How Ablation Treatment Works

How Ablation Treatment Works: The Procedure, Risks, and Results

Ablation is used to try and correct or control abnormal heart rhythms (arrhythmias).

Using cryoablation (freezing) or radiofrequency (heat), it targets the area of your heart that’s causing the arrhythmia. This causes scar tissue to form which either disrupts the heart’s abnormal circuits or destroys the muscle that’s causing the abnormal heart rhythm.

In most cases, it’s carried out using catheters which are inserted into an artery or vein. This is fed through to the heart to deliver extreme cold or heat. Sometimes, this requires open-heart surgery, however, when using catheters, it’s a far less invasive procedure with a much quicker recovery time.

If this treatment has been recommended to you, let’s find out more about how it works, what you can expect before, during, and after the treatment, and the potential risks involved.


Why Might You Need a Cardiac Ablation? 

ablation - WHY MIGHT YOU NEED A CARDIAC ABLATION

There are certain cells in your heart that stimulate electric signals that travel around this vital organ. These impulses help maintain a proper sequence in the beating of your heart’s lower and upper chambers.

But when these cells are abnormal, this can disorder the electrical signals. This, in turn, causes rapid or irregular heartbeats – arrhythmias.

When this occurs, you may feel faint as your heart isn’t pumping blood effectively around your body. You may also feel a pounding sensation in your chest, have breathlessness, or feel weak.

In the majority of cases, medication will help treat these irregular heartbeats. However, you may be referred for catheter ablation if:

  • Medications aren’t working
  • The medication you are taking for the arrhythmia is causing serious side effects
  • You have supraventricular tachycardia, Wolff-Parkinson-White syndrome, or other types of arrhythmias that are known to respond best to this treatment method
  • You’re at high risk of suffering complications due to your arrhythmia, e.g. cardiac arrest


How Does the Treatment Work?

ablation - TREATMENT cardiac ablation

To get more of an idea of how ablations work, let’s take a look at what the procedure entails and what happens before and straight after your operation.



How to Prepare for Your Treatment 

Pre-procedure, your doctor will talk you through what you can expect from the treatment. They may also make certain recommendations, including:

  • What to eat and drink before the electrophysiology (EP) study, which is often carried out at the same time as your procedure. This enables the doctors to see if there are any additional electric pathways that may be triggering your arrhythmia.
  • Not eating or drinking anything for 6-8 hours before the procedure.
  • Whether you need to bring any of your current medication to the test or should stop taking some beforehand. You shouldn’t stop taking any of this medication unless advised to do so by the doctor, however.
  • Getting someone to drive you to and from your procedure.


What to Expect During Your Treatment

Before you undergo the treatment, an intravenous (IV) line will be inserted into your hand or forearm. A specialist will inject a sedative into this IV line to help you relax throughout the procedure.

In some cases, a general anesthesia will be required, but this all depends on your medical condition.

Once the sedative gets to work, a small area near a vein on our forearm, neck, or groin is numbed. This is where the doctor will insert a needle to pass a sheath through.

The doctor will guide catheters through the sheath into certain areas of your heart. To help them see where your blood vessels are, they may inject a dye first and use an X-ray to pinpoint them.


The Electrophysiology (EP) Study

ablation - ELECTROPHYSIOLOGY (EP)

At the tips of the catheters are electrodes which may be used to release electrical impulses and allow the doctor to monitor the electrical activity of your heart. These processes that are used to establish the cause of your arrhythmia are known as the electrophysiology (EP) study which we mentioned previously.

While this needs doing before the procedure’s carried out, it’s often done just before because it also requires the use of catheters. It also ensures the doctors know the most effective treatment they can use.


The Ablation

ablation - THE ABLATION

After establishing the cause of the arrhythmia, the catheter tips will be moved toward the heart tissue that’s abnormal. To destroy and/or scar this tissue, energy is administered through the catheter. As already noted, this is extreme cold or heat, but lasers may also be used.

Sometimes, to stop your heart beating abnormally, the procedure will prevent these signals from traveling around your heart, blocking their pathway. This means they’ll have to use a normal, healthy route instead.

In total, the entire procedure will take around 3 to 6 hours, but in more complicated cases, it could take longer.

What will you feel during the operation?

When the doctor moves the catheter into your heart and starts delivering the energy, you may feel some mild discomfort. Patients sometimes note shortness of breath or severe pain – in that case, you should notify the doctor straight away.

There may also be some bleeding in the area where the catheter has been inserted, which may also feel tender to the touch.



Having a Pacemaker Fitted

If the AV node is going to be destroyed by the operation, a pacemaker may need fitting. This is because the AV node is responsible for controlling your heart rate.

Should you require a pacemaker, this will be fitted a few days or weeks before. This type of procedure is known as “ablate and pace.”



What to Expect Straight After Your Treatment  

ablation - WHAT TO EXPECT STRAIGHT AFTER YOUR TREATMENT

Following the operation, you’ll need to rest for several hours, lying flat on your back. This helps reduce any bleeding from the catheter site. During this time, nurses and doctors will closely monitor your blood pressure and heartbeat to ensure there are no complications.

You may need to stay overnight in hospital but some patients are allowed to go home after a few hours. This will depend on your condition but if you are allowed to go home it’s important to have someone else drive you.

Tiredness is common post-procedure, but after a few days you should start to return to normal. After a couple of days, most patients are able to start driving and doing normal activities (your doctor or nurse will tell you when you’re OK to do so).



How Quickly Does the Treatment Work?

Ablations don’t tend to work straight away, which is why ongoing symptoms are often experienced afterward, e.g. palpitations.

You’ll need to wait around 8 to 10 weeks before you know whether it has been successful or not.

What happens if it doesn’t work?

You may be referred for another ablation or to try alternative methods.



What Are the Risks?

As with all procedures, this does come with some risks but these tend to be quite small. All of these risks will be discussed in detail with you beforehand as you’ll need to consent to the procedure. Furthermore, it will only be recommended if these risks are outweighed by the benefits.

Where the catheter is inserted, you may notice some bleeding and bruising. However, a hematoma may also occur, which is when a small pool of blood collects underneath your skin. Should this area become swollen and red, you should contact your doctor.

Other more serious side effects include:

  • Damage to the normal electrical pathways of your heart: When this occurs, you’ll need a pacemaker to ensure your heart’s beating at the correct pace.
  • Damage to your blood vessels: This may happen if the catheter scrapes a blood vessel as it’s traveling to the area of your heart.
  • Damage to heart valves. 
  • Puncturing of the heart.
  • Blood clots: These may arise in your lungs or legs.
  • Heart attack or stroke.
  • Pulmonary vein stenosis: This happens when the veins that carry blood from your heart and lungs and back become narrowed.
  • Damage to your kidneys: This may be sustained due to the dye that’s used to identify the abnormal cells.
  • Death: This is extremely rare, however.


What Results Can You Expect from the Procedure?  

ablation - WHAT RESULTS CAN YOU EXPECT FROM THE PROCEDURE

While ablations are successful in a lot of cases, further treatment or medication may be required to stabilize your heart.

Whatever the outcome, though, it’s important to take key steps that will improve your heart health. This will help treat or prevent certain conditions that may worsen or cause arrhythmias, e.g. high blood pressure.

Lifestyle changes you can make include:

  • Quitting smoking
  • Avoiding alcohol
  • Increasing physical activity
  • Reducing salt intake
  • Maintain a healthy weight
  • Eating foods that are good for your heart
  • Keeping stress levels and strong emotions, like anger, in check


Learning More About Ablations

Hopefully the above has explained how the treatment works and what you can expect from each stage. But if you do have any more questions, your doctor is the best person to ask.

You should discuss their expectations for your ablation, whether or not they feel you’ll need medication/further treatments afterward, and what they think caused your arrhythmia in the first place.

Talking through your hopes and concerns with your doctor will help you get the best possible outcome from this procedure.

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