Cardiac Ablation Procedures

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 shouldn’t 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 (Bufferin), warfarin (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.

First, your anesthesia provider gives you medication through an intravenous (IV) line in your arm that will make you drowsy and may cause you to fall asleep. Equipment monitors your heart’s electrical activity.

Your doctor cleans and numbs an area of skin on your arm, neck, or groin. Next, they thread a series of catheters through a blood vessel and into your heart. They inject a special contrast dye to help them see areas of abnormal muscle in your heart. The cardiologist then uses a catheter with an electrode at the tip to direct a burst of radiofrequency energy. This electrical pulse destroys 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 lie still in a recovery room for four to six hours to help your body recover. Nurses 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 buildup 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 will be done and resulting rhythm strips reviewed to monitor 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.

Outlook after the procedure is relatively good but is dependent on the type of issue and its severity. Before success of the procedure can be determined, there is about a three-month waiting period to allow for healing. This is called a blanking period.

When treating atrial fibrillation, a large global study found catheter ablation was effective in about 80 percent of people with this condition, with 70 percent not requiring further antiarrhythmic drugs.

Another study looked at ablation rates in general for various supraventricular arrhythmia problems and found that 74.1 percent of those who underwent the procedure perceived ablation therapy as successful, 15.7 percent as partially successful, and 9.6 percent as unsuccessful.

In addition, your success rate will depend on the type of issue requiring the ablation. For instance, those with persistent issues have a lower success rate than those with intermittent problems.

If you’re considering a cardiac ablation, check the success rates at the center where your procedure would be done or of your specific electrophysiologist. You might also ask how success is defined to make sure you’re clear on how they measure success.