Let’s Talk Cardiac Ablations

There are many different treatments for heart failure as well as other cardiac conditions. While most are medications, there are other non-surgical type treatments. Ablations have evolved over the years and are now often used for many arrhythmias that cause continual symptoms for people. There is also a surgical form of cardiac ablation, but for this article, I will be focusing on the non-surgical type.

A bit of history

In the late 1960s, catheter ablation was first introduced. In 1967 the induction of cardiac arrhythmias was first performed via electrical stimulation. It wasn’t until the late 1970s that mapping of the heart's electrical signals was done followed by ablation of the faulty electrical signal.

Prior to this, a much more invasive surgical procedure was performed where the area of the heart was surgically excised. In the 1990s, radiofrequency ablation was used in place of the previous direct current. The heart tissue that is in contact with the catheter is damaged by the radio frequency which creates a damaged spot, stopping the arrhythmia.¹

What is cardiac ablation?

Cardiac ablation is a procedure to fix the incorrect/faulty electrical signals within the heart thus restoring it to a regular rhythm. It creates scar tissue in the heart to block abnormal electrical signals. Sometimes people will have extra electrical signals that cause the heart to beat irregularly. The irregular heart rhythms can sometimes be serious and require a procedure to correct them.

While there are medications that can sometimes help control cardiac arrhythmias, an ablation actually destroys the tissue where the faulty rhythm originates from. A specialty cardiologist known as an electrophysiologist is highly trained in heart rhythm disorders performs the procedure. Cardiac ablations have an 85-98% cure rate among the arrhythmias that are treated most frequently.²

Indications

There are several different indications for an ablation. They include:¹

• Atrial Fibrilation (AFib) that is lifestyle imparing or treatment resistant.
• Supraventricular tachycardia (SVT) due to atrioventricular nodal re-entrant tachycardia.
• (AVNRT) or atrial flutter.
• Ventricular tachycardia (V-tach) that is symptomatic.
• High burden PVC’s that are symptomatic and/or interfere with lifestyle.

How is it performed?

When you arrive, you will be prepped to go into the electrophysiology lab. You will be given an IV and be put on a heart monitor. Once in the lab, an anesthesiologist will give you a sedative to help keep you relaxed. Sometimes they might put you all the way to sleep under general anesthesia. The doctor will numb the area in your groin and/or your neck and possibly your forearm.

Then the team will insert a needle and a small sheath/tube through it and run them up through your veins into your heart. The doctor will use a combination of imaging and electrodes to pinpoint the area that is causing the arrhythmia. Once they find the area(s) they will use the radio frequency to ablate the tissue.

You should not feel or be aware of most of this while it is happening but you might experience some discomfort during the process. Depending on the arrhythmia, the doctor might use medication or other means to stimulate your arrhythmia to help find the exact spot(s) to ablate. The entire procedure takes anywhere from 3-6 hours depending on how things go and how difficult it is to access the spot.³

Recovery

Once the procedure is finished you will be taken to the recovery room where you have to lay flat for several hours. This is to help make sure your incisions don’t bleed. You might experience some temporary chest discomfort due to inflammation caused by the procedure itself as well as possibly a sore throat if you were put under general anesthesia.

Soreness of the incision sites where the catheters were placed might linger for a few days afterward so you’ll have to take it easy for a bit. Your doctor might give you some temporary lifting restrictions as well.³ Once you have recovered, there will be follow-up appointments with your cardiologist and/or electrophysiologist to see if the ablation was successful and to make a plan if it wasn’t.