Cardiac ablation is a modern method used to treat arrhythmias that cause your heart to beat irregularly. If you feel that your heart beats are too fast or irregular and medication therapy is not sufficient for you, cardiac ablation can provide a permanent solution for your heart to regain its normal rhythm. Through this procedure, your obligation to constantly use medication can be eliminated, and complaints such as fainting, palpitations, or shortness of breath can be reduced or ended. Your quality of life improves significantly. Cardiac ablation finds the “short circuits” that disrupt your heart’s natural rhythm and permanently eliminates them.
- What is cardiac ablation?
- What are the types of cardiac ablation?
- Why is cardiac ablation performed?
- How is cardiac ablation performed?
- What should i pay attention to after cardiac ablation?
- How does my life change after cardiac ablation?
- What are the success rates of cardiac ablation?
- What are the risks of cardiac ablation?
- When should i consult a doctor?
- Frequently Asked Questions
What is cardiac ablation?
Cardiac ablation is the process of eliminating or neutralizing electrical foci in the heart that cause arrhythmias. This procedure offers a non-surgical method for your heart to regain its normal rhythm. During the cardiac ablation procedure, the source of abnormal electrical activity is burned, frozen, or neutralized using methods called radiofrequency energy (heat), cryoablation (cold), or Pulsed Field Ablation (electrical pulses). In this way, the faulty foci that lead to arrhythmias are permanently eliminated and regular heart rhythm is restored. Cardiac ablation is performed by an electrophysiology specialist.
What are the types of cardiac ablation?
Cardiac ablation differs according to the type of energy used. Your doctor will choose the most suitable cardiac ablation method according to your arrhythmia type and the location of the abnormal focus in your heart. Each method works with similar principles but has different advantages.
Radiofrequency ablation (RF)
In radiofrequency ablation, a low-energy, high-frequency electric current is sent from the tip of the catheter. This current creates a local temperature increase in the abnormal tissue, burning and neutralizing these cells. RF is the most commonly used and oldest ablation method.
Cryoablation
In the cryoablation method, abnormal tissue is frozen using liquid nitrogen sent from the tip of the catheter. Since cold energy damages tissue in a more controlled manner, it can be safer especially in sensitive areas of your heart (such as the AV node).
Pulsed field ablation (PFA)
This is the newest ablation technique. In PFA, very short-duration, high-voltage electrical pulses are sent to abnormal tissue. These pulses destroy cells by creating micro holes only in the membranes of heart muscle cells, while not interacting with surrounding tissues (nerves or esophagus). This feature makes PFA a safer and more effective option especially in atrial fibrillation ablations.
Balloon ablation
Balloon ablation is a special cryoablation method used particularly in atrial fibrillation treatment. A balloon placed at the mouth of the pulmonary veins is cooled to treat a large area at once. It provides faster results.
Why is cardiac ablation performed?
Cardiac ablation is performed to treat arrhythmias that cause your heart to beat irregularly or rapidly. Especially if your symptoms continue despite medication therapy or if you are uncomfortable due to the side effects of medications, cardiac ablation can offer a permanent solution for you. This procedure is applied to eliminate your symptoms, improve your quality of life, and reduce serious risks such as sudden cardiac arrest.
What arrhythmias are treated with cardiac ablation?
Cardiac ablation is successfully used in many different arrhythmias. The most commonly treated arrhythmia types with cardiac ablation are:
- Atrial fibrillation (AFib): This is the irregular and very rapid beating of the upper chambers of your heart (atrium). Cardiac ablation isolates the abnormal electrical foci that trigger AFib (usually around the pulmonary veins) and enables your heart to return to normal rhythm.
- Supraventricular tachycardia (SVT): This is a fast and regular arrhythmia originating from the upper chambers of your heart. These types of arrhythmias (AVNRT, AVRT, WPW, etc.) can be permanently treated with cardiac ablation.
- Atrial flutter: This is similar to atrial fibrillation but a more regular arrhythmia. Its treatment with cardiac ablation is generally easier and more effective.
- Ventricular tachycardia (VT): This is a fast and potentially dangerous arrhythmia originating from the lower chambers of your heart (ventricles). Especially in people without structural heart disease, VT ablation is an effective option.
- Premature beats: These are extra beats that occur outside your heart’s normal rhythm. When they are very frequent and bothersome, they can be treated with cardiac ablation.
How is cardiac ablation performed?
Cardiac ablation is a procedure applied to treat arrhythmias in your heart. This procedure aims to find the areas in the heart that cause abnormal electrical signals and neutralize these areas. In this way, your heart regains a healthy and regular rhythm.
What is done before cardiac ablation?
Before cardiac ablation, some tests are performed to clarify the structure of your heart rhythm and the type of disorder. ECG, echocardiography, Holter monitoring, and blood tests can be used in this process. The medications you are using are especially reviewed. If you are using blood thinning medication, whether it should be stopped before the procedure is decided by your physician.
On the day of cardiac ablation, generally 8-12 hours of fasting is required. When you come to the hospital, intravenous access is established, and the groin area is prepared with antiseptic solution. The anesthesia plan is determined specifically for you. In most cases, local anesthesia is applied along with mild sedation. For longer procedures, general anesthesia may be preferred.
How is the cardiac ablation procedure performed?
During the cardiac ablation procedure, thin catheters are usually used to reach your heart through the groin vessels. With these catheters, the electrical map of your heart is created. This stage is called electrophysiological study (EPS). After the areas causing arrhythmias are identified, heat (radiofrequency) or cold (cryoablation) energy is applied to those regions. These energies burn or freeze abnormal tissues. Each energy application usually lasts 30-60 seconds. At the end of the procedure, controlled stimuli are given to your heart to test the arrhythmia. If the arrhythmia does not repeat, the procedure is successfully completed.
How is recovery after cardiac ablation?
After the removal of catheters, pressure is applied to the vascular entry sites. Bed rest is recommended for the first 4-6 hours. There may be mild pain, bruising, or swelling in the procedure area. Severe pain is not expected. You are discharged the same day or the next day. It is recommended that you avoid heavy activities for the first 24 hours. Your return to daily life is usually possible within a few days.
What should i pay attention to after cardiac ablation?
You need to restrict your physical activity for the first week. Avoid heavy lifting. Do not lift more than 5 kilograms. Walking is safe and recommended. You can start running and cycling after one week.
Pay attention to your medication use. You may continue to use your rhythm-regulating medications for 2-3 months after cardiac ablation. This is the healing period. After that, your doctor may start reducing medication.
Monitor your heart rhythm. You may experience temporary arrhythmias within the first 2-3 months. This condition is normal and part of the healing process. Permanent success is evaluated after 3-6 months.
If you have anticoagulant treatment, use it regularly. At least 2 months of anticoagulation is required after atrial fibrillation ablation. Check your INR values regularly.
Pay attention to signs of infection. Fever, chills, redness at the catheter entry site are important findings. In this case, consult your doctor immediately.
How does my life change after cardiac ablation?
Most patients experience significant improvement in quality of life after cardiac ablation. Your palpitation attacks are greatly reduced or completely stopped. Your exercise capacity increases. You can comfortably perform your daily activities.
You can quickly return to your work life. You can work 2-3 days later for desk jobs. If you do physical work, one week of rest is sufficient. Avoid stressful situations as much as possible.
Gradually increase your sports activities. Walk in the first week. From the second week onwards, you can do brisk walking, cycling, and swimming. Start competitive sports with doctor approval.
You can travel. Air travel is safe. Move frequently on long trips. If you use anticoagulants, carry your medications with you.
Limit alcohol consumption. Excessive alcohol can trigger arrhythmias. If you smoke, you must quit. Caffeine consumption is generally safe, but do not overdo it.
What are the success rates of cardiac ablation?
Cardiac ablation success rates vary according to the type of arrhythmia. Atrial flutter ablation is successful in over 95% of cases. Permanent success is usually achieved in a single session.
SVT ablation is also very successful. Success in AVNRT and AVRT ablations is between 95-98%. Re-ablation need is very rarely seen in these patients.
Atrial fibrillation ablation is more complex. If your arrhythmia is paroxysmal type (coming in episodes), the first-year success rate is between 85-90%. This rate may decrease somewhat in subsequent years. Because atrial fibrillation usually shows a progressive course and may recur from a different location than the ablated area. Therefore, a second ablation may be needed. Success is higher after the second ablation.
In ventricular tachycardia ablation, success depends on the cause of the disease. Success is higher in patients without structural heart disease. While some have a 95% success rate, others have an 80% success rate.
In WPW syndrome ablation, success is over 95%. After the accessory pathway is successfully cut, the risk of recurrence is very low.
What are the risks of cardiac ablation?
Although cardiac ablation is generally considered a safe procedure, like every medical intervention, it carries some risks. These risks are rare and minimal in experienced centers.
- Bleeding or bruising may occur where the catheter enters.
- In very rare cases, the catheter may puncture the heart wall and cause blood accumulation (tamponade) in the membrane around the heart.
- Clots formed during the procedure may go to the brain causing stroke or pulmonary embolism.
- If ablation is performed in an area very close to the heart’s natural electrical pathways, the heart’s electrical conduction may be disrupted and a pacemaker may need to be implanted.
Most of these complications are seen in less than 1%. The risks mentioned above are general complications for all types of cardiac ablation. Each arrhythmia carries a different risk profile. Which risks apply to your situation varies according to the type of your arrhythmia and your personal characteristics. Before the procedure, your doctor will explain your specific risk profile in detail.
When should i consult a doctor?
After cardiac ablation, you need to consult your doctor immediately in some cases. Chest pain, severe shortness of breath, fainting are emergency situations. These symptoms may be signs of cardiac tamponade.
- Consult if there is swelling, pain, or inability to feel pulse at the catheter entry site. Pseudoaneurysm may have developed. It is successfully treated with early intervention.
- Fever, chills, weakness may be signs of infection. Blood culture is taken and antibiotic treatment is started. It is important to receive treatment without delay.
- You may experience arrhythmias within the first 2-3 months. This condition is usually normal, but if it is very frequent or severe, inform your doctor. Medication adjustment may be needed.
- Go to routine check-ups regularly. The first check-up is done 1-2 weeks later. Ablation success is evaluated at the 3rd month check-up. If necessary, Holter monitoring is performed.
Frequently Asked Questions
Is ablation surgery?
Cardiac ablation is not a surgical operation. It is an interventional procedure performed through the vascular route with thin wires called catheters. No incision is made to reach inside the heart and no sutures are placed. The procedure is usually performed under local anesthesia.
Is ablation painful?
Cardiac ablation is a painless procedure performed under local anesthesia. The entry point of the catheters is numbed and the patient is monitored comfortably throughout the procedure. After the procedure, there may be slight discomfort in the groin area, but severe pain is not expected.
Does ablation work permanently?
The possibility of arrhythmia recurrence after cardiac ablation depends on the type of rhythm and the structure of the heart. In simple SVT types (AVNRT, AVRT, WPW, Atrial flutter, etc.), the success rate is over 95% and usually provides permanent results. In progressive arrhythmias such as atrial fibrillation, new foci may develop from different regions. In atrial fibrillation, the first-year success rate approaches 90%; however, the risk of rhythm recurrence may increase in the following years. If necessary, the procedure can be repeated and subsequent sessions are usually shorter and more effective.
Ablation procedure duration
The duration of the cardiac ablation procedure varies according to the type of arrhythmia. In simple arrhythmia types, the procedure can take less than 1 hour. In more complex cases, the duration can extend to 2-6 hours. Throughout the entire procedure, the patient is continuously monitored for heart rhythm and comfort is ensured.
Hospital stay after cardiac ablation
After the cardiac ablation procedure, patients are usually discharged the same day. If deemed necessary, they may be kept under observation for one night. The discharge decision is made according to the patient’s general condition and the findings observed after the procedure.
Anesthesia during ablation
The cardiac ablation procedure is usually performed with local anesthesia and mild sedation. The patient is not completely put to sleep, but comfort is ensured. In some special cases, general anesthesia may be preferred. The type of anesthesia is determined according to the type of arrhythmia and the patient’s condition.
Is ablation Safe?
Cardiac ablation is a safe procedure when performed in experienced centers. The serious complication rate is low. The most common side effects are bleeding at the entry site, temporary arrhythmia, or rarely fluid accumulation in the heart membrane. All risks are evaluated before the procedure and precautions are taken.
Who qualifies for ablation?
Cardiac ablation may not be the first choice in every arrhythmia. Suitability is determined according to the patient’s rhythm type, heart structure, and complaints. In some cases, medication therapy may be kept in the foreground. Which patient is suitable for cardiac ablation is clarified by electrophysiological evaluation.
Sports after cardiac ablation
If you have serious structural heart disease regardless of cardiac ablation, you should avoid competitive sports. If you have had SVT ablation, you can do any sport whenever you want. If you have had atrial fibrillation or flutter ablation, yes, we strongly recommend that you do sports. If you have had VT or PVCs ablation and you do not have serious structural or electrical heart disease, you can certainly do sports. If you have serious structural or electrical heart disease, you should follow the doctor’s advice.
Reference: Ablation
