. In some cases, you may be placed under medicine (general anesthesia) that puts you in a state like deep sleep. Most people don’t feel pain during the procedure. You may sense mild discomfort in your chest or shoulder during ablation.

• After the medicine has taken effect, your doctor will numb an area in your groin. In rare cases, the arm or neck is used.

• Next, your doctor will put several IV lines into a blood vessel in your groin and move them toward the heart.

• Through the IVs, your doctor will insert several wires and a small catheter into your heart. A type of X-ray helps them see the heart and wires as the procedure is occurring.

• The doctor will test the electrical system of your heart. They will assess the abnormal heart rhythm. This part of the procedure is called an electrophysiology study.

• Once the doctor finds the abnormal area of the heart, they will place another catheter (ablation catheter) to get rid of the abnormal heart tissue. The doctor will use energy to destroy (ablate) the problem cells. The main types of ablation are:

  • Thermal ablation. This is the most common type of heart ablation. It uses either heat (radiofrequency) or extreme cold (cryoablation) to destroy the small areas of heart tissue causing the abnormal rhythm.

  • Pulsed field ablation (PFA). PFA uses short, high-voltage electrical pulses to target and destroy only the heart cells causing the abnormal rhythm. Since it only targets the problem areas, PFA may lower the risk of damage to nearby areas like the esophagus, nerves, or blood vessels. It is mainly used to treat atrial fibrillation.

• After ablation, your doctor will test your heart to make sure that the abnormal heart rhythm is gone. Medicine to stimulate the heart may also be used to test for abnormal heart rhythms.

• Your doctor will remove the catheters from your body. Pressure will be put on the insertion site to stop any bleeding.

What happens after catheter ablation? 

After catheter ablation, you will be told to lie still for 4 to 6 hours to lower the risk of bleeding. Your heart rhythm will be watched. You will be offered pain medicine if needed. Depending on how your heart is doing and what type of ablation procedure was done, you may be able to go home the same day. In other cases, you may need to stay overnight.

In the days after the procedure, you may have mild symptoms, such as an achy chest and mild pain or bruising where the catheter was put in. You might also notice skipped heartbeats or short fluttering of your heartbeat for a few days after the procedure. This depends on the type of ablation procedure you had.

After catheter ablation, follow all instructions from your doctor. Also make sure you:

• Don’t drive the next day.

• Don’t lift anything over 10 pounds for the next few days.

• Don’t exercise for the next 5 days, or until you see your doctor for follow-up.

• Keep the insertion sites dry for 2 days.

• Take all medicines as instructed by your doctor.

Call 911 or get immediate medical care at the nearest Emergency Department if you have:

• Bleeding from the puncture site does not slow down when you press on it firmly.

• Chest pain or shortness of breath.

• Sudden numbness or weakness, especially on one side of the body, or difficulty speaking.

• Dizziness, faintness, or lightheadedness.

• Loss of consciousness or responsiveness.

Contact your doctor right away if you have:

• Redness, pain, swelling, or drainage from the area where the catheter was put in.

• A fever of 100.4°F (38°C) or higher, or as directed by your doctor.

• Intermittent bleeding, or bleeding that can be easily controlled.

• Sudden coldness, pain, or numbness in the leg or arm where the catheter was put in.

• Nausea or vomiting.

• Difficulty swallowing, excessive pain when swallowing, or vomiting blood.

• Ongoing problems with your heartbeat.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure.

• The reason you are having the test or procedure.

• What results to expect and what they mean.

• The risks and benefits of the test or procedure.

• What the possible side effects or complications are.

• When and where you are to have the test or procedure.

• Who will do the test or procedure and what that person’s qualifications are.

• What would happen if you did not have the test or procedure.

• Any alternative tests or procedures to think about.

• When and how you will get the results.

• Who to call after the test or procedure if you have questions or problems.

• How much you will have to pay for the test or procedure.