When Your Child Needs Catheter Ablation

Catheter ablation is a way to treat an abnormal heart rhythm (arrhythmia) in which the heart beats too fast (tachycardia). It is also called a tachyarrhythmia. It is also used to treat Wolff Parkinson White Syndrome, even if there is no fast heartbeat. Thin, flexible tubes (catheters) are put into veins and arteries and guided to the heart. The tissue that is causing the heart to beat too fast is then destroyed. This may be done with heat using radiofrequency (RF) waves. Or it may be done with cold temperature (cryoablation). The procedure takes about 3 to 5 hours and is done by a pediatric electrophysiologist. This is a doctor who is trained to treat electrical problems in the heart in children. 

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

Before the procedure

• Tell the doctor if your child takes medicines. Your child may need to stop taking them 3 to 5 days before the procedure.
• Tell the doctor if your child has allergies.
• Your healthcare provider will instruct you on when your child should stop eating and drinking before the procedure.
• Follow all other instructions you are given.

During the procedure

• You will stay in a waiting area while the procedure is done.
• Your child is given general anesthesia for the procedure. This will help your child relax and not feel pain. This is given by an anesthesiologist.  This is given by a facemask or IV. A breathing tube will be placed in your child’s trachea (windpipe). Your child’s heart rate, oxygen levels, and blood pressure are closely watched by an anesthesiologist.
• The neck, the groin, or both are numbed with a local anesthetic. The doctor will make small cuts (incisions). The doctor will then put the catheters through blood vessels.
• The doctor will move the catheters to the inside of the heart. 3D mapping technology to help move the catheters is used, which greatly reduces the need for X-ray pictures. An electrophysiology study (EPS) is done first. During this, the doctor evaluates the health of the conduction system and actually tries to start the arrhythmia. This shows the type of tachycardia your child has. It also shows where in the heart the problem is located.
• The doctor will move an ablation catheter to the abnormal area. RF energy or cold temperature is generated at the catheter tip. This destroys the problem cells and breaks the electrical circuit causing the arrhythmia.
• After the tissue is ablated, the doctor will try again to start up the arrhythmia. If the doctor cannot restart the arrhythmia, we know we are successful. If the doctor can restart the arrhythmia, the ablation procedure continues. 
• When the procedure is done, the catheters are removed. Pressure is applied to the insertion sites to help them close. No stitches are needed.

After the procedure

• Your child is taken to a recovery room. You can join your child at this time. It may take 1 to 2 hours for the anesthesia to wear off.
• Your child will need to lie flat for 4 to 6 hours. This is how long it takes for the insertion sites to close.
• Your child may need to stay in the hospital overnight or may go home the same day.
• Before your child leaves the hospital, you will be given instructions for home care. 

Follow-up care

Your child will need a follow-up visit. This is to review the results of the procedure. You will be told if your child can stop taking heart rhythm medicine. In many cases, one ablation is enough to treat a tachycardia. But the tissue can heal itself and the problem can return, or another tachycardia can develop. If this happens, your child may need a second catheter ablation. Tell the doctor if your child has new or returning symptoms. Sometimes a child will say that he or she thought the arrhythmia was about to start, but then it does not. This is normal after the procedure and will go away.

Risks and possible complications of catheter ablation

Risks and possible complications include:

• Bleeding or bruising at the catheter insertion sites
• Blood clot
• Infection
• Return of the tachycardia
• A slow heart rhythm. This could require a permanent pacemaker.
• Perforation of the heart muscle, blood vessel, or lung. This may need an emergency procedure.
• Damage to heart valve (rare)