When Your Child Needs Catheter Ablation

Catheter ablation may be used to treat your child if he or she has a tachycardia (also called a tachyarrhythmia). A tachycardia is an abnormal heart rhythm (arrhythmia) in which the heart beats too fast. During the procedure, special catheters (thin, flexible tubes) are guided into your child’s heart. Then, either radio frequency (RF) waves or cold temperature (cryoablation) is delivered through the catheters to destroy (ablate) the problem area. In most cases, catheter ablation is done in an electrophysiology (EP) lab. The procedure is performed by an electrophysiologist. This is a doctor who has special training to diagnose and treat electrical problems in the heart. The procedure takes about 2–6 hours.

Catheter ablation destroys problem tissue in the heart that causes fast heart rhythm.

Before the Procedure

• Let the electrophysiologist know if your child is taking medications or has any allergies. Your child may need to stop taking some or all medications 3–5 days before the procedure.

• Don’t give your child anything to eat or drink 4–6 hours before the procedure.

• Follow all other instructions given by the healthcare provider or electrophysiologist.

During the Procedure

• You’ll stay in a waiting area while the procedure is done.

• Your child is given a sedative and pain reliever through an intravenous (IV) line. This is medication to help your child relax and not feel pain during the procedure. Anesthesia may also be used. It’s given by a facemask or an IV. A breathing tube may be placed in your child’s trachea (windpipe). Special equipment monitors your child’s heart rate, oxygen levels, and blood pressure.

• The insertion sites (neck and/or groin) are numbed with an anesthetic (numbing medication). Then the catheters are inserted through blood vessels.

• The catheters are gently guided to the inside of the heart with the help of live x-rays.

• An electrophysiology study (EPS) is done. During this study, the electrophysiologist tries to induce (start) the arrhythmia. An electrical map of the inside of the heart can then be created. This shows the type of tachycardia your child has and where in the heart the problem is located.

• Once the EPS shows where the problem is, an ablation catheter is moved to that area. RF energy or cold temperature is generated at the catheter tip. This destroys the problem tissue. One or more of the following may be ablated:

  • An extra pathway of electrical tissue.

  • Abnormal tissue that’s firing off rapid electrical signals.

  • A portion of the AV node. If this is done, a permanent pacemaker is usually required. This is a device that takes over the AV node’s job of coordinating the contractions (squeezing) of the atria and ventricles.

• After ablating the problem tissue, another attempt is made to start up the arrhythmia. If nothing happens, then the ablation is considered an early success. If the arrhythmia recurs, more attempts at ablation may be needed.

• When the procedure is finished, the catheters are taken out of your child’s body. Pressure is applied to the insertion sites to help them close. Typically, no stitches are needed.

  After catheter ablation treatment, your child can be active.

After the Procedure

• Your child is taken to a recovery room. You can be with your child during this time. It may take 1–2 hours for medications to wear off.

• Your child needs to lie flat for 2–6 hours while the insertion sites close up.

• An overnight hospital stay is often needed for further monitoring.

• Before your child leaves the hospital, you’ll be given instructions for home care and follow-up.

Follow-Up

A follow-up visit is needed to review the results of the procedure. You’ll be told if your child can stop taking heart rhythm medications. In many cases, one ablation is enough to treat a tachycardia. But sometimes the problem returns or another develops. If this happens, your child may need a second catheter ablation. Tell the cardiologist if your child has any new or returning symptoms.

Risks and Possible Complications of Catheter Ablation Include:

• Bleeding or bruising at the catheter insertion sites

• Blood clot

• Infection

• Return of the tachycardia

• A slow heart rhythm (could require a permanent pacemaker)

• Perforation of the heart muscle, blood vessel, or lung (may require emergency procedure)

• Damage to heart valve (rare)