Radiofrequency (RF) Ablation

Cardioversion is a procedure used to convert an irregular or abnormal heart rhythm to a normal heart rhythm by applying high energy shock. Common rhythms that may require elective cardioversion include atrial fibrillation, atrial flutter and ventricular tachycardia.

   • Your Illness
   • RF Ablation
   • Preparation
   • Procedure
   • Your Recovery
   • Health Maintenance






Your Illness
Ordinarily, your heart beats at a regular, steady pace called a normal sinus rhythm that is regulated electrically by the sinus node. When the heart beats too rapidly, the arrhythmia is called a tachycardia. If the tachycardia originates in one of the upper chambers of the heart, it's called a supraventricular (above the ventricles) tachycardia (SVT).

SVT may occur when an extra electrical pathway exists in or between some of the structures of the heart. These abnormal pathways can make the electrical impulses that control your heart rate travel in a circular pattern within the heart, causing a tachycardia. These arrhythmias can be treated, but not cured, with medications.

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RF Ablation
Your physician may choose to treat your arrhythmia with a non-surgical procedure called radiofrequency ablation. Often, this treatment permanently resolves the arrhythmia by destroying the abnormal pathway that causes it.

A radiofrequency (RF) ablation is very similar to an Electrophysiology (EP) Study. If you haven't already had an EP Study, the two procedures are frequently performed one after the other. The EP Study helps identify the specific type and location of the abnormal heart rhythm. Then, in a process called mapping, a catheter (small, flexible tube) is manipulated until it locates the abnormal pathway that is causing the tachycardia. At this point, an ablation is performed.

A special catheter will be used to direct radiofrequency energy to the abnormal pathway in the heart. Radiofrequency energy is a form of electrical energy that causes the tissue at the tip of the catheter to heat up, permanently damaging (ablating) that small area of tissue. When the abnormal pathway is destroyed, the heart's electrical impulses can only travel through the normal conduction pathways, and the arrhythmia is eliminated.

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Preparation
Before your procedure, we will order an electrocardiogram (ECG) and some blood tests, and we will discuss the RF ablation procedure-explaining its purpose, benefits, and potential risks. We will also go over all medications you are taking, and give you any special instructions concerning them. You'll also be asked to sign a consent form. This is a good time to ask any questions or voice any concerns you may have.

If you'll be coming into the hospital as an outpatient, you'll be told where and when to report. You'll be instructed not to eat or drink anything after midnight the evening just before your procedure. You may, however, take sips of water to swallow pills. You should plan to be at the hospital for most of the day (typically, the procedure takes three or more hours and then recovery can be around three hours). You should arrange for someone to drive you home.

Just before your RF ablation, an intravenous (IV) will be inserted into your arm to administer any medication. Since you'll be awake during the procedure, you'll be given a sedative to help you relax. The area (in the groin) where the catheters will be inserted will be washed with an antiseptic soap and shaved if necessary.

You'll then be moved by stretcher or wheelchair to an electrophysiology (EP) laboratory where you'll be positioned on a special table and covered with sterile drapes. The entire EP staff, who have been trained specifically in the electrical activity of your heart, will be wearing surgical hats and masks to assure that everything remains sterile throughout your procedure.

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Procedure
The catheters used for the ablation will be inserted through the veins in your groin. Usually, two catheters are inserted into a vein on the right side of the groin and two on the left. You won't feel the catheters moving through the blood vessels and into your heart. These catheters will be positioned in your heart using a special type of x-ray called fluoroscopy (live-action picture).

Controlled impulses will then be delivered through one of the catheters to induce the suspected abnormal heart rhythm. Your electrophysiologist may decide to use sophisticated computer aided 3 Dimensional mapping system to identify the arrhythmia circuit and its source. Once the arrhythmia source is identified and located, the RF energy will be delivered for 60 to 90 seconds at a time through one of the catheters to the abnormal pathway. Sometimes it's necessary to deliver the energy several times to ablate (eliminate) the pathway. When it appears the abnormal pathway has been ablated, the physician will test to be certain your abnormal heart rhythm can no longer be triggered.

Some people feel a mild, burning sensation in the chest during the RF energy delivery. However, it's usually described as only mildly uncomfortable.

Throughout the entire procedure, your ECG, heart rate, blood pressure, and oxygen level will be constantly observed on monitors in the laboratory. Although an ablation is usually not painful, you may experience some discomfort from lying still for a long time. Be sure to notify the staff of any discomfort you have at any time during the procedure.

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Your Recovery
After the ablation is completed and the catheters are removed, pressure will be applied to the insertion site to prevent bleeding. If you have received blood thinners during your procedure the nurse will wait till your blood is thickened up to remove the plastic tubes from your groin. You'll then be taken back to your room or to a recovery area and required to stay in bed for three hours, keeping your head on a pillow and your legs straight. During this time, you'll be given something to eat and drink, and your heart will be monitored. If you feel any warmth, pain, or swelling at the catheter insertion site, be sure to tell your nurse immediately.

Depending upon the type of arrhythmia and location of the ablation, you may stay in the hospital overnight for observation. Before leaving the hospital, you'll be given detailed instructions about caring for the puncture sites. Your physician will also explain follow-up plans and discuss what signs & symptoms should be reported.

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Health Maintenance
Your RF ablation should restore your heartbeat to the regular rhythms necessary to pump oxygen-rich blood throughout your body. However, you also play an important role in staying healthy. Be sure to keep all appointments for exams and follow-up tests. Follow your instructions, don't hesitate to talk about your concerns, and immediately report any new symptoms.

As always, if you have any questions about your health, be sure to call our office.

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