Cardiac Ablation

What Is Cardiac Ablation?

This procedure uses energy to make small scars in your heart tissue. They stop unusual electrical signals that move through your heart and cause an uneven heartbeat (your doctor might call it arrhythmia). Cardiac ablation can also treat atrial fibrillation (AFib), a type of irregular heartbeat. If this is the case, your doctor might call it atrial fibrillation ablation.

The doctor may try cardiac ablation if medications and resetting your heartbeat — also known as cardioversion — don’t work.

Types of Cardiac Ablation

There are two ways your doctor can do the ablation. Catheter ablation is the more common procedure.

Types of cardiac catheter ablation

Catheter ablation, also called radiofrequency or pulmonary vein ablation, isn’t surgery. Your doctor puts a thin, flexible tube called a catheter into a blood vessel in your leg or neck and guides it to your heart. When it reaches the area that’s causing the arrhythmia, it can destroy those cells. This helps get your heartbeat regular again. There are two main kinds:

• Radiofrequency ablation. The doctor uses catheters to send radiofrequency energy (similar to microwave heat) that makes circular scars around each vein or group of veins.
• Cryoablation. A single catheter sends a balloon tipped with a material that freezes the tissues to cause a scar.

Types of cardiac surgical ablation

Surgical ablation involves cutting into your chest. There are three main kinds:

• Maze procedure. Your doctor will usually do this while you’re having open heart surgery for another problem, like a bypass or valve replacement. They make small cuts in the upper part of your heart and stitch them together to form the scar tissue that stops unusual signals.
• Mini maze. Most people with AFib don’t need open heart surgery. That’s where this less invasive type comes in. Your doctor makes several small cuts between your ribs and uses a camera to do catheter ablation. Some hospitals offer robotic-assisted surgery that uses smaller cuts and makes the procedure more precise. Your doctor will put a video camera or tiny robot into your chest. It’ll guide the creation of scar tissue that may help keep your heartbeat at the right pace.

• Convergent procedure. This pairs catheter ablation with a mini maze. The doctor uses radiofrequency ablation in the pulmonary vein, and a surgeon makes a small cut under your breastbone to use radiofrequency energy on the outside of your heart.

Risks of Cardiac Ablation

Any procedure has risks. Problems with cardiac ablation can include:

• Bleeding or infection where the catheter went in
• Damaged blood vessels if the catheter scrapes them
• Arrhythmias caused by damage to your heart’s electrical system
• Blood clots in your legs or lungs
• Heart damage, like punctures or damaged valves
• Stroke or heart attack
• Narrowing of the veins between your lungs and heart
• Kidney damage from the dye
• Radiation

Death

What Are the Benefits of Ablation?

If you don’t treat AFib, your odds of blood clots, heart failure, or a stroke go up. These could be life-threatening.

The doctor will take your risk factors into account before they suggest a treatment. If you have no symptoms or if they’re mild, the doctor may watch and wait. But they might prescribe warfarin or another blood thinner to protect you from strokes.

Cardiac ablation may be right for you if AFib symptoms are more severe and make it hard to do daily tasks.

Which Type of Cardiac Ablation Is Right for Me?

Your doctor will talk with you about AFib treatments, including ablation. The plan will depend on:

• The cause of your AFib
• Whether you have symptoms
• Your chance of having heart disease

Different types of ablation target different parts of your heart. You may be able to go home the same day, or you may need to stay a night or longer in the hospital.

Drugs can treat AFib and keep your heart at a regular rhythm, but they may have side effects or stop working after a while. Cardiac ablation might be the next option. This treatment could last longer or cure the AFib.

Nonsurgical and less invasive ablation are successful for many people with AFib. If the first procedure isn’t successful, a second often will be. With those options, you’ll be able to recover and get back to your routine quickly.

How Do You Prepare for Ablation?

Your medical team will probably tell you to:

• Stop eating or drinking the night before the procedure.
• Stop taking medications to treat arrhythmia several days before.
• Ask the doctor if you should stop any other medications.
• Ask the doctor about precautions if you have a pacemaker or implanted defibrillator.

The doctor will give you any other specific instructions.

What to Expect During Cardiac Ablation

A member of the medical team will put a needle into your forearm or hand that’s attached to a tube called an intravenous (IV) line. They’ll use it to give you a sedative, to relax you, or general anesthesia, to put you to sleep.

If you’re having catheter ablation, your doctor will numb an area near a vein on your groin, neck, or forearm. They’ll put a needle into the vein and run a small tube called a sheath through the needle. Catheters go through this sheath and into your veins to your heart. Your doctor can use electrodes or dye to find the cause of your arrhythmia and destroy unusual tissue.

You may feel some minor discomfort. Tell the medical team if you have severe pain or shortness of breath.

Surgical ablation is more complex. During a maze procedure, your doctor will cut down the center of your chest and separate your breastbone. They’ll attach a heart-lung bypass machine to keep your blood flowing. For other types, they’ll make one or more small cuts on your chest for the ablation instruments.

Cardiac ablation usually lasts 3 to 6 hours, but it depends on your case.

What is recovery like?

It depends on the type of procedure you have:

Catheter ablation. You may need to spend a night in the hospital, but most people can go home the same day. If so, you’ll rest in a recovery room for a few hours while a nurse closely watches your heart rate and blood pressure. You need to lie flat and still to prevent bleeding from where your skin was cut. Plan to have someone drive you home.

The doctor will prescribe a medication to prevent blood clots and another to prevent AFib. You’ll probably take them for 2 months. A shower is OK once you’re home, but keep the water on the cooler side. Don’t take a bath, swim, or soak for 5 days or until the cuts have healed.

For the first week:

• Don’t lift more than 10 pounds.
• Skip activities that make you push or pull heavy things, like shoveling or mowing the lawn.
• If you get tired, stop and rest.
• Don’t exercise. You can go back to normal in week two.

Maze procedure. You’ll probably be in the hospital about a week. You’ll spend the first couple of days in an intensive care unit (ICU) and then move to a regular room before you go home. Full recovery takes about 6 to 8 weeks, but you should be able to return to normal activities within 2 or 3 weeks. You should start to feel better in about 4 weeks. You’ll probably take a blood thinner for about 3 months.

Mini maze. You’ll be in the ICU for a few hours to a day. You’ll probably stay for 2 to 4 days, total.

Open-heart maze. This is major surgery. You’ll spend a day or two in intensive care, and you may be in the hospital for up to a week. At first, you’ll feel very tired and have some chest pain. You can probably go back to work in about 3 months, but it may take 6 months to get back to normal. Once you’re home:

• You may need someone to drive you for a while. The doctor will tell you when you can drive again.
• You’ll probably need help at home.
• You’ll need to go back in about 10 days to get the stitches out.
• Don’t lift anything heavy for several weeks.

Convergent procedure. This usually requires a 2- to 3-day hospital stay. Recovery is similar to catheter ablation.

Life after cardiac ablation

Catheter ablation may not cure your AFib, but it will often ease your symptoms. You could still have AFib episodes during the first 3 months because it takes that long for the scars to form.

If you’ve had AFib a long time, you’ll probably need another treatment to keep your heartbeat regular. You may also need medicine to control your heart rhythm for a few months after the procedure.

Most people who have the maze procedure get long-term relief from their symptoms. And many don’t need to take heart rhythm medicine afterward.

Your doctor may recommend lifestyle changes to keep your heart healthy, including:

• Eat a good diet with less salt and alcohol.
• Quit smoking.
• Keep a healthy weight.
• Get more physical activity.
• Try to manage stress and strong emotions.