Cardiac catheter ablation is a specialized procedure that is used to treat an abnormal heart rhythm (arrhythmia). There are two parts to the procedure: the electrophysiology (EP) study and the ablation. The procedure takes 2 to 4 hours and is done by a doctor (pediatric electrophysiologist) who is specifically trained to treat electrical problems of the heart in children.
During the EP study, small wires are put into the heart to create a 3D map of the heart. These wires are used to record the electrical activity of the heart and to control the heartbeat (“pacing”). This helps the doctor find any areas that may be causing the abnormal heart rhythm. Once the abnormal electrical pathway is found, an ablation catheter is used to apply heat (radiofrequency) or cold (cryoablation) energy to safely and carefully destroy the abnormal areas (see Figure). This part of the procedure is called Ablation.
Abnormal heart rhythms may be treated with observation, medication, and/or ablation. Ablation can be used to treat certain types of heart rhythms and resolve their symptoms. This procedure is safe and has a high success rate. If successful, medications and follow-up appointments may not be needed. For certain conditions, a successful ablation can improve insurability and remove activity or career restrictions. The decision to have an ablation is made by you and your child, in consultation with your child’s heart doctor.
Fasting (no food intake) is required starting at midnight the night before the procedure. Clear fluids are allowed up to two hours before the procedure. If your child is taking medication to treat their heart rhythm, please discuss with your child’s heart doctor if and when these medications need to be stopped prior to the procedure.
The procedure takes place in a special room called the EP lab and typically takes 2 to 4 hours. Before the procedure, an intravenous line (IV) will be started. A sedative and pain reliever will be given through the IV to help your child relax and not feel pain. Your child will be asked to lie down on a movable bed and will then be placed under general anesthesia. The doctor will make approximately three small pokes (access points) in the blood vessels. The area around these points will be numbed to lessen any pain.
Your child will recover in the post anesthetic care unit (PACU) until they are ready to go home. Small bandages will be applied over the access points. It is important to lie quite still for a few hours to minimize any bleeding. It is not unusual for your child to experience mild discomfort in their leg where the wires were placed. Your child may have occasional irregular heartbeats and/or chest pain for a few days following the procedure. Specific instructions will be given about returning to normal activities, school or work.
Ablation has a 90% to 95% success rate, although this will vary slightly depending on the type of heart rhythm being treated. Generally, the procedure is safe and individuals are ready to go home the same day. Rarely, a short period of observation in the hospital might be needed.
EP studies are generally safe procedures. Potential complications include: infection, unexpected abnormal heart rhythms, injury to blood vessels, radiation exposure, chest pain, bleeding at the access sites and adverse effects of the anesthesia such as nausea and vomiting. About 1 in 10 people can have their abnormal heart rhythm recur even if initially it appeared to be successfully treated in the EP lab. This is an invasive procedure, therefore, there is also a risk of much less common but more serious complications including a 1:5000 risk of death, 1:1000 risk of a stroke or heart attack or cardiac puncture, and a 1:100 risk of conduction block requiring a permanent pacemaker. This means that if one hundred individuals had this procedure performed, one of them would require a permanent pacemaker if the normal electrical system of the heart were damaged during the procedure. Although a general risk of 1:100 is given, the risk may be higher or lower depending on what type of heart rhythm is being treated. Cardiac puncture may require emergency treatment, including placement of a drain in the chest or going to the operating room.
Acetaminophen (eg Tylenol) is recommended for any discomfort following the procedure. Your child may need to take aspirin for one month to prevent blood clots from developing in the areas where the ablation was performed. If your child was on a medication to treat their abnormal heart rhythm prior to the ablation, their heart doctor will advise as to whether this medication needs to be continued, weaned or stopped completely. After the ablation it is important to clarify with your child’s heart doctor when and how to resume any other heart medications.
https://www.healthchoicesfirst.com/videos/cardiac-ablation-in-children
http://pediatricepsociety.org/Patient-Resources/How-is-an-Electrophysiology-Study-Performed.aspx
http://www.uptodate.com/patients/content/topic.do?topicKey=hrt_dis/9779
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