Heart ablation

Overview

Heart ablation, also known as cardiac ablation, refers to a group of procedures aimed at correcting irregular heartbeats, known as arrhythmias. These procedures involve the removal or destruction of tissue in the heart that generates these abnormal electrical impulses. During the process, a heart specialist, or cardiologist, employs either heat or cold to create small scars in the heart’s tissue. These scars are strategic; they’re placed where they can effectively prevent the generation and propagation of erratic heartbeats. The typical method for performing cardiac ablation involves inserting flexible, slender tubes called catheters through the blood vessels. However, it can also be performed less frequently during heart surgery.

Healthcare professionals utilize various methods to conduct heart ablation, aiming to correct irregular heart rhythms through either a catheter procedure, surgery, or a blend of both approaches.

• Catheter ablation: This is the predominant method and is minimally invasive. A cardiologist carefully inserts a thin, flexible tube, known as a catheter, into a vein—often starting at the groin—and maneuvers it to the heart. This catheter emits either heat or cold to the heart’s tissue, causing scar formation that impedes erratic heart rhythms.
• Surgical ablation: When performing concurrent heart surgeries, such as bypass or valve replacement, cardiac surgeons may integrate a maze procedure, an open-heart ablation technique. This method now also employs hot or cold energy to generate scarring within the heart, obstructing the electrical pathways that lead to arrhythmia.
• Hybrid surgical/catheter ablation: For patients who do not require full open-heart surgery, a hybrid approach is available, often referred to as a mini maze. The cardiac surgeon makes several small cuts in the chest through which a catheter is introduced to target and treat the sources of the arrhythmia.

Reasons for undergoing the procedure.

Cardiac ablation may be recommended when medications are ineffective at managing arrhythmias, when significant side effects from such drugs occur, or for treating specific arrhythmias such as Wolff-Parkinson-White syndrome or supraventricular tachycardia, which respond well to this intervention. It is also an option for individuals at high risk of severe arrhythmia complications.

This procedure can correct various types of irregular heartbeats, including:

• Atrial fibrillation (Afib): The most common reason for heart ablation. In Afib, the heart’s upper chambers, the atria, quiver instead of beating in a coordinated manner, leading to ineffective blood pumping. This increases the risk of blood clots and potentially causes a stroke if a clot reaches the brain.
• Atrial flutter: This condition causes the atria to beat too rapidly, leading to a faster-than-normal heartbeat. It shares the increased risk of blood clots and stroke with Afib.
• Supraventricular tachycardia (SVT): With SVT, the heart beats normally but can suddenly accelerate to up to 300 beats per minute. Frequent or prolonged SVT episodes may damage the heart and cause severe symptoms.
• Ventricular tachycardia (VT): An arrhythmia in the lower chambers, or ventricles, causes the heart to beat too fast, reducing the time for the heart to fill with and pump blood, potentially leading to a significant drop in blood pressure and is life-threatening.

Types of heart ablation

Doctors can use a combination of treatments, surgery, or a minimally invasive catheter procedure to achieve heart ablation.

• Catheter ablation: The most popular kind of cardiac ablation is catheter ablation. The process involves little invasiveness. A catheter, which is a thin, flexible tube, is inserted into your heart by a cardiologist through a vein, usually in your groin. By applying heat or cold energy to your heart’s tissue, the catheter can cause scarring that prevents aberrant or irregular cardiac beats.
• Surgical ablation: While undergoing other heart surgeries, cardiac surgeons frequently carry out an open-heart ablation known as a “maze procedure.” Your doctor might recommend a maze operation if you require ablation in addition to bypass surgery or valve replacement. These days, scar lines are also created in the heart using hot or cold radiation, which stops the electrical impulses that cause the arrhythmia.
• Hybrid surgical/catheter ablation: Your cardiac surgeon may do a hybrid treatment, also referred to as a mini maze, if open-heart surgery is not necessary for you. Your chest is lightly incised by the surgeon. After that, doctors can address the signals causing the arrhythmia by inserting a catheter.

Risks

Heart ablation carries a higher likelihood of side effects when performed surgically compared to when it’s done using a catheter. The risks associated with this procedure can include:

• Development of new arrhythmias.
• Formation of blood clots.
• Injury to the vein from the catheter and its protective sheath.
• Potential harm to the heart, such as valve damage or perforation.
• Pulmonary vein stenosis, which is a narrowing of the veins connecting the lungs to the heart.
• Radiation exposure, which is a concern during catheter ablation.
• Possibility of infection or bleeding at the catheter insertion site.
• Risks of stroke or heart attack.
• Although very rare, there is a risk of death.

Before the procedure

Cardiac ablation is a hospital-based procedure where a specialist, either a cardiologist or cardiac surgeon, will administer sedation through an IV in your forearm or hand to help you relax. The level of sedation varies from being fully alert to deeply sedated or under general anesthesia, depending on the type of arrhythmia and other health issues you may have.

This procedure is carried out by a cardiologist or cardiac surgeon who will perform a comprehensive evaluation of your heart and general health to determine the most suitable ablation technique. Prior to the procedure, you’ll receive detailed instructions from your provider. You may need to discontinue any blood-thinning medications such as aspirin or warfarin and halt any arrhythmia treatment, but only under your provider’s advice. Fasting the night before the procedure is also commonly required. Moreover, if you’re undergoing an outpatient ablation, it’s essential to arrange transportation as you will not be in a position to drive yourself home post-procedure.

During the procedure

During a heart ablation procedure, whether it’s a catheter ablation or a surgical ablation, the following steps are taken by medical professionals:

• Catheter ablation: During a catheter ablation procedure, an intravenous (IV) line is inserted into your arm to administer anesthesia, typically placing you under general anesthesia to ensure comfort throughout the procedure due to its duration. The cardiologist then inserts a small tube, known as a sheath, through your skin and into a vein, often in the groin area. Within this sheath, electrode catheters, thin tubes equipped with wires, are threaded and guided to the heart with the aid of X-ray imaging. These catheters deliver either hot or cold energy, such as radiofrequency or cryoablation, to effectively eliminate irregular or abnormal heart rhythms.
• Surgical ablation: General anesthesia is also used. The procedure may be performed during open-heart surgery or through a less invasive method with small incisions in the chest. The surgeon directly applies hot or cold energy to the heart tissue to produce the necessary ablation.

Patients may experience some discomfort during the catheter maneuvering and energy delivery. It’s important to immediately inform the health care provider of any severe pain or breathing difficulties.

After the procedure

Catheter ablation typically has a shorter recovery period compared to surgical ablation. The details of each recovery process are as follows:

Catheter Ablation

Catheter ablation typically lasts two to four hours and involves the removal of the catheter and sheath from your vein once completed. Subsequently, you will be moved to a recovery room, where you may stay for several hours, occasionally overnight, under the supervision of a nurse who monitors your recovery. Before your discharge, you will receive detailed guidance on at-home care, which may include a prescription for aspirin or other blood-thinning medications to prevent blood clots during the recovery period, which can extend for several months.

Surgical Ablation

After undergoing surgical ablation, your post-operative care will involve being transferred to the Intensive Care Unit (ICU), with the length of your ICU stay determined by the complexity of the surgery. Following your discharge from the ICU, your recovery will continue within the hospital setting for a few more days, until you have reached an adequate level of improvement to be safely discharged home. Throughout your home recovery period, you might still need to adhere to a regimen of aspirin or other blood-thinning medications for several months as a precautionary measure against the development of blood clots.

Outcome

The recovery time after heart ablation varies depending on the type of procedure: catheter ablation, a hybrid approach, or surgical ablation. It can range from a few days to several weeks or even months. It’s common to experience arrhythmias during the healing process, which can last up to three months. Your doctor may recommend continuing anti-arrhythmia medication during this time.

If you’ve had a catheter ablation, you can usually return to work within a day or two. However, if your job involves physical labor, you may need a few extra days off.

After catheter ablation, avoid heavy lifting and strenuous activities for at least three days. Discuss with your doctor when it’s safe to resume physical activities.

With surgical ablation, you’ll typically spend about a week in the hospital. Once home, it may take several more weeks to recover enough to return to work. If you had a less-invasive surgical procedure, your recovery may be shorter.

After ablation, contact your healthcare provider if you experience:

• Arrhythmias (rapid or irregular heartbeats).
• Chest pain.
• Bleeding at the catheter or surgical incision site.
• Nausea or vomiting.
• Dizziness or lightheadedness.
• Numbness or tingling in your leg (if the catheter site was in your groin).
• Swelling or pain at the catheter or incision site.