Ventricular Tachycardia (VT) Ablation

Is it time to see a heart rhythm specialist?

A problem with your heart’s rhythm is called an arrhythmia (uh-RITH-mee-uh). If your heart beats too quickly, this is called tachycardia, which can be harmless. In some cases, if an irregular rhythm is coming from the bottom part of your heart, it may be ventricular tachycardia (ven-TRI-kyuh-lar tack-uh-CARD-ee-uh), or VT.

A healthy heart normally beats about 60 to 100 times a minute while you are at rest. VT makes the heart beat faster – about 100 or more beats a minute. This kind of fast heartbeat can keep your heart from moving blood to the body as it should. It can make you feel breathless or dizzy. You might even faint. VT is caused by a problem with the electrical signals in the lower chambers of the heart.

VT episodes can be very short, and these short episodes cause no harm. Longer VT episodes (sustained VT) can be dangerous. It is important to treat VT, because a fast heartbeat can lead to dizziness or fainting. It can also lead to a possibly life-threatening condition called ventricular fibrillation, or even cause the heart to stop.

Treatment for ventricular tachycardia may include a catheter ablation. This is a minimally invasive medical procedure that uses cold or heat energy to make tiny scars in the heart to block electrical signals that cause a rapid heartbeat. The goal of VT ablation is to make the heart beat the way it should.

Your doctor may try medications to treat ventricular tachycardia. These medications are called anti-arrhythmics. They can be given in a pill form or by a needle in your arm that slowly drips medicine into your body. Other medicines may also be used, alone or with anti-arrythmics. Calcium channel blockers and beta blockers are two commonly used drugs for VT. These drugs slow the heart rate and reduce blood pressure.

Some VT can be treated with medication, but a ventricular ablation medical procedure might be right for you. You will talk to an electrophysiologist (eh-LEK-troh-fi-zee-AHLL-uh-juhst), who has an expertise in understanding your heart’s electrical signals.

Before recommending ablation, your cardiologist will check:

  • If your VT cannot be treated well with medication
  • How well medication works for you
  • If you have or have had heart failure
  • If you have reduced ejection fraction (low EF), which is a measure of the amount of blood the lower left chamber (ventricle) of your heart pushes out with each heartbeat

 Your doctor may also take into consideration your age.

If you have a device that sends electrical signals to your heart to get it to beat correctly, called an implantable cardioverter-defibrillator, ablation can reduce the number of times signals are needed.

The ablation procedure typically has a higher success rate than medication alone, which means symptoms are less likely to return. There is a low risk of complications with this procedure, as well as a quickrecovery time.

Treatment for VT involves managing any diseases that causes the condition, as well as the symptoms of VT. Common treatments for VT include:

  • Radiofrequency catheter ablation (RCA): After locating the point where an abnormal rhythm starts in the heart, your physician will destroy tissue in that area with an electrical current.
  • Implantable cardioverter-defibrillator (ICD): This small machine monitors and controls your heart’s rhythm. A battery is inserted below the collarbone, usually on the left side just underneath the skin. It is connected to leads, which are passed through the blood vessel to the heart. If the ICD detects an episode of VT, it quickly sends an electrical signal to get your heart back to a normal rhythm.
  • Medications: These can slow heart rate, and may help your heart maintain a safe rhythm. Your health care provider can help you understand the pros and cons of medications.

What to Expect During VT Ablation

One of the most common non-invasive treatments for VT is called a catheter ablation (KATH-i-tur ah-BLAY-shun). A catheter is a thin flexible tube. It travels through a blood vessel in your groin up to your heart. The procedure uses hot or cold energy to create scars in your heart tissue where the arrhythmia is occurring. The scars help block certain electrical impulses and prevent irregular rhythms. The scars only destroy tissue involved with the targeted heart patterns, and they don’t cause any lasting pain.

In most cases, catheter ablations are done in an electrophysiology lab at a hospital, and it can take approximately one to three hours for the procedure. Sometimes it may take longer.

Norton Heart & Vascular Institute has two state-of-the-art electrophysiology labs where catheter ablations are performed, located in Norton Audubon Hospital and Norton Hospital. We use 3D imaging to map your heart and identify the spot of tissue that’s causing theabnormal heartbeat. Then we complete minimally invasive ablation procedures to treat the issue.

Your health care provider will go over what you need to do before a catheter ablation. Always follow your provider’s guidance and do not stop or start taking medications unless you are told to do so. You may be asked to stop blood-thinning medications like aspirin or warfarin. You will also be asked to stop eating and drinking for several hours before your procedure. Your provider will give you exact instructions.

Before the procedure, arrange for a trusted friend or family member to take you home after the procedure.

A nurse will help get you ready for an ablation by putting an IV line into your arm. You can receive medicine through the IV line, including drugs to make you comfortable and keep you from feeling any pain (this is also called anesthesia – an-uhs-THEE-zyuh). You may be awake during the procedure, but you’ll be sedated and you will not feel pain.

Your electrophysiologist will:

  1. Insert a small tube called a sheath through the skin and into a vein to create an opening. Usually, providers use a vein in your groin (between your legs).
  2. Insert thin tubes with wires called electrode catheters into the sheath, and use real-time X-ray to guide them to the right place.
  3. Use the catheter to deliver hot or cold energy to the areas of your heart causing irregular rhythms. The catheter destroys the targeted heart tissue to help restore a normal rhythm.
  4. Remove the catheter and sheath from your vein.

You will stay in the hospital for several hours after the procedure. Your doctor may have you stay the night.

Many patients wonder if catheter ablation hurts. Most people say catheter ablation is mildly uncomfortable but the discomfort doesn’t last long. Some patients also have little or no discomfort from the ablation. The place where the catheter went into your vein may be sore and have a bruise. The opening for the catheter is very small and should heal quickly.

Your heart will heal and recover in time. For a little while – usually a few weeks – you may still feel irregular heart rhythms and experience more tiredness than you are used to. This is normal. Tell your physician if you have any questions or concerns after an ablation.

You should begin to notice a decrease inabnormal heartbeats after the ablation. You will need to visit the doctor for some follow-ups to be sure you are recovering. Most people see improvements in their quality of life after VT ablation, including feeling less tired or needing fewer signals from their implantable cardioverter-defibrillator. If your abnormal heart rhythm does not stop or stops and starts again, you may need a repeat procedure or alternate treatment.

Techniques for VT Ablation

Before the procedure, a doctor will find out exactly where the arrhythmia is in your heart. The electrophysiologist will do a study to know which tissue is causing the arrhythmia. Once the area of the arrhythmia is known, the doctor will create a more precise electrical map of your heart with a 3D mapping system. This map gives the doctor an electrical view of your heart and tells the cardiologist where to position the catheter wires for the procedure. Norton Healthcare is one of the only health systems in the area that offers this advanced 3D mapping technology.

During the VT ablation, sensors on the tip of the catheter send electrical impulses and record the heart’s electricity. Your health care team will use this information to determine the best place to apply the VT ablation treatment.

There are two types of ablation:

  • Heat (radiofrequency energy)
  • Extreme cold (cryoablation)

Either type of ablation can be done from inside or outside the heart. Sometimes, treatment is done at both locations.

  • Inside the heart (cardiac ablation). Your abnormal heartbeat may come from inside the heart. If so, heat or cold energy is applied to the target area, damaging the tissue and causing scarring. This helps block the electrical signals that cause ventricular tachycardia.
  • Outside the heart (epicardial ablation). If the abnormal heartbeat starts in tissue outside the heart, the physician will insert a needle through the skin on the chest and into the lining of the fluid-filled sack (pericardium – payr-ee-CARD-ee-um) that surrounds the heart. A hollow tube (sheath) is inserted and catheters are passed through the tube to access the outside surface of the heart.

Benefits and Risks of Catheter Ablation

The benefits of catheter ablation include:

  • Procedure performed by a board-certified electrophysiologist whose training includes three years additional training beyond board certification in cardiology
  • Potentially, reduced or even eliminated symptoms of your heart arrhythmia
  • Stitches not required
  • For many patients, a reduced number of episodes and severity of symptoms over the long term
  • Typically, a return to your regular life and activities after the procedure
  • For many patients, reduced need for medications following a successful catheter ablation
  • No chest incisions or ports
  • Short hospital stay (overnight), or even going home the same day

Possible risks include:

  • Blood clots
  • Damage to the vein from the sheath or catheter
  • Damage to heart tissue or heart valves
  • Infection or bleeding
  • Stroke
  • The need for a permanent pacemaker

Your physician will talk to you about all these issues, as well as any concerns or questions you have.

Heart and Vascular Care for the Whole Person

Norton Heart & Vascular Institute offers patient resources to support you and your family, including free classes for people of all ages who are seeking to improve cardiovascular health or living with a heart condition.

Cardiac Rehabilitation Program

Our cardiac rehabilitation providers are leaders in developing and applying innovative techniques that can help you recover and resume your life.

Connecting Hearts Support Group

The group provides education and support to individuals who have had a heart attack, are living with a heart condition or are at risk for cardiovascular disease.

Heart Health Screenings

Prevention is the best way to manage heart disease, and screenings are available to detect early signs of cardiac and vascular disease and identify risk factors.

About Norton Heart & Vascular Institute

Every year, more than 137,000 people in Louisville and Southern Indiana choose Norton Heart & Vascular Institute specialists for their heart and vascular care. That’s more than any other health care provider.

  • Norton Healthcare’s adult-service hospitals in Louisville all have received Chest Pain Center accreditation from the American College of Cardiology (ACC). This is the seventh consecutive accreditation for all four hospitals, which ensures quality for the treatment of heart attack.
  • Norton Audubon Hospital, Norton Brownsboro Hospital and Norton Hospital all are recognized as having ACC Chest Pain Center with Primary PCI accreditation.
  • Norton Healthcare has the most facilities across the city of Louisville with the ability treat a life-threatening heart attack.
  • You have access to more than 100 physicians and advanced practice providers with specialized training and experience in a comprehensive range of conditions and treatments.
  • Patients can make appointments at 28 locations in Louisville and Southern Indiana. Telecardiology is offered at more than 30 sites in the region.
  • Norton Audubon Hospital, a key location for Norton Heart & Vascular Institute services, has been recognized with a HeartCare Center National Distinction of Excellence year after year by the American College of Cardiology. This is the only hospital in Louisville to be recognized for this distinction.
  • U.S. News & World Report 2023-24 Best Hospitals ranked Norton Healthcare’s adult-service hospitals in Louisville as high performing in heart attack, heart failure, aortic valve surgery and heart bypass surgery.
  • Norton Audubon Hospital earned ventricular assist device (VAD) accreditation from DNV – Healthcare and the Centers for Medicare & Medicaid Services.
  • Communicate with your health care provider, renew prescriptions, get lab results and more through your free Norton MyChart account.

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