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Cardiac ablation is a procedure that can correct heart rhythm problems (arrhythmias). Ablation usually uses long, flexible tubes (catheters) inserted through a vein in your groin and threaded to your heart to correct structural problems in your heart that cause an arrhythmia.
Cardiac ablation works by scarring or destroying tissue in your heart that triggers an abnormal heart rhythm. In some cases, ablation prevents abnormal electrical signals from traveling through your heart and, thus, stops the arrhythmia.
Cardiac ablation is sometimes done through open-heart surgery, but it’s often done using catheters, making the procedure less invasive and shortening recovery times.
Why it is done
When your heart beats, the electrical impulses that cause it to contract must follow a precise pathway through your heart. Any interruption in these impulses can cause an abnormal heartbeat (arrhythmia), which can sometimes be treated with cardiac ablation.
Ablation isn’t usually your first treatment option. Ablation is a treatment option for people who:
Cardiac ablation does carry risks, which include:
Your risk of having these complications may increase if you have diabetes or kidney disease.
How you prepare
Your doctor will evaluate you and may order several tests to evaluate your heart condition. Your doctor will discuss with you the risks and benefits of cardiac ablation.
You’ll need to stop eating and drinking about six to eight hours before your procedure. If you take any medications, ask your doctor if you should continue taking them before your procedure.
Your doctor will let you know if you need to follow any other special instructions before or after your procedure. In some cases, you’ll be instructed to stop taking medications to treat a heart arrhythmia several days before your procedure.
If you have an implanted heart device, such as a pacemaker or implantable cardioverter-defibrillator, talk to your doctor to see if you need to take any special precautions.
What you can expect
During the procedure
Catheter ablation is performed in the hospital. Before your procedure begins, a specialist will insert an intravenous line into your forearm or hand, and you’ll be given a sedative to help you relax.
After your sedative takes effect, your doctor or another specialist will numb a small area near a vein on your groin, neck or forearm. Your doctor will insert a needle into the vein and place a tube (sheath) through the needle.
Your doctor will thread catheters through the sheath and guide them to several places within your heart. Your doctor may inject dye into the catheter, which helps your doctor to see your blood vessels and heart using X-ray imaging.
The catheters have electrodes at the tips that will be used during the procedure. Once in place, the electrodes will send electrical impulses to your heart and record your heart’s electrical activity. This will help your doctor to find the abnormal heart tissue that is causing the arrhythmia in your heart.
Once the abnormal heart tissue that’s causing the arrhythmia is identified, your doctor will aim the catheter tips at the area of abnormal heart tissue. Energy will travel through the catheter tips to create a scar or destroy the tissue that triggers your arrhythmia.
In some cases, ablation blocks the electrical signals traveling through your heart to stop the abnormal rhythm and allow signals to travel over a normal pathway instead.
The energy used in your procedure can come from:
Cardiac ablation usually takes two to four hours to complete, but complicated procedures may take longer. During the procedure, it’s possible you’ll feel some minor discomfort when the dye is injected in your catheter or when energy is run through the catheter tips. If you experience any type of severe pain or shortness of breath, you should alert the cardiologist performing the procedure.
After the procedure Following your procedure, you’ll be moved to a recovery area where you’ll need to lie still for four to six hours to prevent bleeding at your catheter site. Your heartbeat and blood pressure will be monitored continuously to check for complications of the procedure.
Depending on your condition, you may be able to go home the same day as your procedure, or you may need to stay in the hospital for one day. If you go home the same day, plan to have someone else drive you home after your procedure.
You may feel a little sore after your procedure, but the soreness shouldn’t last more than a week. You’ll usually be able to return to your normal activities within a few days after having cardiac ablation.
Although cardiac ablation can be successful, some people need repeat procedures. You may also need to take medications, even after you’ve had ablation.
To keep your heart healthy, you may need to make lifestyle changes that improve the overall health of your heart, especially to prevent or treat conditions that can cause or worsen arrhythmias, such as high blood pressure. Your doctor may suggest that you:
A coronary angiogram is a procedure that uses X-ray imaging to see your heart’s blood vessels. Coronaryangiograms are part of a general group of procedures known as heart (cardiac) catheterization.
Heart catheterization procedures can both diagnose and treat heart and blood vessel conditions. Acoronary angiogram, which can help diagnose heart conditions, is the most common type of heartcatheterization procedure.
During a coronary angiogram, a type of dye that’s visible by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels. If necessary, your doctor can perform procedures such as an angioplasty during your coronary angiogram.
Your doctor may recommend that you have a coronary angiogram if you have:
You may also need an angiogram if you’re going to have surgery unrelated to your heart, but you’re at highrisk of having a heart problem during that surgery.
Because there’s a small risk of complications, angiograms are usually done after noninvasive heart testshave been performed, such as an electrocardiogram, an echocardiogram or a stress test.
As with most procedures done on your heart and blood vessels, a coronary angiogram has some risks. Major complications are rare, though. Potential risks and complications include:
How to prepare
In some cases, coronary angiograms are performed on an emergency basis. More commonly, though, they’re scheduled in advance, giving you time to prepare.
Angiograms are performed in the catheterization (cath) lab of a hospital. Usually you go to the hospital the morning of the procedure. Your health care team will give you specific instructions and talk to you about any medications you take. General guidelines include:
Before your angiogram procedure starts, your health care team will review your medical history, including allergies and medications you take. The team may perform a physical exam and check your vital signs — blood pressure and pulse. You empty your bladder and change into a hospital gown. You may have to remove contact lenses, eyeglasses, jewelry and hairpins.
For the procedure, you lie on your back on an X-ray table. Because the table may be tilted during the procedure, safety straps may be fastened across your chest and legs. X-ray cameras may move over and around your head and chest to take pictures from many angles.
An intravenous (IV) line is inserted into a vein in your arm. You may be given a sedative through the IV to help you relax, as well as other medications and fluids. You’ll be awake during the procedure so that you can follow instructions. Throughout the procedure, you may be asked to take deep breaths, hold your breath, cough or place your arms in various positions.
Electrodes on your chest monitor your heart throughout the procedure. A blood pressure cuff tracks your blood pressure and another device, a pulse oximeter, measures the amount of oxygen in your blood. You may receive medication (anticoagulants) to help prevent your blood from clotting on the catheter and in your coronary arteries.
A small amount of hair may be shaved from your groin or arm where the catheter is to be inserted. The area is washed and disinfected and then numbed with an injection of local anesthetic. A small incision is made at the entry site, and a short plastic tube (sheath) is inserted into your artery. The catheter is inserted through the sheath into your blood vessel and carefully threaded to your heart or coronary arteries.
Threading the catheter shouldn’t cause pain, and you shouldn’t feel it moving through your body. Tell your health care team if you have any discomfort.
Dye (contrast material) is injected through the catheter. When this happens, you may have a brief sensation of flushing or warmth. But again, tell your health care team if you feel pain or discomfort.
The dye is easy to see on X-ray images, and as it moves through your blood vessels, your doctor can observe its flow and identify any blockages or constricted areas. Depending on what your doctor discovers during your angiogram, you may have additional catheter procedures at the same time, such as a balloon angioplasty or a stent placement to open up a narrowed artery.
Having an angiogram takes about one hour, although it may be longer, especially if combined with other heart catheter procedures. Preparation and post-procedure care can add more time.
After the procedure
When the angiogram is over, the catheter is removed from your arm or groin and the incision is closed with manual pressure, a clamp or a small plug.
You’ll be taken to a recovery area for observation and monitoring. When your condition is stable, you return to your own room, where you’re monitored regularly. You’ll need to lie flat for several hours to avoid bleeding. During this time, pressure may be applied to the incision to prevent bleeding and promote healing.
You may be able to go home the same day, or you may have to remain in the hospital for a day or longer. Drink plenty of fluids to help flush the dye from your body. If you’re feeling up to it, have something to eat. Ask your health care team when you should resume taking your medications, bathe or shower, return to work, and resume other normal activities. Avoid strenuous activities and heavy lifting for several days. Your puncture site is likely to remain tender for a while. It may be slightly bruised and have a small bump.
Call your doctor’s office if:
If the catheter site is actively bleeding or begins swelling, apply pressure to the site and contact emergency medical services.
An angiogram can show doctors what’s wrong with your blood vessels. It can:
Knowing this information can help your doctor determine what treatment is best for you and how much danger your heart condition poses to your health. Based on your results, your doctor may decide, for instance, that you would benefit from having coronary angioplasty to help unblock clogged arteries. It’s also possible that angioplasty or stenting could be done during your angiogram to avoid needing another procedure.
Coronary Angioplasty and Stents
Coronary angioplasty (AN-jee-o-plas-tee), also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and inflating a tiny balloon where your artery is clogged to help widen the artery.
Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease its chance of narrowing again. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).
Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.
Why it is done?
Angioplasty is used to treat a type of heart disease known as atherosclerosis. Atherosclerosis is the slow buildup of fatty plaques in your heart’s blood vessels. Your doctor might suggest angioplasty as a treatment option when medications or lifestyle changes aren’t enough to improve your heart health, or if you have a heart attack, worsening chest pain (angina) or other symptoms.
Angioplasty isn’t for everyone. If the main artery that brings blood to the left side of your heart is narrow, if your heart muscle is weak or if you have multiple diseased blood vessels, then coronary artery bypass surgery may be a better option than angioplasty. In coronary artery bypass surgery, the blocked part of your artery is bypassed using a blood vessel from another part of your body.
If you have diabetes and multiple blockages, your doctor may suggest coronary artery bypass surgery. The decision of angioplasty versus bypass surgery will depend on the extent of your heart disease and overall medical condition.
Although angioplasty is a less invasive way to open clogged arteries than bypass surgery is, the procedure still carries some risks.
The most common angioplasty risks include:
Other rare risks of angioplasty include:
Before a scheduled angioplasty, your doctor will review your medical history and do a physical exam. You’ll also have an imaging test called a coronary angiogram to see if your blockages can be treated with angioplasty. A coronary angiogram helps doctors determine if the arteries to your heart are narrowed or blocked. Liquid dye is injected into the arteries of your heart through a catheter — a long, thin tube that’s fed through an artery from your groin, arm or wrist to arteries in your heart. As the dye fills your arteries, they become visible on X-ray and video, so your doctor can see where your arteries are blocked. If your doctor finds a blockage during your coronary angiogram, it’s possible he or she may decide to perform angioplasty and stenting immediately after the angiogram while your heart is still catheterized.
You’ll receive instructions about eating or drinking before angioplasty. Typically, you have to stop eating or drinking six to eight hours before the procedure is scheduled. Your preparation may be different if you’re already staying at the hospital before your procedure.
Whether the angioplasty is pre-scheduled or done as an emergency, you’ll likely have some routine tests first, including a chest X-ray, electrocardiogram and blood tests.
The night before your procedure, you should:
Your body isn’t cut open except for a very small incision in the skin over a blood vessel in the leg, arm or wrist through which a small, thin tube (catheter) is threaded and the procedure performed. Angioplasty can take 30 minutes to several hours, depending on the difficulty and number of blockages and whether any complications arise.
Angioplasty is performed by a heart specialist (cardiologist) and a team of specialized cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory. This room is often called the cath lab.
Angioplasty is commonly performed through an artery in your groin (femoral artery). Less commonly, it may be done using an artery in your arm or wrist area. Before the procedure, the area is prepared with antiseptic solution and a sterile sheet is placed over your body. A local anesthetic is injected to numb the area where the catheter will be inserted. Small electrode pads are placed on your chest to monitor your heart during the procedure.
General anesthesia isn’t needed. You’ll be sedated but awake during the procedure. You’ll receive fluids, medications to relax you and blood-thinning medications (anticoagulants) through an IV catheter. Then, the procedure begins:
If you have several blockages, the procedure may be repeated at each blockage. Because the balloon temporarily blocks blood flow to part of your heart, it’s common to experience chest pain while it’s inflated.
Nuclear Stress Test
A nuclear stress test measures blood flow to your heart at rest and while your heart is working harder as a result of exertion or medication. The test provides images that can show areas of low blood flow through the heart and damaged heart muscle.
The test usually involves taking two sets of images of your heart — one while you’re at rest and another after you heart is stressed, either by exercise or medication.
You may be given a nuclear stress test, which involves injecting a radioactive dye into your bloodstream, if your doctor suspects you have coronary artery disease or if a routine stress test didn’t pinpoint the cause of symptoms such as chest pain or shortness of breath. A nuclear stress test may also be used to guide your treatment if you’ve been diagnosed with a heart condition.
Your doctor may recommend a nuclear stress test to:
Diagnose coronary artery disease. Your coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease develops when these arteries become damaged or diseased — usually due to a buildup of deposits called plaques.
If you have symptoms that might indicate coronary artery disease, such as shortness of breath or chest pains, a nuclear stress test can help determine if you have coronary artery disease.
See the size and shape of your heart. The images from a nuclear stress test can show your doctor if your heart is enlarged and can measure its pumping function (ejection fraction).
Guide treatment of heart disorders. If you’ve been diagnosed with coronary artery disease, arrhythmia or another heart condition, a nuclear stress test can help your doctor find out how well treatment is working. It may also be used to help establish the right treatment plan for you by determining how much exercise your heart can handle.
A nuclear stress test is generally safe, and complications are rare. But, as with any medical procedure, it does carry a risk of complications, including:
You may be asked not to eat, drink or smoke for two hours before a nuclear stress test. Ask your doctor if you should avoid caffeine or certain medications the day before the test, because they can interfere with certain stress tests. Otherwise, you can take your medications as usual.
If you use an inhaler for asthma or other breathing problems, bring it to the test. Make sure your doctor and the health care team member monitoring your stress test know that you use an inhaler.
Wear or bring comfortable clothes and walking shoes.
What to expect
A nuclear stress test can take two to five hours. When you arrive, you’ll be asked about your medical history and how often and strenuously you exercise.
During a nuclear stress test
Before you start the test, a technician inserts an intravenous line (IV) into your arm or hand and places sticky patches (electrodes) on your chest, legs and arms, which connect by wires to an electrocardiogram machine. The electrocardiogram records the electrical signals that trigger your heartbeats. A cuff on your arm checks your blood pressure during the test.
If you’re unable to exercise adequately, you may be given a medication through your IV that increases blood flow to your heart muscle — simulating what exercise does — for the test. Depending on which medication is used, possible side effects may be similar to those caused by exercise, such as a flushing or shortness of breath.
If you’re exercising, you’ll likely begin walking on the treadmill slowly. As the test progresses, the speed and incline of the treadmill increases. You can use the railing on the treadmill for balance, but don’t hang on tightly, as this may skew the results of the test. On a stationary bike, the resistance increases as the test progresses, making it harder to pedal.
You continue exercising until your heart rate has reached a set target, you develop symptoms that don’t allow you to continue or you develop:
You can stop the test any time you’re too uncomfortable to continue.
Injection of dye
A radioactive dye is injected into your bloodstream through the IV. First, images will be taken of’ your heart at rest. Then, after you’ve exercised or been given medication to stimulate your heart, you’ll receive more radioactive dye through the IV. You’ll again lie on a table while a scanner similar to an X-ray machine creates images of your heart muscle. The dye shows inadequate blood flow to part of your heart as a light spot on the images.
The two sets of images allow your doctor to compare the blood flow through your heart while you’re at rest and while your heart is pumping harder as a result of exercise or medication.
After a nuclear stress test
When the test is complete, you may return to normal activities unless your doctor tells you otherwise. The radioactive material will naturally leave your body in your urine or stool, but drinking plenty of water will help flush the dye out of your system.
Your doctor will discuss the results of your nuclear stress test with you. Your results could show:
If you don’t have enough blood flow through your heart, you may need to undergo coronary angiography — a test to look directly at the blood vessels supplying your heart. If you have severe blockages, you may need a coronary intervention (balloon angioplasty and stent placement) or open-heart surgery (coronary artery bypass).
Most people who have angioplasty also have a stent placed in their blocked artery. The stent is usually inserted in the artery once it is widened by the inflated balloon. The stent supports the walls of your artery to help prevent it from re-narrowing after the angioplasty. The stent looks like a tiny coil of wire mesh.
Here’s what happens:
After your stent placement, you may need prolonged treatment with medications, such as aspirin or clopidogrel (Plavix) to reduce the chance of blood clots forming on the stent.
You’ll probably remain hospitalized one day while your heart is monitored and your medications are adjusted. You should be able to return to work or your normal routine the week after angioplasty.
When you return home, drink plenty of fluids to help flush your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for several days afterward. Ask your doctor or nurse about other restrictions in activity.
Call your doctor’s office or hospital staff immediately if:
It’s important that you closely follow your doctor’s recommendations about your treatment with bloodthinning medications — aspirin and clopidogrel or similar medications.
Most people who have undergone angioplasty with or without stent placement will need to take aspirin for life. Those who have had stent placement will need a blood-thinning medication such as clopidogrel for a year or longer in some cases. If you have any questions or if you need noncardiac surgery, talk to your cardiologist before stopping any of these medications.
Coronary angioplasty greatly increases blood flow through the previously narrowed or blocked coronary artery. Your chest pain should decrease, and you may be better able to exercise.
Having angioplasty and stenting doesn’t mean your heart disease goes away. You’ll need to continue healthy lifestyle habits and take medications as prescribed by your doctor. If your symptoms return, such as chest pain or shortness of breath, or if other symptoms similar to those you had before your procedure occur, contact your doctor. If you have chest pain at rest or pain that doesn’t respond to nitroglycerin, call 911 or emergency medical help. To keep your heart healthy after angioplasty, you should:
Successful angioplasty also means you might not have to undergo a surgical procedure called coronary artery bypass surgery. In a bypass, an artery or a vein is removed from a different part of your body and sewn to the surface of your heart to take over for the blocked coronary artery. This surgery requires an incision in the chest. Recovery from bypass surgery is usually longer and more uncomfortable.
If you have many blockages or narrowing of the main artery leading to the heart, reduced heart function, or diabetes, your doctor may recommend bypass surgery instead of angioplasty and stent placement. In addition, some blockages may be better treated with bypass surgery.