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What is cardiac ablation?
Cardiac ablation is a procedure that can correct heart rhythm problems (arrhythmias). Cardiac ablation works by scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart and, thus, stops the arrhythmia.
Cardiac ablation usually uses long, flexible tubes (catheters) inserted through a vein or artery in your groin and threaded to your heart to deliver energy in the form of heat or extreme cold to modify the tissues in your heart that cause an arrhythmia. Cardiac ablation is sometimes done through open-heart surgery, but it's often done using catheters, making the procedure less invasive and shortening recovery times.
Why is it done?
Cardiac ablation is a procedure that's used to correct heart rhythm problems. Ablation isn't usually your first treatment option. Ablation is a treatment option for people who:
Have tried medications to treat an arrhythmia without success
Have had serious side effects from medications to treat arrhythmias
Have certain types of arrhythmias that respond well to ablation, such as Wolff-Parkinson-White syndrome and supraventricular tachycardia
Have a high risk of complications from their arrhythmias, such as sudden cardiac arrest
Cardiac ablation carries a risk of complications, including:
Bleeding or infection at the site where your catheter was inserted
Damage to your blood vessels where the catheter may have scraped as it traveled to your heart
Puncture of your heart
Damage to your heart valves
Damage to your heart's electrical system, which could worsen your arrhythmia and require a pacemaker to correct
Blood clots in your legs or lungs (venous thromboembolism)
Stroke or heart attack
Narrowing of the veins that carry blood between your lungs and heart (pulmonary vein stenosis)
Damage to your kidneys from dye used during the procedure
Death in rare cases
You'll need to stop eating and drinking the night before your procedure. If you take any medications, ask your doctor if you should continue taking them before your procedure. Your doctor will let you know if you need to follow any other special instructions before or after your procedure. In some cases, you'll be instructed to stop taking medications to treat a heart arrhythmia several days before your procedure. If you have an implanted heart device, such as a pacemaker or implantable cardioverter-defibrillator.
During cardiac ablation
Catheter ablation is performed in the hospital. Before your procedure begins, a specialist will insert an intravenous line into your forearm or hand, and you'll be given a sedative to help you relax. In some situations, general anesthesia may be used instead to place you in a sleep-like state. What type of anesthesia you receive depends on your particular situation. After your sedative takes effect, your doctor or another specialist will numb a small area near a vein on your groin, neck or forearm. Your doctor will insert a needle into the vein and place a tube (sheath) through the needle.
Your doctor will thread catheters through the sheath and guide them to several places within your heart. Your doctor may inject dye into the catheter, which helps your care team see your blood vessels and heart using X-ray imaging. The catheters have electrodes at the tips that can be used to send electrical impulses to your heart and record your heart's electrical activity. This process of using imaging and other tests to determine what's causing your arrhythmia is called an electrophysiology (EP) study. An EP study is usually done before cardiac ablation in order to determine the most effective way to treat your arrhythmia.
Once the abnormal heart tissue that's causing the arrhythmia is identified, your doctor will aim the catheter tips at the area of abnormal heart tissue. Energy will travel through the catheter tips to create a scar or destroy the tissue that triggers your arrhythmia. In some cases, ablation blocks the electrical signals traveling through your heart to stop the abnormal rhythm and allow signals to travel over a normal pathway instead.
The energy used in your procedure can come from:
Extreme cold (cryoablation)
Cardiac ablation usually takes three to six hours to complete, but complicated procedures may take longer. During the procedure, it's possible you'll feel some minor discomfort when the catheter is moved in your heart and when energy is being delivered. If you experience any type of severe pain or shortness of breath, let your doctor know.
After cardiac ablation
Following your procedure, you'll be moved to a recovery area to rest quietly for four to six hours to prevent bleeding at your catheter site. Your heartbeat and blood pressure will be monitored continuously to check for complications of the procedure. Depending on your condition, you may be able to go home the same day as your procedure, or you may need to stay in the hospital. If you go home the same day, plan to have someone else drive you home after your procedure. You may feel a little sore after your procedure, but the soreness shouldn't last more than a week. You'll usually be able to return to your normal activities within a few days after having cardiac ablation.
Radiofrequency ablation (RFA) is a procedure used to put the heart back into normal rhythm. During RFA, a thin wire sends heat to fix problem areas that cause abnormal heart beats. Medicines can also be used to put the heart back into normal rhythm.
The ablated (or destroyed) areas of tissue inside your heart may take up to eight weeks to heal. You may still have arrhythmias (irregular heartbeats) during the first few weeks after your ablation. During this time, you may need anti-arrhythmic medications or other treatment.
You may have to stay in the hospital overnight after your ablation so your doctor and nurses can keep an eye on you while you recover. You may need to rest in bed about 6 to 8 hours after your ablation. Some people leave the hospital the same day. Most people leave the hospital the next morning.
An individual who has very bothersome symptoms, such as palpitations, lightheadedness, shortness of breath, and exertional fatigue that is not responsive to at least one concerted effort at antiarrhythmic drug therapy, is a candidate for catheter ablation.
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