Catheter ablation is a way to treat irregular heartbeats, or arrhythmias, like atrial fibrillation (AFib), atrial flutter, or supraventricular tachycardia (SVT). It destroys the tissue that’s causing your heartbeat to get off course. This creates scar tissue inside your heart that helps your heartbeat stay in rhythm.
Your cardiologist (a doctor who specializes in treating hearts) won’t have to cut into your chest to do this procedure. The catheter is a long, flexible tube that they insert into a blood vessel and guide into your heart. The catheter sends energy to the specific part of your heart that’s causing the abnormal heart rhythm.
AFib usually starts in the upper left part of the heart (called the atrium). When this happens, the normal communication between the upper and lower chambers of the heart is disrupted.
How Should I Prepare for My Catheter Ablation?
Before your procedure, your doctor may ask you to get some tests. The tests will tell your doctor more about your heart and overall health. They may include:
The day before your ablation, don’t eat or drink anything after midnight. Food or drinks in your stomach may cause you to react badly to your anesthesia, the medicine you get before the procedure to make you “sleep” and keep you from feeling pain. For example, you might vomit, and it could get into your lungs.
What to Expect: Catheter Ablation, Step by Step
- A nurse will weigh you, give you a physical exam, take your medical history, ask you about all the medications you take, and review your blood test results for levels of blood thinner drugs.
- Your anesthesiologist will also examine you, ask you about your medical history, and talk to you about your anesthesia for the ablation.
- You’ll get anesthesia to put you under during the ablation. It is not a painful procedure.
- You’ll lie on a surgical table for your ablation.
- A nurse will attach electrocardiogram (EKG) electrodes on patches onto your back and chest. Wires attached to the electrodes will send signals to computers to guide your doctor during your ablation.
- If your skin has hair, a nurse may shave a small area where the catheter tube goes in. It will usually go in through a blood vessel in your groin at the top of your legs, or sometimes in your neck.
- Once your doctor puts the catheter into your blood vessel, they’ll guide it into the inside of your heart. They'll use ultrasound to see where it's going.
- Your doctor will use the end of the catheter to zap the spots in your heart that cause trouble. Afterward, the electrical current in the heart should be fixed and blood should flow normally.
- Doctors can use these energy sources to create the scar tissue:
- Radiofrequency waves
- Cryothermy (This freezes tissue, a process called cryoablation.)
Radiofrequency ablation and cryoablation are the most common types.
Radiofrequency Ablation vs. Cryoablation
Doctors have used radiofrequency ablation for decades. With this method, it takes only about a minute for your cardiologist to create the damage that leads to scar tissue. But it's less useful in areas where you have low blood flow. And its effect may not be permanent.
Cryoablation is a newer method that delivers extremely low temperatures to freeze the trouble spots in your heart. It's reversible, which lets your cardiologist test an area to see whether it works. If not, they can rewarm it with no damage. This process takes a few minutes longer than radiofrequency ablation.
Your doctor will choose an ablation method depending on the area of your heart they need to target and how comfortable they are with each procedure.
What Happens After Catheter Ablation?
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’ll rest in bed after the procedure. Some people leave the hospital the same day, while others go home the next morning.
Your doctor will tell you how well the procedure went and how good a job it should do to treat your AFib.
Catheter Ablation Recovery
After you go home:
- You may feel sore, tired, or have some discomfort in your chest for a few days.
- You may need to nap more than usual for a few days as you recover.
- It can take several weeks for the work done during your procedure to turn into scar tissue. You might not have a normal heartbeat until the scar tissue forms. Your heart arrhythmia could seem the same or worse until then. In all, it takes about 3 months to find out how much your ablation helped.
- You may need to take blood thinners for several months after your ablation.
- You may get antacids or anti-inflammatory drugs, too.
- Sometimes the procedure has to be repeated to work. Your doctor will check your heart rhythm in the days and weeks after your procedure to see if that’s something you’ll need.
What Recovery Tips Can Help?
Don’t lift, push, or pull any objects heavier than 10 pounds for about a week after your ablation. That means not doing things like mowing the lawn.
- Avoid intense exercise for about 3 weeks after your procedure, too.
- Make sure your surgical wounds stay clean and dry until they heal.
- You can take a shower, but for the first 5 days, don’t use very hot water or soak in the bath. Gently pat dry near your wound.
- Don’t use lotions or creams there.
- If you notice any signs of infection of your wound sites, such as a fever, redness, heat, or swelling, call your doctor.
Catheter Ablation Risks
Your doctor should explain your risks to you. But common risks include:
- Bleeding, an infection, or pain where your catheter went into your skin
- Blood clots
- Accidental damage to tissues in your body
- Accidental damage to your heart
How Successful Is Catheter Ablation?
Catheter ablation gets rid of heart arrhythmias like AFib, atrial flutter, and supraventricular tachycardia (SVT) for most people. But it could come back within a few years, especially if you’re:
- Have another heart condition
- Have a history of hard-to-treat AFib
It’s also possible for the tissue in your pulmonary veins – which doctors tend to target during ablation – to change in the upper left chamber of your heart over time. If that happens, electrical signals might start to move across the lines of scar tissue your doctor created during the procedure. And that, too, could cause AFib to come back.
If your AFib does return, you might need a second ablation – in general, these work very well. Or your doctor may be able to treat it with medications.
If your problems continue, your doctor might implant a pacemaker to control your heart’s electrical signals.
Does Ablation Cure AFib?
AFib may go away for a long time, but it can return.
It’s rare, but if you have persistent or chronic AFib, you might need a second ablation within 1 year. If you’ve had AFib for more than a year, you may need one or more treatments to fix the problem.
If your symptoms come and go (your doctor will call this paroxysmal AFib), ablation is more likely to work for you. About 3 out of 4 people will have a normal heart rhythm after one treatment. A second treatment will get rid of AFib for most of the rest.
Ablation may not help everyone. Older adults and those with other heart conditions are the hardest to treat.
Catheter Ablation Costs
No two hospitals will charge exactly the same, because no two people or cases of AFib are the same. If your doctor suggests catheter ablation for your heart arrhythmia, check with your insurance company to make sure it covers the procedure.
Ablation vs. Medication
A recent clinical trial found that people with sporadic AFib and heart failure benefited more from ablation than medication. Over 8 years, those who got ablation were half as likely to be admitted to a hospital as those who took medicine only. And fewer people who had ablation died.
A 5-year study compared the two treatments. It also showed that ablation worked better than medication for treating people with sporadic AFib alone.
The longer you have AFib, the less likely any treatment will work. One study looked at people with longstanding, persistent AFib. Again, ablation led to better results. Symptoms were less likely to return in people who had the treatment than those taking medication only. The group that took medicine also required more hospital stays during the study than the other group.
What Are the Risks of Ablation and Medication Treatments?
Talk to your doctor about the pros and cons of treating AFib with medication or ablation. Your medical history will be a factor.
Certain AFib medications may not be safe if:
- You have allergies to foods or dyes.
- You’re pregnant, breastfeeding, or planning a pregnancy.
- You’re over age 60.
- You have liver or kidney disease, lupus, or other heart conditions.
- You have asthma, lung, or breathing problems.
Catheter ablation is a low-risk procedure. The most common problem is bleeding or infection where the tube goes into your blood vessel.
Also, close to a third of people who have ablation will feel a new heart flutter. If medication doesn’t stop it, you may need a second ablation.
Combining Ablation and Medication
For many people with AFib, the best results are achieved by pairing ablation with medicine.
Even if your AFib doesn’t go away, these treatments can still help control your symptoms and prevent heart failure or stroke.