When Your Child Needs Catheter Ablation

Catheter ablation is a way to treat a heart rhythm problem (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 to medicines, latex, or surgical soap and what kind of reaction they had.

  • Follow the healthcare provider's instructions about what your child should not eat or drink 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 IV (intravenous) line. This will help your child relax and not feel pain. Anesthesia may also be used. This is given by a face mask or IV. A breathing tube may be placed in your child’s windpipe (trachea). 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 then put the catheters through blood vessels using IV lines

  • The doctor will move the catheters to the inside of the heart. X-ray pictures are used to help with this.

  • 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 made. 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 happens again, your child may need more ablation.

  • When the procedure is done, the catheters are removed. Pressure is put on the catheter 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 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

  • Blood clot

  • Infection

  • A slow heart rhythm. This could require a permanent pacemaker.

  • Puncture or tearing 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:

  • Fever (see Fever and children, below)

  • Increased bleeding, bruising, redness, or pain at the catheter insertion sites

  • Shortness of breath or chest pain

  • Coldness, swelling, or numbness of the arm or leg near the catheter insertion sites

  • A bruise or lump that’s larger than a walnut at the catheter insertion sites

  • Lasting feeling that the heart is skipping or adding a beat (palpitations)

  • Lightheadedness or fainting spells (syncope)

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.