What is a cardiac arrhythmia?
A cardiac arrhythmia, also called dysrhythmia, is an irregular or abnormal heart rhythm.
Electrical system of the heart
The atria and ventricles work together, alternately contracting and relaxing to pump blood through the heart. The electrical system of the heart is the power source that makes this possible.
Normally, the electrical impulse begins at the sinoatrial (SA) node, located in the right atrium. The electrical activity spreads through the walls of the atria, causing them to contract.
Next, the electrical impulse travels through the AV node, located between the atria and ventricles. The AV node acts like a gate that slows the electrical signal before it enters the ventricles. This delay gives the atria time to contract before the ventricles do. From the AV node, the electrical impulse travels through the His-Purkinje network, a pathway of specialized electricity- conducting fibers. Then the impulse travels into the muscular walls of the ventricles, causing them to contract. This sequence occurs with every heartbeat (usually 60-100 times per minute).
What is catheter ablation?
Catheter ablation is a treatment for cardiac arrhythmias. During ablation, a doctor inserts a catheter (thin, flexible tube) into the heart. A special machine delivers energy through the catheter to tiny areas of the heart muscle that cause the abnormal heart rhythm. This energy “disconnects” the pathway of the abnormal rhythm.
Ablation can also be used to disconnect the electrical pathway between the upper chambers (atria) and lower chambers (ventricles) of the heart. The type of ablation performed depends upon the type of arrhythmia.
What types of rhythms are treated with this procedure?
Normally, the heart’s impulses travel down an electrical pathway through the heart. The atria and ventricles work together, alternately contracting and relaxing to pump blood through the heart. The electrical system of the heart is the power source that makes this possible. Each electrical impulse causes the heart to beat. Catheter ablation can be used to treat:
- AV Nodal Reentrant Tachycardia (AVNRT): An extra pathway lies in or near the AV node, which causes the impulses to move in a circle and re-enter areas it already passed through.
- Accessory Pathway: Extra pathways can exist from birth that connect the atrium and ventricles. The extra pathway causes signals to travel back to the atrium, making it beat faster.
- Atrial Fibrillation and Atrial Flutter: Extra signals originating in different parts of the atrium cause the atria to beat rapidly (atrial flutter) or quiver (atrial fibrillation).
- Ventricular Tachycardia: A rapid, potentially life-threatening rhythm originating from impulses in the ventricles. The rapid rate prevents the heart from filling with enough blood, and less blood is able to circulate through the body.
How successful is catheter ablation?
The type of catheter ablation performed and individual variables affect the success rate of the procedure. Please talk to your doctor about the success you can expect.
Are there any risks?
The catheter ablation procedure is generally very safe. However, as with any invasive procedure, there are risks. Special precautions are taken to decrease these risks. Your doctor will discuss the risks of the procedure.
A thorough evaluation is needed to determine if catheter ablation is an appropriate treatment option for you. This evaluation may include:
- A review of your medical history
- Complete physical examination
- Electrocardiogram (ECG)
- Echocardiogram (Echo)
- Holter monitor test
- Other tests as needed
After the evaluation, your doctor will talk to you about appropriate treatment options and, together, you will decide the best option for you.
How can I schedule an evaluation?
If you are currently being treated outside of Cleveland Clinic, please call the Heart & Vascular Institute resource nurse toll-free at 866.289.6911 or 216.445.9288. The nurse can offer options for evaluation at Cleveland Clinic. Or call Cardiology Appointments at 216.444.6697 or toll-free at 800.223.2273, ext. 46697.
If you are a Cleveland Clinic patient and are receiving treatment for your arrhythmia, talk to your cardiologist about whether catheter ablation is an option for you.
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!).
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.
How will I feel after the procedure?
You may feel fatigue or chest discomfort during the first 48 hours after the procedure. Please tell your doctor or nurse if any of these symptoms are prolonged or severe.
You may experience skipped heartbeats or short episodes of atrial fibrillation after the procedure. After your heart has healed, these abnormal heartbeats should subside.
What instructions will I receive before I leave the hospital?
Your doctor will discuss the results of the procedure and answer any questions you have. You will receive specific instructions about how to care for yourself after the procedure including medication guidelines, wound care, activity guidelines, pacemaker care and maintenance, and a follow-up schedule.
Will I be taking new medications?
You may need to take an antiarrhythmic medication to control abnormal heartbeats. Your doctor will give you the prescriptions and medication instructions you need. Ask your doctor if you should continue taking your previous medications.
Will I be able to drive myself home?
For your safety, a responsible adult must drive you home. Your driver should be ready to take you home by 10:00 a.m. on the morning of your discharge day.
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.
Cleveland Clinic Heart and Vascular Institute Cardiologists and Surgeons
Choosing a doctor to treat your abnormal heart rhythm depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with Arrhythmias:
- Section of Electrophysiology and Pacing: cardiology evaluation for medical management or electrophysiology procedures or devices - Call Cardiology Appointments at toll-free 800.223.2273, extension 4-6697 or request an appointment online.
- Department of Thoracic and Cardiovascular Surgery: surgery evaluation for surgical treatment for atrial fibrillation, epicardial lead placement, and in some cases if necessary, lead and device implantation and removal. For more information, please contact us.
- You may also use our MyConsult second opinion consultation using the Internet.
The Heart and Vascular Institute also has specialized centers to treat certain populations of patients:
For younger patients with abnormal heart rhythms:
See: About Us to learn more about the Sydell and Arnold Miller Family Heart & Vascular Institute.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
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Abnormal Heart Rhythm Conditions
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Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.