Radio Frequency Ablation

About the Procedure

Radiofrequency Ablation (RFA) or Radiofrequency Catheter Ablation (RFCA) is a procedure which uses high frequency, low voltage radio waves to correct a disturbance in heart rhythm. Healthy heart muscles contract through continuous and regular electrical impulses which originate from an area intended to act as the heart's natural pacemaker. When cells in this area behave abnormally, the electrical impulses become irregular, resulting in tachycardia - a heartbeat which is too fast. RFA applies heat to the abnormal area, scarring the abnormal tissue, which becomes unable to conduct electricity and eliminates the arrhythmias. Radiofrequency ablation benefits tachycardia, atrial flutter, atrial fibrillation, and is used in patients with implantable defibrillators and pacemakers

A cardiac electrophysiologist (heart rhythm specialist), using low energy X-rays, performs an RFA in a hospital in a two to five hour procedure. The patient is awake but heavily sedated. Thin catheters are inserted into a vein in the side of the neck, chest, or arm, or an artery in the groin and threaded up to the heart. A dye, visible with fluoroscopy, is injected through the catheter, giving the doctor a 3-D view to map out the heart while s/he provokes an arrhythmia to identify where the abnormal electrical current originates. The tip of the catheter is an electrode which is placed along the abnormal pathway and heat is transmitted from a machine controlled by the doctor. The tissue is ablated - caused to die off - so no electricity can pass through or be emitted from those cells. The doctor again tries to provoke an arrhythmia and, if one can't be induced, the ablation has been successful. If an arrhythmia can be brought on, the procedure continues until there are none. At the end of the RFA, the catheters are removed, pressure is applied to the insertion site to control bleeding, and the patient is sent to a recovery area.

What to Know Before the Procedure

The possible complications resulting from the use of the catheter, i.e., perforation of the vessels leading to the heart, damage to the heart valves and nearby structures, and infection, are major concerns. Embolisms and cardiac complications, such as bleeding, hematoma, and heart block (failure of the electrical impulse to travel from the top to bottom of the heart) can occur. While the risk of radiation is low, it exceeds the risk from other radiologic procedures such as dental and traditional X-rays.

Pre-admission evaluations tend to be more extensive than some other cardiac procedures. An EKG, blood tests which include kidney function and electrolyte levels, in addition to other routine blood assays, are done the week prior to admission. Other tests are conducted at the discretion of the doctor. The patient's current prescription and over-the-counter medications will be reviewed, particularly cardiac and clot-reducing medications. While many patients are discharged the day of the procedure, some stay overnight and plans should be arranged for that possibility. The patient needs to plan for a driver upon discharge as driving is not recommended.

What to Know After the Procedure

Immediately post-op the patient is taken to the recovery area where the catheter site is monitored for bleeding and their heart rhythm observed. To reduce the risk of bleeding, the patient must remain in bed with limited mobility for one or more hours. For two or three days afterwards, patients may experience tiredness, achiness in the chest, and possible skipped or irregular heartbeats, and may note a small bruise or walnut-sized lump at the catheter insertion site. Normal activities can be resumed within a few days with few restrictions. Success rates for RFA vary according to the specific area of the procedure, the number of ablated sections, and the patient's overall health. For most cardiac ablation patients, there is a long-term reduction in arrhythmic episodes and their severity, or a complete return to a normal heart rhythm

If you Need to Travel Outside of your Local Hospital

Patients with arrhythmia serious enough to affect quality of life may feel that radiofrequency ablation is a very desirable option. Due to concerns about its risks, however, seek a doctor with considerable experience and a history of positive outcomes. The post-op recovery period is short and restrictions are manageable; meaning that your main priorities should lie with finding the correct doctor for the procedure, as well as the overall costs of domestic versus international travel.