SVT ablation

Catheter ablation is an effective way to manage SVT. Age and comorbidities influence the management options. Procedural success is estimated at 90-98% depending in the subtype and requirement for repeat procedure varies between 2 and 10%.

 What are the risks of having an SVT ablation?

They include but are not limited to the following.

Common risks and complications (more than 5%) include:
• Bruising bleeding at the puncture site. Bruising can extend beyond the puncture site and can take a few weeks to improve in some cases.

Uncommon risks and complications (0.5- 5%) include:

• Major bleeding related to the groin puncture site or injury to an artery in the groin. This (rarely) may need surgery and or blood transfusion.

Rare risks and complications (less than 0.5%) include:

• A stroke. This may cause long term disability (0.1%)
• Requirement for a pacemaker following the procedure (0.2%)
• Injury to the food pipe related to the ultrasound used during the procedure.
• Injury to the urinary tract if a urinary catheter is required for the procedure.
• Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs called pulmonary embolus.
• Death because of this procedure is rare

What are the costs involved with an ablation?

If you are having this procedure in a public hospital as a public patient, the cost is covered by Medicare.  If you are having this procedure in a private hospital, there is no additional out of pocket cost for our specialists. The usual hospital excess applies. Some anaesthetists have an out-of-pocket cost that we encourage you to discuss prior to your planned procedure.

How do I prepare for an ablation?

You will receive a letter with instructions and steps required prior to your procedure including, date of admission, fasting instructions, medications to stop and items to bring with you.

In General, do not eat or drink for 6 hours before your procedure. Ask your doctor about taking your usual medications. Blood thinners are usually continued for SVT ablation procedure. If you take SGLT2 medicine for heart failure or diabetes, you will need to stop taking them at least 3 days before your surgery. Leave any personal items of value such as jewellery at home.

What happens when you arrive at the hospital?

Once you arrive at the hospital for your procedure, you will usually be directed to the cardiac catheter laboratory admission area where you will be formally admitted as a hospital patient. You will be asked to change into hospital gown and put away all your valuable belongings. You will have some basic tests such as ECG, have your vitals recorded, groin shaved and have a cannula inserted into your arm to assist with the procedure. The technologists will place special stickers and wires on your chest and back.

Ablation may be performed under general anaesthesia which requires an anaesthetist. The anaesthetist will speak with you about their role. You will require an arterial line to monitor your blood pressure during the ablation that carries some risk of complications.

What happens during the procedure?

The anaesthetist may get you off to sleep (general anaesthesia). Local anaesthetic is administered at the groin which numbs the area. Three small tubes called sheaths are passed into the vein in the right groin through which catheters are inserted and gently passed up until they reach your heart. An X-ray machine guides the catheters to your heart. If required, a special ultrasound camera called a trans oesophageal echo (TOE) probe maybe advanced via your mouth into your oesophagus (gullet) that sits next to your heart. This is used when the SVT involves the left atrium. The TOE is used to guide the wires across from the right side to the left atrium (LA) through a thin membrane called the interatrial septum. A long needle is used to get access across the septum. Additional blood thinners are given to thin the blood further to prevent a stroke in selected cases. A mapping catheter maybe used to make a 3-D model which identifies the structures of relevance. An ablation catheter is advanced into the atrium that applies the radiofrequency energy at the relevant site. The catheter ablation procedure can take 1-2 hr or more in some cases. In some cases, additional unexpected rhythms become apparent. Your doctor will proceed to further ablation if required to prevent you having to return for a second procedure.

What happens after an ablation?

At the end of your procedure, your doctor will remove the catheters and apply pressure, followed by a dressing. You may have a little device applying pressure at the puncture site for a few hours. You’ll be watched closely in a recovery area, and depending on how you feel, you might need to rest in bed for a while. You will be admitted to the ward for observation overnight with rhythm monitoring. You may be required to lay flat on your back for about 4 hours after your procedure. People are usually discharged the next day.

What happens after discharge?

Follow up:

• An appointment will be made for you to be seen in clinic about 2 months after the procedure
• If you do not receive a date for an appointment within 8 weeks, please call the clinic and ask to speak to the secretary

Medications:

• Continue your medications as instructed. If you are uncertain about your medications, please ring the rooms for clarification
• Your SVT medications are generally discontinued

Postoperative care:

• Avoid strenuous exercise for 1 week
• Start with gentle exercise after 1 weeks – e.g. walking.

Symptoms to monitor:

• It is not uncommon to have a bruise at the groin that extends / spreads after the ablation. This usually resolves over time without any other problems.
• Bleeding: It is rare to have severe bleeding from the puncture site once you are at home. If bleeding does occur you must: lie flat, apply pressure to the site for 10 minutes. If it continues, call an ambulance for assistance.

Please contact the rooms if you have any questions or concerns at any time.

In recommending this procedure your doctor has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead. This is a very complicated assessment.