Cardiac Ablation

What is cardiac ablation?

Cardiac ablation (or catheter ablation) is a minimally invasive treatment for abnormal heart rhythms (arrhythmias). Healthcare providers use this procedure to find and treat abnormal tissue in your heart. This can correct your heart rhythm.

A cardiologist (heart specialist) performs a cardiac ablation procedure by inserting a catheter (tube) through a blood vessel into your heart. They use heat (radiofrequency ablation), cold (cryoablation) or short bursts of energy (pulsed field) to create scars in areas where the arrhythmia starts. These scars help block abnormal electrical impulses and prevent abnormal rhythms.

During heart ablation, you’ll generally receive sedation or possibly general anesthesia. The heart specialist creates scars in carefully selected areas of your heart so that they only affect tissue involved with faulty heart rhythms. They don’t cause any residual pain in your heart or create problems with your heart’s function.

What does cardiac ablation treat?

Cardiac ablations treat most types of fast heart arrhythmias. They’re generally the first-line option when you have symptomatic and/or life-threatening arrhythmias. Your cardiologist may suggest this procedure if you have an abnormal heart rhythm that medication can’t treat. Your provider will evaluate your heart and overall health to choose the best procedure for treating the arrhythmia that affects you.

A heart ablation procedure can treat these types of arrhythmias:

• Atrial fibrillation (AFib) and atrial flutter (AF): These cause the upper chambers of your heart (called the atria) to beat irregularly and ineffectively. As a result of irregular beats leading to blood sitting in your atria, AFib and AF can cause clots that can travel anywhere in your body, potentially leading to a stroke.
• Supraventricular tachycardia (SVT): People with SVT experience episodes of fast, irregular heartbeats (up to 300 beats per minute). Your heart can still pump blood normally, but repeated or long-lasting bouts of SVT can damage your heart over time.
• Ventricular tachycardia (VT). With VT, your lower chambers (ventricles) can start to beat too rapidly. This is a potentially dangerous arrhythmia that can lead to cardiac arrest.

Healthcare providers may also recommend a cardiac ablation procedure if you’re at high risk of sudden cardiac arrest (when your heart stops without warning). When the cause of the cardiac arrest isn’t obvious, your provider will use specific catheters to study your heart chambers’ rhythm from the inside. This is called an electrophysiology study. It helps assess which type of abnormal rhythm caused the cardiac arrest. If needed, your provider will ablate the abnormal rhythm.

How should I prepare for this procedure?

Before a cardiac ablation procedure, you may need to:

• Stop taking blood-thinning medications like apixaban, rivaroxaban or warfarin (follow your provider’s guidance and stop these medications only as directed)
• Stop eating or drinking for several hours (usually after midnight) before your procedure (your provider will give you exact instructions)
• Arrange for someone to pick you up and take you home from the hospital after the procedure
• Wear comfortable clothing and leave jewelry and valuables at home
• Get an intravenous (IV) line in your arm so you can receive medicine, including sedation or anesthesia (you’ll be relaxed, even if you’re awake)

What happens during cardiac ablation?

A provider will:

1. Shave, clean and numb the area where they’ll be working
2. Insert a small tube (sheath) through your skin and into a vein or artery to create an opening (providers use a blood vessel in your groin, arm, leg or neck)
3. Insert the electrode catheters (thin tubes with wires) into the sheath — they thread the catheters through your vein or artery and up to your heart (using X-rays to guide them)
4. Map out the problem area so they know which tissue to treat
5. Use the catheter to treat the abnormal heart tissue and block irregular rhythms
6. Remove the catheter and sheath from your vein or artery
7. Apply special plugs or stitches to prevent bleeding

How long does a heart ablation take?

A cardiac ablation can take two to four hours to complete, but it’s often longer. The exact length of time it takes is different from person to person.

What happens afterward?

After a cardiac ablation procedure, you move to a recovery room and stay there for several hours. A nurse monitors your condition while you recover. You’ll need to stay at the hospital for six to eight hours after the procedure. Depending on your condition, you may go home that day or spend the night at the hospital.

When it’s time to go home, you’ll receive detailed instructions about at-home care. Your provider may prescribe apixaban or other blood-thinning medication to help prevent blood clots. You may take this medicine for several months or longer after the procedure, depending on your medical history.

What are the benefits of cardiac ablation?

Cardiac ablation is a minimally invasive procedure that usually doesn’t require a prolonged hospital stay. A cardiac ablation procedure can restore a normal heart rhythm when medications fail or aren’t an ideal option because of their side effects. This procedure can even be lifesaving in some cases.

Pulsed field ablation can destroy heart muscle with little impact on nearby tissue (like nerves or your esophagus), which makes this procedure extremely safe. It does this by providing more targeted destruction to the abnormal heart muscle.

How successful is heart ablation?

The cardiac ablation success rate varies by the type of abnormal heart rhythm you have. People with SVT may see a 90% to 95% success rate. But the success rate is only 60% to 80% for:

• AFib
• Atrial tachycardia
• Ventricular tachycardia

What are the risks or complications of cardiac ablation?

Cardiac ablation risks are low. People rarely have complications, especially at hospitals that perform a lot of cardiac ablations. Possible risks include:

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

You do receive some radiation during radiofrequency catheter ablation. If you’re pregnant, ask your provider if you can safely wait to have the procedure after delivering your baby.

What is the downside of cardiac ablation?

Depending on the type of abnormal heart rhythm you have, a cardiac ablation may not work. And when the procedure works, the effect isn’t always immediate. You may have symptoms for several weeks before they improve, or you may need another ablation procedure in the future.

What is the recovery time for a catheter ablation?

The recovery from the procedure takes only a few hours, but the full effect of the ablation can take several weeks to manifest. During the first three months after cardiac ablation, you may continue to have arrhythmias while your heart tissue continues to fully heal. This is normal.

Follow-up appointments

You’ll likely have follow-up visits with your provider for a year after your cardiac ablation. If your symptoms come back during that time, you may need to repeat the procedure.

When can I go back to work?

Unless your job involves heavy lifting or other physical labor, you’ll likely feel ready to return to work five to seven days after your catheter ablation procedure.

You should avoid heavy lifting (more than 10 pounds) and strenuous exercise for at least a week. Consult with your provider about when it’s safe to return to physical activity or driving.

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Bleeding or a lump at the puncture site
• Chest pain
• Dizziness or lightheadedness
• Nausea or vomiting
• Numbness, pain or tingling in your leg (if the puncture site is in your groin)
• Drooping in your face or weakness in your arm (you should get emergency care if you have these stroke symptoms)
• Racing heart rate leading to severe symptoms (like dizziness, lightheadedness, shortness of breath or chest pain) or lasting three hours or more
• Swelling (edema) or pain at the puncture site

Contact your provider if you have any questions or concerns about anything you’re feeling after a heart ablation.

Is a catheter ablation major surgery?

No, a cardiac ablation isn’t major surgery. Providers perform this procedure through your blood vessels. They don’t open your chest. The only incision you’ll have is the one where they puncture your skin to go through your blood vessel.

Is catheter ablation painful?

Generally, cardiac ablation gives people mild discomfort for a short time. Many have little or no discomfort from the ablation at all. Afterward, the site where the catheter went into your vein may be sore and have a bruise. The puncture is very small and should heal quickly.