Preparing for Complex Ablation

Diagnostic Imaging Tests

To help plan for your complex ablation procedure, you will be scheduled for specific imaging tests. Below is a list of the diagnostic imaging tests your doctor could order.

Transesophageal echocardiogram (TEE): A TEE is a type of echocardiogram that is used to check for the presence of blood clots inside your heart. A flexible ultrasound probe is inserted down the back of your throat and into your esophagus. Its tip is positioned behind your heart, where it uses sound waves to create moving pictures of specific areas inside the chambers of your heart.

You will be scheduled for a TEE one to seven days before your procedure. When you are scheduled, you will receive detailed instructions and information about the test.

Magnetic resonance imaging (MRI): An MRI is an imaging test that uses a large magnet, radio waves and a sophisticated computer system to generate highly detailed, cross-sectional pictures of your heart. The images from this test give your doctor a very clear picture of your heart muscle and its chambers.

Computerized tomography (CT) scan: A CT scan uses a type of X-ray device that rotates around your body, taking multiple images. These are then combined with specialized computer software to provide three-dimensional pictures of your heart and blood vessels.

The images from your CT scan will be used, along with the specialized mapping software, in the EP Lab to construct a precise and accurate picture of the electrical pathways in your heart.

Risks of Complex Ablation

Complex ablation procedures are considered to be very safe, but with any invasive procedure, there can be complications.

Rare complications include:

  • Excessive bleeding where the catheters were put in
  • Bruising or swelling

Very rare complications:

  • The heart or lung can be punctured
  • Disruption of the heart’s electrical system
  • Blood clot inside the vein or lung
  • Heart attack or stroke
  • Fistula (opening) between the esophagus and the heart
  • Death

During the procedure and throughout the recovery period, we will monitor you closely.

Medication Changes

If you are having complex ablation for atrial fibrillation (AF ablation), or a type of atypical atrial flutter, you will be started on a medication called pantoprazole (Tecta®, Pantoloc®) five days before your procedure and 30 days after. This drug is commonly used to treat acid reflux. The left atrium of your heart sits very close to your esophagus, the “swallowing tube” that carries food and liquids from your mouth to your stomach. During the ablation procedure, heat is generated that could travel to the esophagus and cause some injury. The purpose of the pantoprazole is to protect your esophagus and reduce the risk of injury or damage.

Before your ablation procedure, your doctor may change the dose of your anticoagulation medication, or start you on a new or different anticoagulation drug.

Some of the heart medications you currently take may also be changed or discontinued. Before changing any of your drugs, make sure you fully understand which ones must be changed and on what specific dates.

Pre-Admission Unit (PAU)

Most patients undergoing complex ablations will receive general anesthesia and be asleep for the entire procedure. As part of the preparation, you will be scheduled for an appointment with the Pre-Admission Unit. The purpose of this visit is to meet with the anesthetist and nursing staff to review the procedure and what to expect during your admission, and to have final blood or other tests completed, if necessary.

You may find it helpful to bring a family member or friend to the PAU appointment who can take notes or ask questions that you might not have thought about.