frequency ablation

  Hi:  I wrote to you about a month ago regarding my SVT.  Well, I am scheduled for an
  ablation March 25 and am scared to death.  They say that they won't be sure
  what kind of tachycardia it is until they actually go in.  One of my cardiologists
  is sure it is the SVT kind.  My electrophysiologist is not convinced until he goes
  in.  They say there is a chance of perforating the heart wall, which totally turns me off and
  frightens me to death.  Also, could there be underlying heart disease causing my tachycardia?
  Wouldn't my ecco's have shown if I had a disease in my heart or not?  Will I feel the catheters
  inside me?  Will they sedate me to the point of not remembering--I hope so, I don't want to
  know a thing. They say it takes some 4 hours. True?  I am so tired from my heart I really hope this
  cures it.  The Digoxin I am taking makes me feel bloated, my hands and feet.  Any help for my
  questions would be reassuring!  Have a good weekend and thank you.

[Cleveland Clinic, MD]

_
Dear
Thank you for your question. Here are some of the commonly asked questions concerning radiofrequency ablation.
What is radiofrequency ablation?
                              A radiofrequency ablation or RFA is a treatment for abnormal heart
                              rhythms. During RFA, your doctor will use a special machine to direct high
                              frequency electrical energy to remove areas of the heart muscle that cause
                              the abnormal rhythms. It can also be used to "disconnect" the electrical
                              pathway between the upper chambers (atria) and the lower chambers
                              (ventricles) of the heart. The type of RFA performed depends upon the
                              type of arrhythmia you have.
What to do before a RFA.
                              Should I take my medications?
                              Your doctor may ask you to stop certain medications (such as those that
                              control your heart rate or aspirin products) one to five days before your
                              procedure. Ask your doctors which medications you should stop.
                              Can I eat?
                              You must have an empty stomach. Do not eat or drink anything after
                              midnight the night before your procedure. If you must take medications,
                              drink only small sips of water to help you swallow your pills.
                              What should I wear?
                              When you come to the hospital, wear comfortable clothes. It is best not to
                              wear any jewelry or valuables.

What should I expect during the RFA?
                              Where does it take place?
                              Your test will take place in a special room called the EP
                              (electrophysiology) lab. Before the test begins, a nurse will help you get
                              ready. The nurse will start an IV (intravenous) line, This is so the doctors
                              and nurses may give you medications and fluids during the procedure if
                              necessary.
                              Will I be awake?
                              It is common to be nervous. A light sedative will be given to you through
                              your IV to relax you and make you drowsy. This medication will not put
                              lyou to sleep. You will be asked to report any symptoms, answer
                              questions or follow instructions given to you by your doctor. If you are
                              uncomfortable or need anything, please let your nurse know.
                              Will I be monitored?
                              The nurse will connect you to four monitors:
                              Defibrillator/Pacemaker:
                                   Attached to one sticky patch placed on the center of your back and
                                   one onto your chest. Allows the doctor and nurse to pace your
                                   heart rate if it is too slow or deliver energy to your heart if the rate is
                                   too fast.
                              Electrocardiogram or EKG:
                                   Attached to several sticky electrode patches placed onto your
                                   chest, as well as catheters placed inside your heart. Provides a
                                   picture on graph paper of the electrical impulses traveling through
                                   your heart.
                              Oximeter monitor:
                                   Attached to a small clip on your finger. Checks the oxygen level of
                                   your blood.
                              Blood pressure monitor:
                                   Connected to a blood pressure cuff on your arm. Checks your
                                   blood pressure intermittently throughout the study.
                              These monitors allow the doctor to check your heart rhythm and
                              the body's responses to arrhythmias.

                              What are catheters?
                              The catheters used by the electrophysiologist are special wires that can
                              pace the heart and precisely record its electrical activity.
                              How does the doctor insert the catheters into my heart?
                              Your groin area will be shaved and cleansed with an antiseptic solution.
                              Sterile drapes will be placed to cover you from your neck to your feet. A
                              light restraint will be placed across your waist and arms to prevent your
                              hands from coming in contact with the sterile field.
                              The doctor will numb your groin by injecting a medication. You may feel
                              an initial burning sensation, then it will become numb.
                              The doctor will then insert several catheters into the large blood vessel(s)
                              in your groin. The doctor will use the fluoroscopy machine to guide the
                              catheters into your heart. It is important that you remain still and resist the
                              temptation to raise your head to see what the doctor is doing while the
                              doctor places the catheters are being placed.
                              Sometimes, it may be necessary to use both an artery and a vein.
                              What will I feel?
                              After the catheters are in place, the doctor will look at the monitor to
                              assess your heart's conduction system. Then, the doctor will use an
                              external pacemaker to give the heart electrical impulses to increase your
                              heart rate. You may feel your heart beating faster or stronger when your
                              heart is paced. If an abnormal heart rhythm occurs, the nurse will ask you
                              how you are feeling. It is very Important to tell the doctor or nurse the
                              symptoms you feel.
                              The doctor will then move the catheters around your heart to see which
                              area(s) your arrhythmia is coming from. Once the doctor finds the area of
                              your heart that causes the arrhythmia, energy is applied through the
                              catheter. You may feel some discomfort or a burning sensation in your
                              chest. This is normal. During this time you must stay quiet, keep very still,
                              and avoid taking deep breaths. If you are extremely uncomfortable, tell
                              your nurse or doctor and more medication may be given.
                              How long does on RFA last?
                              About 2 to 6 hours.
                              Are there any risks to an RFA?
                              Radiofrequency ablation is generally very safe. However, as with any
                              invasive procedure, there are risks to having an RFA. Special precautions
                              are taken to decrease the risks. Your doctor will discuss these risks with
                              you. Any specific questions should be directed to your doctor.

What should I expect after the RFA?
                              When will I find out the results?
                              Results of the procedure will be given to you and your family after the test.
                              Your doctor will also discuss when you can resume activities.
                              If you have any other questions, please ask your doctor or nurse.
                              Will I have to stay in the hospital after RFA?
                              After RFA you will be admitted to the hospital. You will be taken to your
                              room and placed on a special monitors 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.
                              You will be discharged the next day and given follow-up instructions.
                              Many individuals feel extra heartbeats on and off for a few weeks.
                              Sometimes you may also feel as if your tachycardia (fast heart rate) is
                              starting, but then it stops. These sensations are normal and you should not
                              be alarmed. If however, your tachycardia reoccurs, notify your doctor.
                              How do I care for the wound site?
                              After the RFA, the doctor will remove the catheters from your groin. To
                              prevent bleeding, the doctor will apply pressure to your groin area for
                              several minutes. Then, you will need to be at bedrest for one to six hours.
                              Keep your legs as still as possible during this time to prevent bleeding.
                              No stitches are needed. Your incision will have a small sterile dressing on
                              it which can be removed the next day. Keep the area clean and dry.
                              Report any redness, swelling, or drainage at the groin site to your doctor
                              or nurse.

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.