Catheter ablation is a minimally invasive procedure performed to treat heart arrhythmias (irregular heartbeat). In addition to medication, catheter ablation is recommended as an effective way to manage several arrhythmias. Specialized heart doctors called cardiologists perform ablations without open heart surgery by accessing the heart through catheters placed in a faraway blood vessel. Using catheters, they deliver energy to burn or freeze the appropriate area to treat arrhythmias.
Read on to learn about catheter ablation, its indications, risks, and long-term effectiveness.
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Heart Conditions That Qualify for Catheter Ablation
Though anti-rhythmic medications may treat some arrhythmias, catheter ablation may be recommended when medications are ineffective, are contraindicated, or cause unwelcome side effects. Ablation may treat the following arrhythmias:
The success, duration and complications of the catheter ablation procedure varies depending on which cardiac rhythm abnormality is treated. For example, ablation for supraventricular tachycardias and atrial flutter tends to be highly successful and short in duration with minimal complications. Whereas, in comparison, atrial fibrillation ablation is a much longer procedure with a higher complication rate and a lower success rate.
Heat vs. Cold Catheter Ablation
There are two ways to perform catheter ablation: with the delivery of heat energy or cold energy to the heart tissue. Both use a catheter to deliver the energy to the heart muscle to target the specific area involved in an arrhythmia. Radiofrequency ablation uses radio waves that heat up the heart tissue to create a scar. Cryoablation, on the other hand, uses cold energy.
Both types are considered effective, but there are some differences in procedure time and potential complications. In general, the decision is made by the electrophysiologist (a specialized cardiologist who deals with problems of the heart's electrical system) who is performing the procedure based on their expertise and their availability at the procedure's particular center.
Catheter Insertion in Ablation Procedure
During catheter ablation, medication is given to sedate you and make you comfortable. In some instances, you may be in a "twilight" state of wakefulness, while in others you may receive general anesthesia and a breathing tube. You will have a cardiac monitor placed with electrodes on your chest to continuously monitor your heart’s rhythm.
The team will prepare the insertion site by cleaning and numbing the area. Then a sheath will be placed in a blood vessel, typically in the femoral vein in the groin. From here, the operator will access the heart with the catheters and perform mapping to identify the area to be ablated. Ultimately, heat or cold energy will be administered through the catheter in the appropriate area to perform the ablation.
The entire procedure can take several hours, and afterward, you will move to a recovery area for further monitoring.
Short-Term Recovery After Catheter Ablation
After catheter ablation, pressure will be applied to the blood vessel. You will move to a recovery room where your heart rate, blood pressure, and breathing are monitored. You may be asked to lay flat or with your legs extended for a period of time (usually six hours) due to the access site in the groin. Depending on the situation, you may be admitted to the hospital for further monitoring or discharged for some time.
Your provider can provide details on any restrictions, such as driving, activities, and bathing. You will also receive instructions on how to care for any incisions and on any medications to take. Watch out for any symptoms like chest pain, shortness of breath, lightheadedness, or bleeding. Report these as well as any signs of infection at the incision site (such as redness or pus drainage) to your provider.
In some cases, a catheter ablation is an outpatient procedure, meaning you come in and go home the same day. In other instances, you may need to stay in the hospital overnight or for longer for further monitoring. This decision is based on how the procedure went or whether any complications occurred, so it's not necessarily predictable.
Complications From Catheter Ablation
Catheter ablations are less invasive than open heart surgery, but like all procedures, they come with certain risks. Specifically, catheter ablation may cause the following:
- Injury to blood vessels
- Blood clots
- Damage to the heart or heart valves
- Damage to lung tissue
- Damage to the esophagus
- The need for a pacemaker
Arrhythmia Recurrence After Catheter Ablation
It’s important to note that immediately following catheter ablation, your arrhythmia may not go away. For instance, after an ablation procedure for atrial fibrillation, it’s not uncommon to still have atrial fibrillation for some time.
However, a successful ablation ultimately gets arrhythmias under control. Recurrence rates vary based on the specific indication for the ablation. Sometimes, more than one ablation is necessary. Long-term success rates, defined as freedom from symptoms due to atrial fibrillation, are about 90%. However, success rates are closer to 50% when arrhythmias are monitored. Monitoring uncovers small bursts of atrial fibrillation that don't necessarily cause symptoms.
Long-Term Outlook of Catheter Ablation
The long-term outlook following a catheter ablation is generally promising. There are no specific physical restrictions after the initial recovery period if your healthcare team has cleared you for normal activities.
However, people who require blood thinners due to a risk of stroke related to their arrhythmia may still need to take a blood thinner because their risk remains higher. Do not stop taking medications before you discuss it with your heart team.
Monitoring Heart Rhythm Post-Catheter Ablation
After ablation, your cardiologist will give specific instructions for necessary monitoring. You will need routine electrocardiograms (ECGs) at follow-up visits and less frequent longer-term monitoring such as a weeklong Holter monitor every six months. Any symptoms or evidence of persistent arrhythmia will also prompt more testing.
To summarize, catheter ablation is a minimally invasive procedure performed by specialized cardiologists to treat certain arrhythmias. Atrial fibrillation and supraventricular tachycardias are common indications for ablation. In this procedure, a catheter is placed in a blood vessel to access the heart in a minimally invasive fashion to deliver heat or cold energy to treat the arrhythmia. As with all medical procedures, there is some risk, and these specifically include bleeding, damage to the heart or blood vessels, and infection. The outlook is generally good with relief from symptoms.
American Heart Association. Ablation for arrhythmias.
MedlinePlus. Cardiac ablation.
Andrade JG, Champagne J, Dubuc M, et al. Cryoballoon or radiofrequency ablation for atrial fibrillation assessed by continuous monitoring: a randomized clinical trial. Circulation. 2019;140(22):1779-1788. doi:10.1161/CIRCULATIONAHA.119.042622
Oral H, Knight BP, Ozaydin M, et al. Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. J Am Coll Cardiol. 2002;40(1):100-104. doi:10.1016/s0735-1097(02)01939-3
Calkins H. When it comes to defining the outcomes of catheter ablation of atrial fibrillation, an implantable monitor is a great place to start. Circulation. 2019;140(22):1789-1791. doi:10.1161/CIRCULATIONAHA.119.043155
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-e444. doi:10.1016/j.hrthm.2017.05.012
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