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JAMA Patient Page
March 19, 2019

Cardiac Catheter Ablation for Heart Rhythm Abnormalities

Author Affiliations
  • 1Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock
  • 2Texas Tech University Health Sciences Center, Lubbock
  • 3Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
JAMA. 2019;321(11):1128. doi:10.1001/jama.2018.9832

Sometimes rapid heart rates are caused by factors such as an overactive thyroid, alcohol, or medications.

If you have a rapid heart rate, these factors must first be excluded as the cause for the rapid heart rate before any procedures are performed to correct the problem. Rapid heart rates are usually caused by abnormal electrical impulses. For the heart to beat in a timely and coordinated fashion, these impulses must travel in particular routes called conduction pathways. Rapid heartbeats, called tachycardias, are caused by many electrical signals traveling through unusual routes in the heart. Cardiac ablation is a procedure performed by cardiac specialists (cardiac electrophysiologists) to fix this abnormality. Ablation is the process of damaging a small part of cardiac muscle on purpose to break up the abnormal electrical circuits. Supraventricular tachycardias are rapid heart rates caused by electrical abnormalities in the upper chambers of the heart. Some supraventricular tachycardias are self-limited, occur very sporadically, and require no ongoing treatment. If treatment is required, medications are tried first. But if the medications cause side effects, are not tolerated, or do not work, then your physician may recommend cardiac ablation. Another common abnormality, atrial fibrillation, may also be treated with ablation.

Overnight fasting is required before the procedure. Plastic tubes called catheters are inserted into a blood vessel in your groin, wrist, or neck after the skin has been cleaned. The tubes will then be guided into the heart with the assistance of imaging. Electrodes at the ends of the tubes help create a 3-dimensional computer image of the inside of your heart called an electroanatomical map. The computer model identifies the location and pathway of the abnormal electrical signals. The physician then performs the ablation using either heat (radiofrequency ablation) or extreme cold (cryoablation) to eliminate the abnormal pathways. The procedure takes about 3 to 4 hours. If all goes well, you can anticipate leaving the hospital the next day, but you may need to stay longer for medical care if you develop another arrhythmia or have any complications related to anesthesia. You may be placed on blood thinners (anticoagulant therapy) or other medications after the procedure to prevent stroke.

As with any other medical procedure, complications can occur from cardiac ablation. Complications occur from cardiac ablation procedures in less than 3% of cases and include bruising or bleeding at the site where the catheter was inserted. More serious problems such as infection and stroke can also occur. The tubes inside the heart can irritate and possibly penetrate the heart, causing fluid to accumulate around it or cause a new arrhythmia. The procedure will need to be repeated if it does not work the first time. The risks and benefits of the procedure should be discussed with your clinician before the procedure is done. Call your physician if you have bleeding from the groin, weakness in any extremity, chest pain, or palpitations after the procedure. More than 80% of patients are cured of their supraventricular tachycardia using cardiac ablation therapy.

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Conflict of Interest Disclosures: None reported.

Sources: Torpy JM. Atrial fibrillation. JAMA. 2010;303(4):380. doi:10.1001/jama.303.4.380

Prystowsky EN, Padanilam BJ, Fogel RI. Treatment of atrial fibrillation. JAMA. 2015;314(3):278-288. doi:10.1001/jama.2015.7505

Amit G, Nyong J, Morillo CA. Efficacy of catheter ablation for nonparoxysmal atrial fibrillation. JAMA Cardiol. 2017;2(7):812-813. doi:10.1001/jamacardio.2017.0901

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