If you feel like your heart is skipping a beat or fluttering in your chest, it might be an irregular heartbeat. A problem with your heart’s rhythm is called an arrhythmia (uh-RITH-mee-uh). No es el único. Millions of Americans are diagnosed with these kinds of heart rhythms. If medications do not help you, your doctor may suggest a catheter ablation (KATH-i-tur ah-BLAY-shun) procedure to treat your heart arrhythmia. There are different types of heart arrythmias and different kinds of catheter ablation. Here’s what you should know.

Kinds of Arrhythmias

Heart arrhythmias are caused by a problem with the electrical signals in your heart.

On average, a healthy heart beats about 60 to 100 times a minute when at rest. If you have an arrhythmia, you might have a slower, faster or irregular heart rate.

Arrhythmias may happen in different parts of the heart, including the upper chambers of the heart, called the atria (ay-TREE-uh), or the lower chambers of the heart, called ventricles (VEN-tri-kulls). 

Supraventricular (soo-prah-ven-TRI-kyuh-lar) arrhythmiasstart in the atria or the opening to the lower chambers of the heart.

• Atrial fibrillation (A-fib) (AY-tree-ull fi-bruh-LAY-shun) This is the most common type of arrhythmia. This condition causes your heart to beat more than 400 times per minute. Also, your heart’s upper and lower chambers aren’t able to work together. When this happens, the lower chambers do not fill completely or pump enough blood to your lungs and body. 

• Atrial flutter This can cause the upper chambers of your heart to beat 250 to 350 times per minute. Sometimes this is caused by a blockage of the signal that tells the atria to beat. This may cause the upper chambers and lower chambers to beat at different rates.

• Paroxysmal supraventricular tachycardia (PSVT) (payr-uhk-SIZ-muhl soo-prah-ven-TRI-kyuh-lar tack-uh-CARD-ee-uh) This condition causes extra heartbeats due to problems with the electrical signals that begin in the upper chambers of the heart. This type of arrhythmia begins and ends suddenly. It can happen during physical activity. It is usually not dangerous and often happens in young people.

Ventricular arrhythmias start in your heart’s ventricles, or the two lower chambers. These arrhythmias can be very dangerous and usually require medical care right away.

• Ventricular tachycardia (ven-TRI-kyuh-lar tack-uh-CARD-ee-uh), or VT, is a fast, regular beating of your ventricles that may last for only a few seconds or for much longer. A few beats of ventricular tachycardia often do not cause problems. However, if this lasts for more than a few seconds, it can lead to more serious arrhythmias, such as ventricular fibrillation.

• Ventricular fibrillation (ven-TRI-kyuh-lar fi-bruh-LAY-shun) This happens if electrical signals make the ventricles flutter instead of squeezing normally. Without the ventricles pumping blood to the body, sudden cardiac arrest and death can happen within a few minutes.

Tratamiento de ablación por catéter

Your doctor may try medications to treat VT. These medications are called anti-arrhythmics. They can be given in a pill form or by a needle in your arm that slowly drips the medicine into your body. Other medicines can also be used, alone or with anti-arrhythmics. Calcium channel blockers and beta blockers are two commonly used drugs for VT. Estos fármacos ralentizan la frecuencia cardíaca y reducen la presión arterial.

VT can be treated with medication, but there are some reasons why a ventricular ablation is right for you. You will talk to an electrophysiologist (eh-lek-tro-fi-zee-AHLL-uh-juhst), who has an expertise in understanding your heart’s electrical signals. Before recommending ablation, the physician will check:

• If your VT cannot be treated well with medication.
• How well medication works for you.
• If you have or have had heart failure.
• If you have reduced ejection fraction (low EF), which is the amount of blood the lower left chamber (ventricle) of your heart pushes out with each heartbeat.

Your physician may also take into consideration your age.

If you have a device that sends electrical signals to your heart to get it to beat correctly, called an implantable cardioverter-defibrillator, ablation can reduce the number of times this device needs to send signals to your heart to get it to beat correctly.

The ablation procedure typically has a higher success rate than medication alone, which means there is less risk of symptoms returning. There is a low risk of complications with this procedure, as well as a quick recovery time.

Treatment for VT involves managing any diseases that causes the condition, as well as the symptoms of VT. Common treatments for ventricular tachycardia include:

• Radiofrequency catheter ablation (RCA): After locating the point where an abnormal rhythm starts in the heart, your physician will destroy tissue in that area with an electrical current.
• Implantable cardioverter-defibrillator (ICD): This small machine monitors and controls your heart’s rhythm. A battery is inserted below the collarbone, usually on the left side just underneath the skin. It is connected to leads, which are passed through the blood vessel to the heart. If the ICD detects an episode of VT, it quickly sends an electrical signal to get your heart back to a normal rhythm.
• Medicamentos: These can slow heart rate and may help your heart maintain a safe rhythm. Your health care provider can help you understand the pros and cons of medications.

What to Expect During VT Ablation

One of the most common non-invasive treatments for VT is called a catheter ablation (KATH-i-tur ah-BLAY-shun). A catheter is a thin flexible tube. It travels through a blood vessel up to your heart. The procedure uses hot or cold energy to create scars in your heart tissue where the arrhythmia is occurring. The scars help block certain electrical impulses and prevent irregular rhythms. The scars only destroy tissue involved with the targeted heart patterns, and they don’t cause any lasting pain.

In most cases, catheter ablations are done in an electrophysiology lab in a hospital, and it can take approximately one to three hours for the procedure. A veces puede tomar más tiempo.

Norton Heart & Vascular Institute has two state-of-the-art electrophysiology labs where catheter ablations are performed located in Norton Audubon Hospital and Norton Hospital. Usamos imágenes tridimensionales para trazar el corazón e identificar el punto de tejido que está causando los latidos cardíacos irregulares. Luego, realizamos procedimientos de ablación mínimamente invasivos para tratar el problema.

Your health care provider will go over what you need to do before a catheter ablation. Always follow your provider’s guidance and do not stop or start taking medications unless you are told to do so. You may be asked to stop blood-thinning medications like aspirin or warfarin. You will also be asked to stop eating and drinking for several hours before your procedure. Your provider will give you exact instructions.

Before the procedure, arrange for a trusted friend or family member to take you home after the procedure.

A nurse will help get you ready for an ablation by putting an IV line into your arm. You can receive medicine through the IV line, including drugs to make you comfortable and keep you from feeling any pain (this is also called anesthesia – an-uhs-THEE-zyuh). You may be awake during the procedure but you’ll be sedated and you will not feel pain.

Your cardiologist will:

1. Insert a small tube (called a sheath) through the skin and into a vein to create an opening. Usually, providers use a vein in your groin (between your legs).
2. Insert thin tubes with wires called electrode catheters into the sheath, using real-time X-ray to guide them to the right place.
3. Use the catheter to deliver hot or cold energy to the areas of your heart causing abnormal rhythms. The catheter destroys the targeted heart tissue to help restore a normal rhythm.
4. Remove the catheter and sheath from your vein.

You will stay in the hospital for several hours after the procedure. Your physician may have you stay the night.

Many patients wonder if catheter ablation hurts. Most people say catheter ablation is mildly uncomfortable but the discomfort doesn’t last long. Some patients also have little or no discomfort from the ablation at all. The place where the catheter went into your vein may be sore and have a bruise. The opening for the catheter is very small and should heal quickly.

Your heart will heal and recover in time. For a little while – usually a few weeks – you may still feel abnormal heart rhythms and experience more tiredness than you are used to. Esto es normal. Tell your doctor if you have any questions or concerns after an ablation.

You should begin to notice a decrease in abnormal heartbeats after the ablation. You will need to visit the doctor for some follow-ups to be sure you are recovering. Most people see improvements in their quality of life after VT ablation, including feeling less tired or needing fewer signals from their implantable cardioverter-defibrillator. If your abnormal heart rhythm does not stop or stops and starts again, you may need a repeat procedure or alternate treatment.

Kinds of VT Ablation

Before the procedure, a doctor will find out exactly where the arrhythmia is. The electrophysiologist will do an electrophysiology (EP) study to know where the tissue is in your heart that is causing the arrhythmia. Once the area of the arrhythmia is known, the physician will create a more precise electrical map of your heart with a 3D mapping system. This map gives an electrical view of your heart and tells them where to position the ablation catheters to send heat or cold energy to the targeted areas. Norton Healthcare is one of the only health care systems in the area that has this advanced 3D mapping technology.

During the VT ablation, sensors on the tip of the catheter send electrical impulses and record the heart’s electricity. Your health care team will use this information to determine the best place to apply the VT ablation treatment.

There are two types of ablation:

• Heat (radiofrequency energy)
• Extreme cold (cryoablation)

Either type of ablation can be done from inside or outside the heart. Sometimes, treatment is done at both locations.

• Inside the heart (cardiac ablation). Yourabnormal heartbeat may come from inside the heart. If so, heat or cold energy is applied to the target area, damaging the tissue and causing scarring. This helps block the electrical signals that cause ventricular tachycardia.
• Outside the heart (epicardial ablation). If the abnormalheartbeat starts in tissue outside the heart, the health care provider will insert a needle through the skin on the chest and into the lining of the fluid-filled sack (pericardium – payr-ee-CARD-ee-um) that surrounds the heart. A hollow tube (sheath) is inserted and catheters are passed through the tube to access the outside surface of the heart.

Recovery and What to Expect After a Catheter Ablation

Some people wonder if a catheter ablation hurts. Most patients say the discomfort is mild and does not last long. Some patients also have little or no discomfort from the ablation at all. The site where the catheter went into your vein may be sore and have a bruise. The spot is very small and should heal quickly.

Catheter ablation can take two to four hours to complete. After the procedure, you move to a recovery room and stay there for several hours. A nurse monitors your condition while you recover. You may need to stay at the hospital overnight.

When it’s time to go home, you’ll receive detailed instructions about at-home care. Your doctor may prescribe aspirin or other blood-thinning medication to help prevent blood clots. You may take this medicine for several months or longer after the procedure, depending upon your unique history.

As your heart tissue heals and recovers, you may continue to feel abnormal heart rhythms for a few weeks and experience more tiredness than you are used to. Esto es normal. You should alert your doctor if you have any questions or concerns about anything you’re feeling after an ablation procedure.

Benefits and Risks of Catheter Ablation

The benefits of catheter ablation include:

• Realizado por un electrofisiólogo certificado, cuya capacitación incluye tres años de formación adicional a la certificación en cardiología
• Puede reducir o incluso eliminar los síntomas de la arritmia cardíaca
• No requiere sutura
• For many patients, can reduce the number of episodes and severity of symptoms over a long term
• Typically, a return to your regular life and activities after the procedure
• Para muchos pacientes, reducción de los medicamentos después de una ablación por catéter exitosa
• Sin incisiones ni puertos en el pecho
• Estadía breve en el hospital (por una noche) o regreso a casa en el mismo día

Possible risks include:

• Blood clots.
• Damage to the vein from the sheath or catheter.
• Damage to heart tissue or heart valves.
• Infection or bleeding.
• Accidentes cerebrovasculares.
• The need for a permanent pacemaker.

Your doctor will talk to you about all these issues, as well as any concerns or questions you have.

¿Dónde se realiza una ablación?

In most cases, catheter ablations are done in an electrophysiology lab at a hospital, and it can take approximately one to three hours for the procedure. A veces puede tomar más tiempo.

El Norton Heart & Vascular Institute tiene dos laboratorios de electrofisiología de última generación donde se realizan las ablaciones por catéter, ubicados en el Norton Audubon Hospital y el Norton Hospital. Usamos imágenes tridimensionales para trazar el corazón e identificar el punto de tejido que está causando los latidos cardíacos irregulares. Luego, realizamos procedimientos de ablación mínimamente invasivos para tratar el problema.

¿Quién es un buen candidato para una ablación por catéter?

Usted podría ser candidato si cumple los siguientes criterios:

• Have symptoms associated with your arrhythmias.
• Have not tolerated or are unable to take medications to control your arrhythmia.
• Have other health conditions that are being worsened by your arrhythmia.
• Have addressed lifestyle factors that influence your arrhythmia and still experience symptoms.

When to Call a Doctor

After an ablation, if you have any of the following symptoms, call your doctor immediately.

You should call your health care provider if you experience:

• Bleeding at the puncture site where your health care provider inserted the sheath and catheter.
• Chest pain.
• Dizziness or lightheadedness.
• Nausea or vomiting.
• Numbness or tingling in your leg (if the puncture site is in your groin).
• Racing heart rate.
• Swelling or pain at the puncture site.

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