Cardiac ablation is a procedure performed by an interventional cardiologist, a doctor who specializes in performing procedures for heart problems. The procedure involves threading catheters (long flexible wires) through a blood vessel and into your heart. The cardiologist uses electrodes to deliver a safe electrical pulse to areas of your heart to treat an irregular heartbeat.
Sometimes, your heart may beat too quickly, too slowly, or unevenly. These heart rhythm problems are called arrhythmias and can sometimes be treated using cardiac ablation. Arrhythmias are very common, particularly among older adults and in people who have diseases that affect their heart.
Many people living with arrhythmias don’t have dangerous symptoms or need medical attention. Other people live normal lives with medication.
People who can see improvement from cardiac ablation include those who:
- have arrhythmias that don’t respond to medication
- suffer bad side effects from arrhythmia medication
- have a specific kind of arrhythmia that tends to respond well to cardiac ablation
- are at a high risk for sudden cardiac arrest or other complications
Cardiac ablation may be helpful for people with these specific types of arrhythmia:
- AV nodal reentrant tachycardia (AVNRT): a very fast heartbeat caused by a short circuit in the heart
- accessory pathway: a fast heartbeat due to an abnormal electrical pathway connecting the heart’s upper and lower chambers
- atrial fibrillation and atrial flutter: an irregular and fast heartbeat starting in the heart’s two upper chambers
- ventricular tachycardia: a very fast and dangerous rhythm starting in the heart’s two lower chambers
Your doctor may order tests to record your heart’s electrical activity and rhythm. Your doctor may also ask about any other conditions you have, including diabetes or kidney disease. Women who are pregnant should not have cardiac ablation because the procedure involves radiation.
Your doctor will probably tell you not to eat or drink anything after midnight the night before the procedure. You may need to stop taking medications that can increase your risk of excessive bleeding, including aspirin, Coumadin, or other types of blood thinners, but some cardiologists wish you to continue these medications. Make certain that you discuss it with your doctor before surgery.
Cardiac ablations take place in a special room known as an electrophysiology laboratory. Your healthcare team may include a cardiologist, a technician, a nurse, and an anesthesia provider. The procedure typically takes between three to six hours to complete. It may be done under general anesthesia, or local anesthesia with sedation.
You’ll get medication through an intravenous (IV) line in your arm that will make you drowsy and you may fall asleep. Equipment will monitor your heart’s electrical activity.
Your doctor will clean and numb an area of skin on your arm, neck, or groin. Next, they will thread a series of catheters through a blood vessel and into your heart. You will be injected with a special contrast dye to help the doctor see areas of abnormal muscle in your heart. The cardiologist will then use a catheter with an electrode at the tip to direct a burst of radiofrequency energy. This electrical pulse will destroy small sections of abnormal heart tissue to correct your irregular heartbeat.
The procedure may feel a bit uncomfortable. Make sure to ask your doctor for more medication if it becomes painful.
After the procedure, you will go to a recovery room and lie still for four to six hours to help your body recover. Nurses will monitor your heart rhythm during recovery. You may go home on the same day, or you may need to stay in the hospital overnight.
Risks include bleeding, pain, and infection at the catheter insertion site. More serious complications are rare, but may include:
- blood clots
- damage to your heart valves or arteries
- fluid build-up around your heart
- heart attack
- pericarditis, or inflammation of the sac surrounding the heart
You may be tired and experience some discomfort during the first 48 hours after the test. Follow your doctor’s instructions about wound care, medications, physical activity, and follow-up appointments. Periodic electrocardiograms (EKGs) and rhythm strips will be done to monitor the heart rhythm.
Some people may still have short episodes of irregular heartbeat after cardiac ablation. This is a normal reaction as tissue heals, and should go away over time.
Your doctor will tell you if you need any other procedures, including pacemaker implantation, especially to treat complex heart rhythm problems.