Overview
Cardiac ablation is a procedure that can correct heart rhythm problems (arrhythmias).
Cardiac ablation works by scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart and, thus, stops the arrhythmia.
Cardiac ablation usually uses long, flexible tubes (catheters) inserted through a vein or artery in your groin and threaded to your heart to deliver energy in the form of heat or extreme cold to modify the tissues in your heart that cause an arrhythmia.
Cardiac ablation is sometimes done through open-heart surgery, but it's often done using catheters, making the procedure less invasive and shortening recovery times.
Types
3. SVT ablation
4. Ventricular tachycardia ablation
Why it's done
Cardiac ablation is a procedure that's used to correct heart rhythm problems.
When your heart beats, the electrical impulses that cause it to contract must follow a precise pathway through your heart. Any interruption in these impulses can cause an abnormal heartbeat (arrhythmia), which can sometimes be treated with cardiac ablation.
Ablation isn't usually your first treatment option. Ablation is a treatment option for people who:
· Have tried medications to treat an arrhythmia without success
· Have had serious side effects from medications to treat arrhythmias
· Have certain types of arrhythmias that respond well to ablation, such as Wolff-Parkinson-White syndrome and supraventricular tachycardia
· Have a high risk of complications from their arrhythmias, such as sudden cardiac arrest
Risks
Cardiac ablation carries a risk of complications, including:
· Bleeding or infection at the site where your catheter was inserted
· Damage to your blood vessels where the catheter may have scraped as it traveled to your heart
· Puncture of your heart
· Damage to your heart valves
· Damage to your heart's electrical system, which could worsen your arrhythmia and require a pacemaker to correct
· Blood clots in your legs or lungs (venous thromboembolism)
· Stroke or heart attack
· Narrowing of the veins that carry blood between your lungs and heart (pulmonary vein stenosis)
· Damage to your kidneys from dye used during the procedure
· Death in rare cases
Discuss the risks and benefits of cardiac ablation with your doctor to understand if this procedure is right for you.
How you prepare
Your doctor will evaluate you and may order several tests to evaluate your heart condition. Your doctor will discuss with you the risks and benefits of cardiac ablation.
You'll need to stop eating and drinking the night before your procedure. If you take any medications, ask your doctor if you should continue taking them before your procedure.
Your doctor will let you know if you need to follow any other special instructions before or after your procedure. In some cases, you'll be instructed to stop taking medications to treat a heart arrhythmia several days before your procedure.
If you have an implanted heart device, such as a pacemaker or implantable cardioverter-defibrillator, talk to your doctor to see if you need to take any special precautions.
What you can expect
During cardiac ablation
Catheter ablation is performed in the hospital. Before your procedure begins, a specialist will insert an intravenous line into your forearm or hand, and you'll be given a sedative to help you relax. In some situations, general anesthesia may be used instead to place you in a sleep-like state. What type of anesthesia you receive depends on your particular situation.
After your sedative takes effect, your doctor or another specialist will numb a small area near a vein on your groin, neck or forearm. Your doctor will insert a needle into the vein and place a tube (sheath) through the needle.
Your doctor will thread catheters through the sheath and guide them to several places within your heart. Your doctor may inject dye into the catheter, which helps your care team see your blood vessels and heart using X-ray imaging. The catheters have electrodes at the tips that can be used to send electrical impulses to your heart and record your heart's electrical activity.
This process of using imaging and other tests to determine what's causing your arrhythmia is called an electrophysiology (EP) study. An EP study is usually done before cardiac ablation in order to determine the most effective way to treat your arrhythmia.
Once the abnormal heart tissue that's causing the arrhythmia is identified, your doctor will aim the catheter tips at the area of abnormal heart tissue. Energy will travel through the catheter tips to create a scar or destroy the tissue that triggers your arrhythmia.
In some cases, ablation blocks the electrical signals traveling through your heart to stop the abnormal rhythm and allow signals to travel over a normal pathway instead.
The energy used in your procedure can come from:
· Extreme cold (cryoablation)
· Heat (radiofrequency)
· Lasers
Cardiac ablation usually takes three to six hours to complete, but complicated procedures may take longer.
During the procedure, it's possible you'll feel some minor discomfort when the catheter is moved in your heart and when energy is being delivered. If you experience any type of severe pain or shortness of breath, let your doctor know.
After cardiac ablation
Following your procedure, you'll be moved to a recovery area to rest quietly for four to six hours to prevent bleeding at your catheter site. Your heartbeat and blood pressure will be monitored continuously to check for complications of the procedure.
Depending on your condition, you may be able to go home the same day as your procedure, or you may need to stay in the hospital. If you go home the same day, plan to have someone else drive you home after your procedure.
You may feel a little sore after your procedure, but the soreness shouldn't last more than a week. You'll usually be able to return to your normal activities within a few days after having cardiac ablation.
Results
Although cardiac ablation can be successful, some people need repeat procedures. You may also need to take medications, even after you've had ablation.
To keep your heart healthy, you may need to make lifestyle changes that improve the overall health of your heart, especially to prevent or treat conditions that can cause or worsen arrhythmias, such as high blood pressure. Your doctor may suggest that you:
· Use less salt, which can help lower blood pressure
· Increase your physical activity
· Quit smoking
· Avoid drinking alcohol
· Eat heart-healthy foods
· Maintain a healthy weight
· Manage strong emotions, such as anger
Catheter Ablation
If you have been diagnosed with a heart arrhythmia — a problem with the rate or rhythm of your heartbeat — your doctor may recommend a procedure called catheter ablation to improve your condition.
Facts About Catheter Ablation
Also known as a cardiac ablation or radiofrequency ablation, this procedure guides a tube into your heart to destroy small areas of tissue that may be causing your abnormal heartbeat.
Not everyone with a heart arrhythmia needs a catheter ablation. It’s usually recommended for people with arrhythmias that can’t be controlled by medication or with certain types of arrhythmia from the heart’s upper chambers, called the atria. Catheter ablation is also sometimes recommended for people with arrhythmia that begins in the lower chambers of the heart, known as the ventricles.
The Procedure
Catheter ablation can take between two and four hours to complete. The procedure is done in an electrophysiology lab where you will be monitored closely.
Before the procedure begins, you will be given intravenous medications to help you relax and even fall asleep. In some cases, you may be put to sleep by an anesthesiologist.
After the medication has taken effect, your doctor will numb an area in your groin and make a small hole in your skin. Then, the doctor will place three or four catheters through blood vessels to your heart to help guide the procedure.
After the catheters have been placed, electrodes at the ends of the catheters are used to stimulate your heart and locate the area that is causing the abnormal heart rhythm. Then, the doctor will use mild radiofrequency heat energy to destroy or “ablate” the problem area, which is usually quite small — about one-fifth of an inch in size. Other types of ablation techniques may be used, such as cryoablation, in which very cold temperatures destroy the problem area. Your doctor will decide which type of ablation therapy is most appropriate for you. Once the tissue is destroyed, the abnormal electrical signals that created the arrhythmia can no longer be sent to the rest of the heart.
Most people do not feel pain during the procedure. You may sense mild discomfort in your chest. After the ablation is over, your doctor will remove the guide wire and catheters from your chest.
After the Procedure
After the catheter ablation, you will probably need to lie still for two to six hours to decrease the risk of bleeding. Medical staff members may apply pressure to the site where the catheter was inserted. Special machines will monitor your heart as you recover. Some people can go home the same day as the ablation, but others will stay in the hospital for one or more nights.
Managing After a Catheter Ablation
Recovery from catheter ablation is usually fairly straightforward. In the days after the procedure, you may experience mild symptoms such as an achy chest and discomfort, or bruising in the area where the catheter was inserted. You might also notice skipped heartbeats or irregular heart rhythms. Most people can return to their normal activities within a few days.
Contact your doctor immediately if you have unusual pain or swelling, excessive bleeding or consistent irregularities in your heartbeat.
Depending on the type of arrhythmia being treated, catheter ablation can have a success rate of more than 90 percent, but some people may need to have the procedure again or other treatments for heart arrhythmias. Your doctor may want you to remain on medications to help control your heartbeat.
After the catheter ablation, be sure to follow all instructions from your doctor, especially regarding follow-up visits, medication schedules and safe levels of physical activity.