How to Prepare
Sometime prior to your procedure your doctor or the nurse coordinator will review your medical history. He or she will also explain the purpose of the Ablation, its potential benefits and possible risks. Because an Ablation is invasive, requiring the insertion of catheters into your body, it involves some risk. The risk is small, however, and the study is relatively safe. Most patients who undergo ablation do not experience complications.
You will need to have a
blood test,
ECG, and a chest x-ray before the procedure. You may also need to have an
echocardiogram or
Doppler of your legs. You will be seen by the anesthetist during your pre-admission appointment. If this has not been arranged prior to your procedure, then call the Triage Office. If you have any questions, call your doctor's office or the Triage Office at 416 340 4800 x 8436.
If there are any changes in the booking of your test, you will be called by the Triage Office.
If you cannot make it to your test, call the Triage Office as soon as you know.
Take a shower the night before or the morning of your test.
Please bring with you all of your current medications in the original containers. This includes prescription medications, over-the-counter medications, vitamin or mineral supplements and herbal remedies.
If your procedure is in the morning you can have NOTHING to eat or drink from midnight the night before your procedure. Your doctor or nurse coordinator will tell you which medications you can take on the morning of the procedure. Medications can be taken with a sip of water unless you are instructed otherwise by your doctor. Your doctor or nurse coordinator will give you instructions about your blood thinner or diabetes pills.
If your procedure is in the afternoon you can have a small breakfast (such as toast and juice) before 6:00 am. Do not have anything else to eat until after your test. Your doctor or the nurse coordinator will explain which medications you can take on the morning of the procedure. Medications can be taken with sips of water unless you are instructed otherwise by your doctor or the nurse coordinator. Your doctor or the nurse coordinator will give you instructions about your blood thinner or diabetes pills.
Blood Thinners such as Coumadin® (Warfarin), Pradaxa® (Dabigatran), Eliquis® Apixaban and Xarelto® (Rivaroxaban) are usually stopped 1 – 3 days before the procedure. You will be given specific instructions about what to do by your doctor or the nurse coordinator.
If you take any medication (pills or insulin) for your diabetes, call the Triage Office or the doctor who is arranging your procedure for instructions. Ask what you will need to do about your medication and breakfast on the day of the test.
If you need an interpreter, bring a friend or family member on the day of the procedure. You'll be sedated during this procedure. Your friend or family member will be instructed on how to care for you or assist with your care after the procedure on discharge and will be required to drive and/or accompany you home. They can also help you gather information, take notes and ask questions.
You can back a small bag with personal toiletries for your hospital admission. DO NOT bring large sums of money or valuables to the hospital.
If you are discharged the same day as your procedure, you'll need to arrange for someone to stay with you during the night, after you have had your procedure.
Checking In
Your procedure will be done in the
Cardiovascular Investigations Unit (Cath Lab) on the 2nd floor Eaton Building. You will check in at the
Cardiovascular Investigations Unit (Cath Lab) or the
Cardiac Short Stay Unit on the 5th floor Munk Building. Please check in at the nurses' station.
Please have the following ready:
- Health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID (such as a driver's license, passport, or other provincial health card). Please arrive 15 minutes before your appointment.
- Your name, address and birth date
Before your Ablation
When you check-in, the receptionist will give you a name band to wear. You will be assigned a room to wait until it's time for your procedure. You will be asked to change into a hospital gown. Your family should keep your valuables with them.
When you have finished changing, a nurse will prepare you for the test and the physician will explain the procedure and ask for your consent. You may have a catheter inserted in your bladder so it is easier for you to pass urine while you lie flat for the procedure, and then during the 4-hour post-procedure recovery period.
Please note that for male patients, the chest and back areas will be shaved to provide a clean, smooth skin surface upon which to apply large patches. These patches help record electrical signals from the heart during the procedure.
An ablation is done using the femoral vein. Catheters are inserted through the femoral veins, which are veins near your groin and advanced into your heart. Before the procedure, it will be necessary to remove hair from the area.
You will be given medication to help you relax when you enter the lab, but you'll remain awake during the procedure. If the sedation is not enough, you may also receive a general anesthetic, with a tube inserted in your airway to help you breathe.
During and After your Ablation
Ablations are done in a lab. The lab is kept cool to keep the machines working properly, so you may feel cool as well. During the procedure, the nurses will monitor your heart rhythm and blood pressure. Sterile sheets will be put on you to keep the insertion site clean.
The doctor will give you an injection to numb the area where the catheter will be inserted. Then a hollow plastic guide (sheath) will be inserted into the veins – you may feel some pressure and tingling, which is normal. Your doctor will then insert 2 to 4 catheters in the right groin, which will enter your heart. You may feel minor discomfort during the procedure from lying flat on the table, or from the injection of the numbing medicine where catheters will be placed. If you feel any pain or discomfort during the procedure, tell the doctor right away.
With the help of fluoroscopy (X-ray on a television screen), all the catheters are guided to several specific locations in your heart, to record specific electrical activity and pinpoint the type and location of the arrhythmia.
Intermittently you may feel your heart racing when the doctors try to induce your abnormal heart rhythm. You will be in a safe and controlled environment while these symptoms are being experienced and the activity being induced in your heart will help your doctor confirm the location of your arrhythmia.
After the mapping of the abnormal electrical pathway is performed, it will be ablated. Ablation is done by applying radiofrequency energy to the area of abnormal rhythm to stop the abnormal impulses.
You may need to have a
conventional or a
complex ablation, depending on the type of arrhythmia you have. The procedures are the same, however; complex ablation involves using complex mapping equipment that allows your doctor to use a computer-aided navigation and mapping system to see inside your heart. This system will allow the doctor to build a three-dimensional, color-coded map of your heart, that will help find the appropriate areas within your heart to ablate.
To ablate and destroy the abnormal tissue and electrical pathways, a burst of radio-frequency energy (a low-voltage, high-frequency current) is emitted from the tip of the catheter at the appropriate site. Once ablated, a small scar or lesion forms within the tissue through which further electrical signals can no longer pass and the arrhythmia is eliminated.
After the procedure, the catheters and the sheath will either be removed in the lab, or in the Cardiovascular Investigations Unit (Cath Lab) recovery room. A clamp will be applied to the femoral vein near your groin area where the catheter was put in. This is to stop any bleeding and to help the area heal.
When you return from the lab, you'll be lying flat on your back with your leg straight.
You need to stay in this position for 4 hours before you're allowed to sit up. This allows more time for the area to heal. The head of the bed will be elevated slightly to make you more comfortable. You may eat or drink if you wish. A nurse will check your blood pressure and the pulses in your feet and will also check the area where the catheters were inserted.
The Results of Your Ablation
The doctor or nurse coordinator will speak to you following the procedure and you will be given specific instructions regarding your medications.
Before you are discharged, you will also be provided with discharge instructions.
How Long Will Your Procedure Be?
Conventional ablation typically takes 2 to 3 hours. Complex ablation typically takes 4 to 6 hours, but it can vary from person to person. You will be here all day.
We do everything that we can to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend that you come prepared for delays.
Recovering at Home
You can resume your normal daily activities (such as walking, bathing, showering) upon discharge from the hospital unless instructed differently. The only restriction is straining or lifting heavy objects more than 10 pounds, for 5 to 7 days, so that the incision site can heal. Avoid vigorous activity such as playing football, basketball, and exercise for one week.
You may experience some tenderness and bruising in your groin and upper leg. This is normal, but if the pain is excessive or continuous, please have your family doctor or closest emergency clinic examine it.
You can return to work in 3 to 4 days unless your job requires you to lift heavy objects.
It is also important to understand that your "normal" electrical system should continue to function as before the catheter ablation procedure. Your heart will work at rest, or during exercise, as it did before the catheter ablation procedure.
Always follow your doctor's or nurse coordinator's instructions for mobility and activity levels.
