What is cardiac ablation?
Cardiac ablation is a medical procedure used to restore a normal heart rhythm in people with certain types of abnormal heartbeats (arrhythmias), most commonly atrial fibrillation (AFib).
How does cardiac ablation work?
Catheter ablation involves the use of specialised catheters (thin, flexible tubes) that are threaded through blood vessels to reach the heart. Once in place, these catheters deliver either heat (radiofrequency energy), extreme cold (cryoablation) or electrical pulses (pulsed field ablation) to specific areas of the heart tissue around the pulmonary veins to permanently disrupt the tissues and cells that are causing the abnormal electrical signals responsible for AFib. In time, the treated cells heal with scar tissue – which is also an effective blockade to the abnormal electrical current.
Radiofrequency ablation (RFA) uses high-frequency energy to create extreme heat to neutralise target tissue
Cryoablation uses extreme cold to neutralise target tissue
Pulsed field ablation uses microsecond electrical pulses to neutralise target tissue
Cardiac catheter ablations, including those to treat AFib, are performed by a special type of cardiologist, called a ‘Cardiac Electrophysiologist’ or an EP. An EP is a cardiologist who has undergone additional years of training to specialise in the diagnosis and treatment of rhythm control issues of the heart, performing different types of ablation procedures as well as implanting and programming cardiac devices such as pacemakers and defibrillators.
What are the benefits of cardiac ablation?
The main benefits of cardiac ablation include:
- Symptom relief: For many patients, cardiac ablation helps to significantly reduce or completely eliminate symptoms of arrhythmias, such as palpitations, shortness of breath, and fatigue.
- Reduced dependence on medications: Successful cardiac ablation often decreases the need for long-term use of heart rhythm medications.
- Prevention of life-threatening arrhythmias: In some cases, ablation may prevent serious arrhythmias that may lead to life-threatening emergencies.
What are the risks of cardiac ablation?
There are some risks associated with having a cardiac ablation including:
- Bleeding or infection where the catheter was placed.
- Blood vessel damage.
- Heart valve damage.
- A new irregular heartbeat or one that gets worse.
- Slow heart rate, which may need a pacemaker to fix.
- Blood clots in the legs or lungs.
- Stroke or heart attack.
- Narrowing of the veins that carry blood between the lungs and heart, called pulmonary vein stenosis.
- Damage to the kidneys from contrast if used during the procedure.
Types of ablation
Pulsed field ablation
Pulsed field ablation (PFA) delivers high energy electric pulses of around 2000 volts to the heart (pulmonary veins) that are responsible for the irregular heartbeats. These electrical pulses are very short (microseconds) are designed to permanently deactivate only the localised heart cells. This procedure is performed under general anaesthetic.
Radiofrequency ablation
In radiofrequency ablation (RF), a catheter with a tip that emits high- frequency electrical energy is guided through the blood vessels to the heart. When the catheter tip reaches the target area identified as the source of abnormal electrical signals (such as the pulmonary veins or areas in the atria) the RF energy heats the tissue and creates small lesions on the heart tissue interrupting the abnormal electrical pathways.
Cryoablation
Cryoablation involves the use of a catheter with a balloon that circulates extremely cold liquid (nitrous oxide) to freeze the tissues responsible for the abnormal electrical activity to create lesions to permanently deactivate the abnormal cells and tissues, similar to PFA and RF ablation.
What is involved with having a cardiac ablation procedure?
Evaluation: Before the procedure, you will undergo a thorough evaluation which may include blood tests, electrocardiogram (ECG), echocardiogram, and possibly a cardiac MRI or CT scan to assess your heart's structure and function.
Medications: Your doctor may adjust your medications before the procedure.
Arrival: You will typically arrive at the hospital or outpatient center in the morning. You may need to fast for several hours before the procedure.
Preparation: You will change into a hospital gown and an IV line will be placed to administer medications and fluids.
Anaesthesia: You will receive local anesthesia and possibly sedation to help you relax during the procedure. General anaesthesia may be required.
Catheter Insertion: The procedure begins with the insertion of catheters into a blood vessel, usually in the groin area, though sometimes in the neck or arm.
Mapping: Specialised catheters are guided through the blood vessels and into the heart chambers using imaging techniques such as fluoroscopy (X-ray) and sometimes 3D mapping systems to create a detailed map of your heart's electrical activity.
Ablation: Once the abnormal electrical signals causing AF are identified, the catheter tip delivers either high energy electric pulses (pulsed field ablation), heat (radiofrequency energy) or extreme cold (cryoablation) to create small scars or lesions on the heart tissue. This disrupts the abnormal electrical pathways.
Monitoring: Throughout the procedure, your heart's electrical activity and other vital signs are closely monitored to ensure the effectiveness of the ablation and to detect any complications.
Recovery: After the procedure, you will be taken to a recovery area where you will be monitored closely for several hours.
Observation: Your heart rhythm and vital signs will continue to be monitored to check for any immediate complications such as bleeding or arrhythmias.
Hospital Stay: Depending on your individual health circumstances and what type of ablation you have, hospital stay can range from same day discharge to overnight to a few days. Your healthcare team will discuss this further once treatment options have been decided.
- Medications: You may need to continue taking medications to control your heart rhythm or prevent blood clots after the procedure. Your doctor will provide specific instructions based on your individual situation.
Follow-up: Regular follow-up appointments with your cardiologist or electrophysiologist will be scheduled to monitor your heart rhythm and make any necessary adjustments to your treatment plan.
It’s important to discuss any concerns or questions you have with your healthcare team before and after the procedure to ensure you have a clear understanding of what to expect and how to care for yourself during recovery.
Effectiveness and outcomes following cardiac ablation
The success rate of catheter ablation for AFib varies depending on many factors such as the type and duration of AFib, other health complications and patient characteristics.
More questions about cardiac ablation?
Learn more about cardiac ablation in the management of atrial fibrillation.
