Ablation therapy 

Overview

Ablation therapy is a medical procedure that employs either extremely high or low temperatures to eliminate abnormal tissue or tumors and address various medical conditions. This technique is minimally invasive, meaning it doesn’t require open surgery and usually involves removing one or more layers of tissue, as opposed to surgical resection, which removes entire organs or parts of them. For instance, ablation therapy can be used to target and destroy small amounts of heart tissue responsible for irregular heart rhythms or to treat tumors found in different parts of the body, such as the lung, breast, thyroid, liver, and more.

Specialists trained in medical imaging, like radiologists, as well as cardiac specialists (cardiologists), and other healthcare professionals perform ablation therapy. They may employ probes inserted through the skin, flexible catheters introduced via arteries, or energy beams for the procedure. Imaging techniques play a crucial role in guiding the ablation process. Abnormal tissue can be compromised or eliminated using various methods, including heat (radiofrequency ablation), extreme cold (cryoablation), lasers, or chemical agents.

Types

Ablation therapy involves the destruction of abnormal tissue through various methods, including:

• Microwave ablation: In this procedure, a thin probe is inserted through the skin, guided by imaging techniques such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Microwaves emitted from the tip of the probe are employed to destroy the targeted tissue.
• High-energy radiofrequency ablation: Similar to microwave ablation, but radiofrequency waves are employed instead.
• Thermal balloon ablation: A heated fluid-filled balloon is inserted into the body cavity.
• Laser ablation: A laser is used to treat skin discolorations or lesions.
• Cryoablation: A probe or device is inserted, then supercooled with liquid nitrogen or argon to -4 degrees Fahrenheit, forming ice crystals that destroy the tissue.

Reasons for the procedure

Ablation procedures are used to treat various medical conditions, with common examples including:

• Catheter or cardiac ablation: This is used to address irregular heartbeats (arrhythmias) by using radiofrequency or cryoablation to destroy or scar the problematic heart tissue. The aim is to restore a normal heart rhythm.
• Endometrial ablation: Women experiencing heavy menstrual bleeding may opt for endometrial ablation, a procedure that treats the uterine lining (endometrium). It can effectively stop or reduce abnormal bleeding, but it’s important to note that it’s irreversible.
• Ablation for cancer: Cancerous tumors in organs like the kidneys and liver can be treated through ablation techniques like cryoablation. These methods aim to destroy cancer cells and manage the disease.

Risk

The risks associated with ablation therapy can vary depending on the specific procedure and the underlying medical condition. Overall, ablation therapy is considered relatively safe, with a low risk of complications. However, potential complications may include:

• Bleeding from the site where the procedure was performed.
• Risk of infections at the site of the procedure.
• Formation of scars or tissue damage near the ablation site.
• Possible damage to blood vessels during the procedure.
• In rare cases, there may be a risk of stroke or heart attack, particularly in procedures involving the heart or blood vessels.

Procedure

Ablation therapy offers several advantages over open surgery, including reduced risks, minimal bleeding, and a faster recovery period. During the procedure, patients can remain conscious under local anesthesia, often avoiding the need for open surgery altogether, leading to shorter hospital stays or even same-day discharge. Importantly, ablation therapy preserves healthy surrounding tissue and can be repeated if necessary. Additionally, it can be combined with other treatment modalities such as chemotherapy or medication therapy for a comprehensive approach to patient care.

Before the procedure

• Pre-procedure fasting: Prior to your procedure, it is imperative that you refrain from consuming solid foods or liquids. The precise duration of this fasting period will be communicated to you by your healthcare provider.
• Medication management: Continue to adhere to your regular medication regimen, unless otherwise directed by your physician. Patients taking anticoagulants such as warfarin may need to temporarily discontinue their usage. It is advisable to discuss any concerns regarding your medications with your healthcare provider.
• Pre-procedural testing: In preparation for the procedure, you may be required to undergo a series of diagnostic tests, including blood tests, as deemed necessary by your medical team.
• Jewelry restrictions: When visiting the hospital for your procedure, kindly refrain from wearing any jewelry. This measure is in place to ensure your safety and the smooth execution of the procedure.

During the procedure

The procedure can be conducted either in a hospital or an outpatient facility and may involve sedation. Preparation includes shaving and disinfecting the area, followed by the administration of a local anesthetic to numb the needle or catheter insertion site. In some cases, general anesthesia is used, rendering the patient unconscious during the procedure. A needle puncture or small incision is made to facilitate the insertion of the probe or catheter. In catheter ablation, a balloon catheter is typically introduced through a blood vessel, often in the groin, forearm, or neck, and guided to the heart with the assistance of imaging for precise placement. The duration of the procedure varies based on the specific ablation type and medical condition, with catheter ablation typically spanning three to six hours.

After the procedure

The length of your hospital stay after the procedure will depend on the specific type of treatment, with catheter ablation typically requiring an overnight stay. If a local anesthetic was used, you may be able to go home within a few hours, while those who received a general anesthetic might experience nausea. Fatigue can be expected for a few days post-ablation, and discomfort may last anywhere from hours to days, varying depending on the procedure and underlying condition. Strenuous activities should be avoided for a period determined by your doctor, and if discharged the same day, arrange for transportation. Women undergoing endometrial ablation may have vaginal bleeding or discharge for up to three to four weeks. In case of high fever, excessive bleeding, vomiting, severe pain, or any unusual symptoms, seek immediate medical attention.

Outcome

Ablation procedures may not always provide the desired results or be the optimal treatment choice for a specific condition, potentially requiring continued medication use even if the procedure succeeds. In cases where ablation therapy proves ineffective, alternative procedures may be necessary, and it’s crucial to have a thorough discussion with your doctor about all available options. Additionally, if the condition reoccurs, the ablation procedure might need to be repeated, typically with a waiting period of three to six months following cardiac or catheter ablation to assess its effectiveness.