Cardiac Ablation to Treat Arrhythmias

Cardiac ablation is a non-invasive procedure (no incisions required / small puncture / low to moderate sedation) performed to correct abnormal heart rhythms (arrhythmias). The term "arrhythmia" refers to any change from the normal sequence of electrical impulses. Normally, the heart beat begins when an electrical impulse form the sinus node or your heart’s “natural pacemaker” moves through it. As the signal spreads from the top of the heart to the bottom, it coordinates the timing of heart cell activity. For the heart to beat properly, the signal must travel down a specific path to reach the ventricles. When the heart’s natural pacemaker is defective, the heart beat may be too early (premature), too slow (bradycardia), too fast (tachycardia), or too erratic (fibrillation).

Although cardiac ablation is the preferred method of treatment, medications are usually the first treatment option. Medicines to treat rapid and irregular heartbeats work very well for most people. But they don’t work for everyone, and may cause side effects in some people. In these cases, your doctor may suggest a cardiac ablation.

Types of Cardiac Ablations

  • Catheter ablation: This type of procedure delivers energy through an ablation device in order to create a scar or destroy the tissue responsible for triggering the arrhythmia. The type of energy used is heat (radiofrequency) or cold (cryoblation).
  • Surgical ablation: This type of ablation may be done in conjunction with an open-heart surgery (large incisions of 8-10 inches long / involves dividing the breast bone / general anesthesia), such as CABG or Aortic valve repair or replacement OR Mitral valve repair or replacement, or as a standalone procedure. There are subtypes:
    • Maze procedure: A type of open-heart surgery primarily used on patients that require additional open-heart procedures. During this surgery, the doctor will cut your sternum in half and proceed to use ablation energy (radiofrequency or cryoblation) to create a pattern of tiny lines (maze).
    • Mini-maze: For those patients not requiring open-heart surgery, the mini-maze is the preferred choice. The mini-maze is a minimally-invasive procedure (small incisions of 2–3 inches long / general anesthesia) that does not require opening of the sternum.

How to prepare for the procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Other recommendations include:

Talk to your doctor about

  • All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
  • Diabetes and how to adjust your medicine on the day of the procedure
  • Radiation exposure, especially for those that are pregnant
  • Any allergies to medicines, latex, tape, iodine, and anesthetic agents
  • Any history of bleeding disorders
  • Any implanted device (e.g. pacemaker or ICD)
  • Any body piercings on your chest or abdomen

Other suggestions

  • Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
  • Leave all jewelry at home
  • Remove all makeup and nail polish
  • Wear comfortable clothing when you come to the hospital.
  • If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect before the procedure

Before the procedure, your doctor may perform a variety of tests, including:

Diagnostic tests and procedures

What to expect during the procedure

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A catheter ablation procedure usually takes 2 to 4 hours, but the preparation and recovery add several hours. The procedure is usually performed in the cardiac catheterization lab. Check with your doctor about the details of your procedure. In general:

  • You will change into a hospital gown.
  • A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
  • Prior to starting the procedure, you will also regional anesthesia (to numb specific area). Once the anesthetic has taken effect, your doctor will insert the catheter (with the ablation device).
  • To locate the abnormal tissue causing the arrhythmia, your doctor sends a small electrical impulse through the catheter.
  • Once identified, your doctor sends a mild, painless, energy (radiofrequency or cryoblation) to the tissue. This destroys the heart muscle cells responsible for the extra impulses causing your arrhythmia.
  • After the procedure is complete, the catheter is removed and the insertion site is closed off with the use of a closure device (collagen) or sutures.

What to expect after the procedure

After the procedure you’ll be moved to a recovery room and stay for at least one night in the hospital. Other recommendations include:

General guidelines

  • A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected leg or arm
  • Most patients must remain in bed for several hours afterwards
  • Tell your nurse right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site
  • You'll be given oxygen, fluids, nutrition and medications through intravenous (IV) lines
  • Your doctor will give you instructions to follow during your recovery
Saint Barnabas Medical Center
94 Old Short Hills Road
Livingston, NJ 07039
(973) 322-5000
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Newark Beth Israel Medical Center
201 Lyons Avenue at Osborne Terrace
Newark, NJ 07112
(973) 926-7000
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Jersey City Medical Center
355 Grand Street
Jersey City, NJ 07302
(201) 915-2000
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Robert Wood Johnson University Hospital
1 Robert Wood Johnson Place
New Brunswick, NJ 08901
(732) 828-3000
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