Before the Procedure
- If you need help making travel arrangements to Cleveland Clinic, please call the Medical Concierge at 800.223.2273, ext. 55580.
- Stop taking Coumadin (warfarin) three days before your procedure. Talk to your doctor before you stop taking any medication.
- Ask your doctor if you should take your other prescription medications before the procedure.
- Do not eat or drink anything after midnight the night before the procedure.
- Do not bring jewelry or valuables to the hospital.
You will receive an instruction sheet that describes how to prepare for the procedure. Here’s an overview of those instructions.
What if I take Coumadin?
If you take Coumadin, your INR test (a blood test to evaluate blood clotting) must be within a suitable range before the procedure can be performed.
Should I take my medications?
Usually, you will be instructed to stop taking Coumadin (warfarin) three days before the procedure. Your doctor may also ask you to stop taking other medications, such as those that control your heart rate or aspirin products.
Do not discontinue any of your medications without first talking to your healthcare provider. Ask your doctor which medications you should stop taking and when to stop taking them.If you have diabetes, ask the nurse how you should adjust your diabetes medications and/or insulin.
Can I eat before the procedure?
Eat a normal meal the evening before your procedure. However, DO NOT eat, drink or chew anything after 12 midnight before your procedure. This includes gum, mints, water, etc. If you must take medications, take them with small sips of water. When brushing your teeth, do not swallow any water.
What should I wear?
Wear comfortable clothes. You will change into a hospital gown before the procedure. Please leave all jewelry (including wedding rings and watches) and other valuables at home.
The clothing you are wearing that morning will be returned to the person who accompanies you or placed in a locker.
Remove all makeup and nail polish before coming to the hospital.
What should I bring?
You will not need a robe or toiletries when you first arrive. Your family member can keep these items to give you after the procedure. Bring your prescription medications with you, but do not take them without first talking to your healthcare provider.You may bring guided imagery materials or music to listen to before the procedure (don’t forget to bring your audio player!).
During the Procedure
What happens when I arrive?
You will lie on a bed, and the nurse will start an intravenous line (IV) in your arm. The IV is used to deliver medications and fluids during the procedure.
A medication will be given through your IV to make you feel drowsy, and you may fall asleep.
Your neck, upper chest, arm and groin will be cleansed with an antiseptic solution, and the catheter insertion site(s) will be shaved. Sterile drapes will be placed to cover you from your neck to your feet.
Where is the procedure performed?
The catheter ablation takes place in a special room called the electrophysiology (EP) lab.
Will I be monitored?
The nurse will connect you to several monitors that will constantly check your heart rhythm and your body’s responses to any arrhythmias you may have during the procedure.
Monitors Used During the Procedure
- Defibrillator/pacemaker/cardioverter: Attached to one sticky patch placed on the center of your back and one on your chest. This allows the doctor and nurse to pace your heart rate if it is too slow, or deliver energy to your heart if the rate is too fast.
- Electrocardiogram (EKG): Attached to several sticky electrode patches placed on your chest, as well as inside your heart. Provides a picture on the monitors of the electrical impulses traveling through the heart.
- Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure throughout the ablation.
- Mapping system: State-of-the-art technology that helps your doctor locate the exact area of your arrhythmia.
- Oximeter monitor: Attached to a small clip placed on your finger. Checks the oxygen level of your blood.
- Fluoroscopy: A large X-ray machine will be positioned above you to help the doctors see the catheters during the procedure.
- Intracardiac ultrasound: Performed by a catheter inserted into the heart. Intracardiac ultrasound is used throughout the procedure to view the structures of the heart and the catheter when it is in contact with the heart lining.
How does the doctor insert the catheters?
After you become drowsy, the doctor will numb the catheter insertion site(s) by injecting a medication. The doctor will insert several catheters through a small incision into a large blood vessel (in your groin, neck or arm, depending on the type of ablation procedure being performed). It may be necessary to use both an artery and a vein. A transducer is inserted through one of the catheters so intracardiac (inside your heart) ultrasound can be performed during the procedure. The ultrasound allows the doctor to view the structures of the heart.
The catheters are passed through the blood vessels to your heart. After the catheters are in place, the doctor looks at a monitor to check your heart’s conduction system. The doctor then uses a pacemaker-like device to send electrical impulses to the heart to increase the heart rate.
If your arrhythmia occurs during the procedure, you’ll be asked to describe the symptoms you feel.
The doctor uses the catheters to locate the area or areas where the arrhythmia is originating. Once the area is located, energy is applied through the catheter to stop the abnormal impulses.
Once the ablation is complete, the electrophysiologist uses monitoring devices to observe the electrical signals in the heart to ensure that the abnormal rhythm was corrected.
What will I feel?
You will feel a burning sensation when the doctor injects medication in the catheter insertion site. You may feel your heart beating faster or stronger when the doctor uses the pacemaker device to increase your heart rate, and you may feel some discomfort or a burning sensation when the energy is applied.
It is important to remain quiet, keep very still and avoid taking deep breaths. If you feel pain, ask your doctor or nurse to give you more medication.
During the procedure, you will be asked to report any symptoms, answer questions or follow instructions given by your doctor.
How long does the procedure last?
The procedure may last 4 to 8 hours.
After the Procedure
- You may stay in the hospital overnight.
- Your doctor and nurse will talk to you about your procedure results, medications, homegoing instructions and follow-up schedule.
- If you have any questions, please ask.
What should I expect after the procedure?
The doctor will remove the catheters and apply pressure to the insertion site to prevent bleeding. You will need to stay in bed 1 to 6 hours after the procedure to prevent bleeding. You'll need to keep your legs still during this time.
No stitches are needed. A small sterile dressing (bandage) will cover the insertion site. Keep this area clean and dry. Tell your doctor or nurse right away if you have redness, swelling or drainage at the procedure site. You can remove the bandage after you go home.
During your recovery, you will be placed on a telemetry monitor, which lets the nurses watch your heart rate and rhythm. Telemetry consists of a small box connected by wires to your chest with sticky electrode patches. The box displays your heart rhythm on several monitors in the nursing unit.
Will I have to stay in the hospital?
Your doctor will determine if you need to stay overnight in the hospital. Some patients are sent home the same day, while others stay overnight in the hospital after the procedure.
When will I find out the results?
After the procedure, the doctor will discuss the results of the procedure with you and your family.
NOTE: This information is about procedures and may include instructions specific to Cleveland Clinic. Please consult your physician for information pertaining to your specific procedure.