What is a radiofrequency (RF) ablation?
A radiofrequency ablation is a specialized procedure that corrects an abnormal rhythm in the heart. If your heart is experiencing an abnormal rhythm, there is an area of heart tissue that is disrupting the normal electrical conduction in your heart. During this procedure, a catheter can be advanced into the heart to fix the issue. Radiofrequency (RF) energy is delivered to the catheter to create tiny scars in the heart tissue, disrupting the path of abnormal electrical activity. The disruption ensures that this tissue can no longer act up, and the arrhythmia can be cured.
Why might you need an RF ablation?
The normal heart beats in what is called Normal Sinus Rhythm, which is at a normal rate (60-100 beats per minute) with normal electrical conduction through the heart. Arrhythmias (abnormal heart rhythms) are sometimes found in patients – some are congenital, and some arise from different lifestyle factors. In these arrhythmias, the normal electrical conduction in the heart is disrupted and the heart does not function at its full potential.
These abnormal rhythms can lead to many symptoms including: fatigue, dizziness, palpitations, sweating, light-headedness, shortness of breath, fainting, and chest pain. An RF ablation procedure first identifies the root cause of the issue, and then eliminates the issue but cauterizing the culprit heart tissue using radiofrequency energy.
Why should I choose an RF ablation over medical management?
Radiofrequency ablations are effectively a cure for your irregular heart rhythm. Rather than using anti-arrhythmic medications which are essentially a “Band-Aid” for your issue, an RF ablation can cure you from your arrhythmia and symptoms all together. There are those who do very well with medical management – experience no side effects and stop having episodes of irregular heart rhythm. However, many people decide that the one-time procedure is worth it as they can avoid taking a new medication on the daily. As stated before, these medications can lead to many side effects. Also, it is not a guarantee that the anti-arrhythmic medications will work for you. By undergoing a radiofrequency ablation, your physician can pinpoint the case of your arrhythmia and destroy the site of your problem, which is more effective than attempting to find a medication that works for you. The hope is that you will be cured from the arrhythmia and no further medications will be needed with respect to your heart rhythm.
How do I prepare for the procedure?
Prior to your procedure, check with our office to see what medications you are allowed to take. We may ask you to discontinue your blood thinners several days before your scheduled procedure. Also, if you have diabetes, check with the office to see if these medications need to be adjusted.
Do not eat or drink anything after midnight on the evening before your procedure. You are only allowed a sip of water with your medications – no other liquids or solids are permitted.
You will be changed into a hospital gown prior to your procedure, so you may wear comfortable clothes into the hospital. Please leave any of your valuables, including jewelry at home.
What is the process of the procedure?
Your procedure, a cardiac ablation, will take place in a specialized lab called the electrophysiology (EP) lab. You will be connected to several monitors for heart rhythm observation.
You will then be taken to the EP lab where you will be connected to further monitors. You will also be shaved and prepped at this time, which includes an antiseptic scrub of the groin area where the doctor is inserting catheters.
Depending on your arrhythmia, you may be placed under general anesthesia or light sedation may be used. An anesthesia provider will discuss and decide on the appropriate care with your EP doctor. He or she will remain at the head of your bed for the entire procedure, so you are constantly monitored. A local anesthetic is used at this site to ensure you have minimal pain during the procedure.
Once asleep or sedated, your physician will insert several catheters into the blood vessels in your groin, and these catheters will be advanced into the right atrium. Once the catheters are placed in the appropriate regions of your heart, your physician will send electrical impulses from these catheters in order to induce the abnormal rhythm that is causing your symptoms. Different medications may also be used to help in this arrhythmia induction. These catheters will then find the abnormally firing cardiac tissue and deliver RF energy or ablate the areas in order to put you back in normal rhythm.
The ablation is done by delivering radiofrequency energy from the tip of a catheter that cauterizes and silences the misfiring tissue. A 3-dimensional computerized mapping system is utilized during this procedure to ensure the location of the different catheters in relation to your specific heart anatomy.
Once the ablation is complete, the physician will test the heart by speeding it up to a high rate with certain medications on board. This “stress” test is done to ensure that the ablation was successful.
RF Ablation procedures in our practice take 1-2 hours with respect to actual procedure time. You will spend longer at the hospital prior to and after your procedure.
What is a Fluoroless Ablation?
Dr. Makkar has specialized in fluoroless ablations. He was one of the first ones to do fluoroless ablations in the state. This means that he does not need to use x-ray (radiation) during the procedure. Instead, he relies on the 3-D map as well as intracardiac ultrasound to guide the ablation. The lack of x-ray leads to greater safety for the lab staff and most importantly, you. The same procedure performed by other physicians can expose you to an average of 30-50 minutes of fluoroscopy, which is a high dose of radiation equivalent to thousands of X rays.
What is the recovery process following the procedure?
Once the procedure is complete, the catheters will be removed from your groin and pressure will be held at the incision site for several minutes to prevent bleeding. You will then be sent to a recovery unit where you will remain on bed rest for 4-6 hours.
After your ablation, you will be admitted to the hospital. You will be taken to your room and placed on a special monitor, called telemetry. Telemetry consists of a small box connected by wires to your chest with sticky electrode patches. The box causes your heart rhythm to be displayed on several monitors on the nursing unit. The nurses will be able to observe your heart rate and rhythm.
Before you go home, we will discuss the results of your procedure with you and your family/friends. We will also go over at-home instructions as well as discuss when you will need to come into the office for a follow-up appointment.
You may still experience palpitations for some time after the ablation. This is normal for about 8 weeks post-procedure. The procedure can cause some irritation to the heart, therefore it takes some time for everything to settle.
Ablation Discharge Instructions
You will need a 1-2-week post-procedure follow-up appointment with us. Please call us at (602) 698-5820 to schedule this appointment if one was not made for you at the time of your discharge from the hospital. Your follow-up will consist of a reassessment of your symptoms and the electrical activity in your heart with EKG and cardiac monitoring.
What To Expect At Home:
- Bruising of the trunk, groin and leg around the puncture site is normal and should resolve in a few days.
- Palpitations as well as mild chest discomfort that is worsened with breathing are normal – even with a successful ablation. These symptoms should resolve within days to weeks post-procedure.
- You will be sent home with a bandage over the area which can typically be removed the day after the procedure.
- Shower as usual after the bandages are removed. You may gently wash the area with soap and water but do not scrub the puncture site.
- If you discontinued any medications pre-procedure, resume taking them unless told otherwise by your physician upon discharge from the hospital
- Do not lift over 10 lbs. for 5 days post-procedure.
- You may resume physical activity after 1-2 days but avoid any strenuous activity such as exercise for 1 week post-procedure.
- Do not take a tub bath, Jacuzzi or swim for 7 days.
- Discuss with your physician prior to discharge about when it is appropriate for you to return to work.
Call If You Experience:
- Significant redness, heat, swelling, drainage or severe pain at your puncture site. If any bleeding occurs, hold direct pressure at the site with gauze or a band-aid. If the bleeding continues past 10 minutes, call your physician and seek immediate medical attention.
- Fever of 100 degrees or higher. A high temperature can be early signs of infection.
- Lightheadedness, dizziness, numbness, tingling or double-vision.
- Difficulty swallowing.
- Significant shortness of breath.