Ablation: What is it? How is it done? What to Expect Before and After the Procedure?

It is a procedure to restore normal heart rhythm, especially if the irregular rhythm has not responded to the medication.

Usually, the heart beats between 60 and 80 times per minute. The pumping action of your heart is triggered by electrical impulses.

Ablation can be used to treat a heart that is beating too fast (more than 100 beats per minute, a condition known as tachycardia ), or a beating heart, so it contracts in an uncoordinated manner, known as fibrillation.

Abnormal heart rhythms known as arrhythmias can cause:

  • Palpitations
  • Fatigue.
  • Difficulty breathing.

The goal is to restore a regular rhythm to prevent these conditions from occurring.

How is it done?

Many abnormally fast heart rhythms are caused by areas of abnormal heart tissue that cause the heart’s electrical system to “short-circuit.”

By removing or destroying these areas, the scar tissue that is formed helps prevent this short circuit and allows a return to a normal regular heart rhythm. There are two main ways in which ablation can be performed: surgically or by catheter (not surgically).

Surgical ablation:

Although it is less common, surgical ablation can be combined with other open-heart surgeries, such as bypass surgery or repair or replacement of the heart valve.

Surgical ablation is performed under general anesthesia; In other words, you will be asleep throughout the procedure.

To reduce the risk of vomiting while asleep, you will be asked not to eat or drink after midnight the night before surgery. If you smoke, you should stop smoking at least two weeks before surgery, since smoking can contribute to blood clotting and breathing problems.

There are two main types of surgical ablation. Some procedures require the heart to be stopped and the patient placed on an extracorporeal circulation machine (called a “pump” ablation).

Others can be performed on a beating heart and do not require the use of a heart-lung machine (“pumpless” ablation).

Cox-Maze procedure:

Doctors will make a precise pattern of incisions (cuts) within the upper chambers of the heart (the right and left atria).

These incisions will be sewn (stitched) together. This creates scar tissue that prevents electrical activity from passing through the upper chambers.

The heart should stop and a lung and heart machine should be used for the Cox-Maze procedure. This procedure is also known as Atrial Fibrillation Ablation. Although there are several techniques, this is the most common technique for surgical ablation.

Surgical ablation:

New technologies have been developed that make cardiac ablation possible without incisions (cuts) inside the heart.

Several different approaches have been developed to destroy areas of cardiac tissue malfunction, including radiofrequency (RF), microwave, laser or freezing waves.

One of the new procedures called Minimally Invasive Cardiac Surgery for Atrial Fibrillation is now performed more frequently in Canada.

Catheter ablation:

Catheter ablation is a non-surgical procedure that uses thin, flexible tubes called catheters to reach the inside of the heart. It does not require general anesthesia or stop the heart. This technique is most commonly used with newer technologies in large centers.

To perform the procedure, one or more catheters are inserted into the blood vessels and inserted into the heart with a fluoroscope (a form of moving X-ray image).

Catheters called diagnostic catheters will be used to study the abnormal heart rhythm and determine where the problem is.

Once the location of the abnormal heart tissue has been identified, a special ablation catheter will be placed nearby.

A tip on the ablation catheter will emit high frequency electrical energy to destroy the abnormal tissue, resulting in a scar.

The scar tissue is unable to initiate the electrical signal that causes the arrhythmia . In other words, fix the short circuit.

What to expect?

Usually, the procedure is scheduled in advance. A week or so before your procedure, you will probably be asked to visit your hospital’s preadmission unit.

Blood and urine tests, an electrocardiogram and an x-ray can be done. Your doctor will explain the risks and benefits of the procedure and you will be asked to sign a consent form. You may be asked if you (or if you tell your doctor):

  • Have you ever had a reaction to any contrast dye, iodine or any serious allergic reaction (for example, from a bee sting or eating seafood)?
  • Have asthma .
  • They are allergic to any medication.
  • You have bleeding problems or are taking blood thinning medications.
  • Have a history of kidney problems or diabetes.
  • Make a body piercing in your chest or abdomen.
  • You have had some recent change in your health.
  • They are, or may be, pregnant.
  • Aftercare.

Your recovery will depend on the type of procedure you underwent (catheter or surgical procedure) and if another surgery was performed at the same time.

When you return home, watch your incisions. Some bruises are normal but contact your doctor if you experience:

  • Increase in pain
  • Redness.
  • Swelling.
  • Bleeding or other drainage of an incision.
  • Fever or chills

Some recurrence of the arrhythmia may be experienced, particularly during the first 2 or 3 weeks. In general, a stable and normal rhythm is not achieved until 3 to 6 months after the procedure.

Most people are probably prescribed antiarrhythmic medications during this period to help the heart regain its normal rhythm.