What Is a Cardiac Ablation?

Cardiac ablation, also called catheter ablation, is a minimally invasive procedure to treat heart rhythm problems or irregular heartbeats (which are medically known as arrhythmias). A specialized heart doctor, known as an electrophysiologist, performs this procedure by placing catheters in your groin and guiding them to your heart. These catheters can deliver cold energy (cryoablation) or heat energy (radiofrequency ablation) to freeze or burn parts of the heart that are causing you to have an arrhythmia.

Purpose of Cardiac Ablation

An electrophysiologist may perform cardiac ablation to treat certain types of heart rhythm problems. The heart has an electrical system that is responsible for making the heart beat in a regular, normal pattern. Problems with the heart's electrical system can cause the heart to beat too fast or irregularly, leading to symptoms like heart palpitations, shortness of breath, and lightheadedness.

Medications are often the first line of treatment for an arrhythmia. However, if medications are ineffective for you, your healthcare team may recommend a cardiac ablation to reduce your symptoms and improve your overall heart health.

Cardiac ablation can help treat one or more of the most common heart rhythm problems. These include:

• Supraventricular tachycardia, which occurs when your heart beats too fast
• Atrial fibrillation, which is an extremely fast and irregular heartbeat
• Atrial flutter, which causes the upper chambers of your heart to beat rapidly
• Ventricular tachycardia, which causes the lower chambers of your heart to beat too fast
• Wolff-Parkinson-White (WPW) syndrome, which is a congenital heart defect that causes a rapid heartbeat
  

Types of Cardiac Ablation

There are two main types of cardiac ablation—and each is based on the type of energy used to destroy the heart tissue that's causing your arrhythmia. Studies have shown that the two options have similar success rates. If you require a cardiac ablation, your healthcare team may recommend one of the following:

• Cryoablation: Uses cold energy (also called cryotherapy) to freeze abnormal tissue in your heart. During this procedure, an electrophysiologist will place a catheter in your heart to deliver cold energy. With cryotherapy, complications like damage to the esophagus or perforation (holes) in the heart are usually less common, but there is a risk of nerve injury.
• Radiofrequency ablation: Uses heat energy to destroy the abnormal heart tissue that's causing your arrhythmia. Once entered, the tip of the catheter delivers radiofrequency to specific areas in the heart. It's worth noting that this type of ablation is more commonly used and has been around longer than cryotherapy.

How Does It Work?

During a cardiac ablation, your electrophysiologist will place catheters into a vein in your groin, and thread them up to the heart using fluoroscopy (a type of X-ray). They will map out your heart's electrical system using catheters, and identify any areas responsible for abnormal heart rhythms.

Then, they will deliver hot or cold energy to destroy the tissue. Once the procedure is done, they will remove the catheters and place a sterile bandage on the wound. Your healthcare team will then bring you to a recovery area for monitoring before either sending you home or admitting you overnight in the hospital for more monitoring.

Before the Procedure

Before a cardiac ablation, your healthcare team will explain the procedure and obtain your consent (or, a signed agreement to do the procedure). You will fill out any needed paperwork and have the opportunity to ask any questions. Your healthcare provider will also give you instructions on any special preparations to take before the procedure, such as any bloodwork you may need or any medications you should not take before the procedure.

It may be helpful to contact your health insurance company and the hospital billing department to discuss how much of the procedure they will cover, including any hospital stay that you may need after the ablation. Sometimes health insurance companies have preferred "in-network" providers or facilities that they will provide better coverage for, which can help lower your out-of-pocket costs for the procedure.

During the Procedure

When it's time for the ablation, a nurse will place an IV in a vein in your arm. Your healthcare team will bring you to the procedural room (typically called an electrophysiology or EP lab) where you will lay on a stretcher or table. Your care team will attach various wires to your chest and arms to monitor your heart rate, breathing, and blood pressure throughout the procedure.

You will then receive medication (such as sedatives or anesthesia) to make you sleepy and comfortable. Keep in mind: your healthcare team will clean and shave any hair in your groin area so they can insert the catheters properly.

Once you are comfortable, the electrophysiologist will inject a numbing agent into the groin area and use a needle to access the femoral vein in your groin. They will then place a sheath (or, a tube that remains in place during the procedure) to serve as an access point to place wires and catheters during the procedure.

Using fluoroscopy (X-rays), the electrophysiologist will guide the wires and catheters into the heart. With specialized equipment and computer monitors, they can map out the electrical system of the heart to determine the exact area of your heart that needs treatment. They then deliver cryotherapy or radiofrequency to destroy the affected tissue.

You may not be fully asleep during the procedure, and in that case, you can expect to feel a small prick from the needle with the numbing agent. However, if you're receiving general anesthesia (especially if you're undergoing a longer ablation), you will be fully asleep during the procedure.

If you are awake, you should not experience any pain during the procedure. If you do feel pain, it's essential to tell your healthcare team as soon as possible. Once the procedure is complete (which generally takes a few hours), your care team will remove all the wires and catheters and place a sterile bandage over the wound in your groin.

After the Procedure

After a cardiac ablation, your healthcare team will monitor you in a recovery room. They will ensure your heart rate and blood pressure are in a normal range, and that there is no significant bleeding from the wound. They will give you instructions on how long it is necessary to lay flat after the procedure. You should tell a provider right away if you have chest pain, shortness of breath, swelling, or bleeding at the groin site so they can treat your symptoms promptly.

Depending on your procedure, you may be able to go home on the same day or may need to spend the night in the hospital for further monitoring. If the plan is for you to go home on the same day, you must have someone to drive you home, as you cannot operate a vehicle after receiving anesthesia. Your team will provide specific instructions on any activities (such as driving or lifting heavy items) that you should avoid doing and for how long.

Once it is time for you to go home, a provider will review discharge instructions with you about any medication changes and activity restrictions. They should also tell you when to contact a provider if you experience symptoms or complications after the procedure. Generally, it's important to seek medical care if you have a fever, bleeding, chest pain, shortness of breath, or difficulty speaking after the procedure.

It's also important to note that immediately after the procedure, your heart rhythm may not immediately be normal. For example, if you have an ablation to treat atrial fibrillation, your heart may still be experiencing atrial fibrillation right after the procedure. This is because it can take time for the heart to settle down after the procedure and for scar tissue to form at the site of the ablation to help treat your condition.

Risks and Precautions

Like any medical procedure, a cardiac ablation does carry some risk. However. serious risks are pretty rare and over the years have become even less common. Getting an ablation carries some exposure to radiation due to the use of X-rays. There are also risks related to any sedatives or anesthesia you receive, such as the possibility of breathing problems, low blood pressure, and allergic reactions.

While complications aren't common, it's worth understanding which risks are possible after you receive a cardiac ablation. These include:

• Bleeding in the groin
• Infection
• Blood clots
  
• Injury to the esophagus, blood vessels, or phrenic nerve (which controls your diaphragm)
• Collapsed lung
• Stroke
• Fistula
• Damage to heart valves
• Pericardial effusion, or bleeding in the sac around your heart

In rare cases, a cardiac ablation may require you to get a pacemaker. In extremely rare cases, heart perforation (holes in the heart) and death can occur. In a study on complications for ablations for atrial fibrillation (a commonly performed procedure) between 2018 and 2022, the risk of a serious complication was 1.9%, and the risk of death was 0.05%.

A catheter ablation is generally safe for most people, including young children and older adults. However, if you are pregnant or are trying to conceive, it's important to tell your healthcare provider, as this procedure can pose some risks during pregnancy. Your care team will weigh the risks and benefits of the procedure for your specific situation to determine whether a procedure is safe for you at this time.

How to Prepare for Cardiac Ablation

Your healthcare provider will give you specific instructions on what to expect and how to prepare for catheter ablation. In general, you should expect to not eat or drink anything (including water) for about eight hours before the procedure. You should also wear comfortable clothes to your procedure so that they are easy to take off when you change into a hospital gown. It's best to leave jewelry and other valuables at home. Your provider will also give you specific instructions on which medications you should take and which you should avoid before your ablation.

Success Rate

Ideally, you only need one cardiac ablation to take care of your arrhythmia. But an abnormal heart rhythm can return months or years later, so you may need a second ablation.

The success of a cardiac ablation in part depends on the type of arrhythmia you have. Ablation for accessory pathways (where there is an abnormal connection between the upper and lower chambers) is very successful.

But for atrial fibrillation (AFib), you may still go in and out of AFib even after the procedure. In fact, 30% to 40% of people with AFib still experienced some symptoms after their first ablation procedure. However, the overall amount of time your heart spends in atrial fibrillation is about 98% less after the procedure, signaling an improvement in symptoms and overall quality of life.

A Quick Review

Cardiac ablation is a minimally invasive procedure that treats abnormal heart rhythms and irregular heartbeats. An electrophysiologist performs this procedure by placing a catheter into your groin and guiding it to your heart. Once inserted, the catheters can deliver heat energy or cold energy to destroy abnormal heart tissue and treat your symptoms. Most ablations are quite successful and while there is a risk of complications, the risk is generally low.