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. 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 radiofrequency (RF) waves. Or it may be done with cold temperature (cryoablation). The procedure takes about 1 to 4 hours and is done by a pediatric electrophysiologist. This is a doctor who is trained to treat electrical problems in the heart in children.
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.
Do not let your child eat or drink 4 to 6 hours 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 a sedative and pain reliever through an intravenous (IV) line. This will help your child relax and not feel pain. Anesthesia may also be used. This is given by a facemask or IV. A breathing tube may be placed in your child’s trachea (windpipe). Your child’s heart rate, oxygen levels, and blood pressure are watched.
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. X-ray pictures are used to help.
An electrophysiology study (EPS) is done. During this, the doctor actually tries to 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. It also shows where in the heart the problem is located.
The doctor will move an ablation catheter to that 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. One or more of the following may be ablated:
An extra pathway of electrical tissue
Abnormal tissue that is making rapid electrical signals
After the tissue is ablated, the doctor will try again to start up the arrhythmia. If it recurs, your child may need more ablation.
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.
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 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.
Risks and possible complications of catheter ablation
Risks and possible complications include:
Bleeding or bruising at the catheter insertion sites
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)
When should I call my child's healthcare provider?
After the ablation procedure, call the doctor right away if your child has:
Increased bleeding, bruising, redness, or pain at the catheter insertion site(s)
Shortness of breath or chest pain
Coldness, swelling, or numbness of the arm or leg near the catheter insertion site(s)
A bruise or lump that’s larger than a walnut at the catheter insertion site(s)
Extra or skipped heartbeats (palpitations)
Lightheadedness or fainting spells (syncope)
Unless advised otherwise by your child’s healthcare provider, call the provider right away if:
Your child is of any age and has repeated fevers above 104°F (40°C).
Your child is younger than 2 years of age and a fever of 100.4°F (38°C) continues for more than 1 day.
Your child is 2 years old or older and a fever of 100.4°F (38°C) continues for more than 3 days.
Your child has a seizure caused by the fever
August 17, 2018
Blaufox, A. Catheter Ablation of Tachyarrhythmias in Small Children, Indian Pacing and Electrophysiology Journal (2005), 5.1; 51-62, Catheter Ablation. UpToDate.
Bass, Pat F. III, MD, MPH,Gandelman, Glenn, MD, MPH,Image reviewed by StayWell medical illustration team.