This procedure uses energy to make small scars in your heart tissue. They stop abnormal electrical signals that move through your heart and cause an irregular heartbeat (the doctor might call it arrhythmia). Cardiac ablation can also treat atrial fibrillation (AFib), also a type of irregular heartbeat. The doctor may try cardiac ablation if medications and resetting your heartbeat -- he’ll probably refer to it as cardioversion -- don’t work.
What Are the Types of Cardiac Ablation?
There are two major options:
Catheter ablation, also called radiofrequency or pulmonary vein ablation, isn’t surgery, and it’s the least invasive option. Your doctor puts a thin, flexible tube into a blood vessel in your leg or neck. Then, it's guided to your heart. When it reaches the area that’s causing the arrhythmia, It sends out electrical signals that destroy those cells. The treated tissue helps get your heartbeat regular again. There are two main types:
- Radiofrequency ablation: The doctor uses catheters to send radiofrequency energy (similar to microwave heat) that creates circular scars around each vein or group of veins.
- Cryoablation: A single catheter sends a balloon tipped with a substance that freezes the tissues to cause a scar.
Surgical ablation involves cutting into your chest. There are three kinds:
Maze procedure: This is usually done while you’re having open-heart surgery for another problem, like a bypass or valve replacement. The surgeon makes small cuts in the upper part of the heart. They’re stitched together to form the scar tissue that stops abnormal signals.
Mini maze: Most people with AFib don’t need open-heart surgery. That’s where this less invasive option comes in. The doctor makes several small cuts between your ribs and uses a camera to guide catheters for either cryoablation or radiofrequency ablation. Some hospitals offer robotic-assisted surgery that uses smaller cuts and makes the procedure more precise. Your doctor will put a video camera or tiny robot into your chest. It’ll guide the creation of scar tissue that may help keep your heartbeat at the right pace.
Which Type of Cardiac Ablation Is Right for Me?
You and your doctor will talk about AFib treatment options, including ablation. The plan will depend on:
- The cause of your AFib
- Whether you have symptoms
- Your chance of having heart disease
Different types of ablation target different parts of your heart. You may be able to go home the same day, or you may need to stay a night or longer in the hospital.
Drugs can treat the AFib and keep your heart at a regular rhythm, but they may cause side effects or stop working. Cardiac ablation might be the next option. It can provide a treatment that lasts longer or cures the AFib.
Nonsurgical and less invasive ablation are successful for many people with AFib. If the first procedure is not successful, often a second will be. With those options, you’ll be able to recover and get back to your normal routine quickly.
How Do You Prepare for Ablation?
More than likely you’ll need to:
- Stop eating or drinking the night before the procedure.
- Stop taking medications to treat arrhythmia several days before.
- Ask the doctor if you should stop any other medications.
- Ask the doctor about precautions if you have a pacemaker or implanted defibrillator.
The doctor will provide any other special instructions.
What Are the Benefits of Ablation?
The doctor will take your risk factors into account before he suggests a treatment. If you have no symptoms, or they’re mild, he may watch and wait. But he might prescribe warfarin or another blood thinner to protect you from strokes.
Cardiac ablation may be right for you if AFib symptoms are more severe and make it hard to do daily tasks
What Is Recovery Like?
It depends on what type of procedure you have:
Catheter ablation: You may need to spend a night in the hospital, but most people go home the same day. If so, you'll rest in a recovery room for a few hours while a nurse closely watches your heart rate and blood pressure. You need to lie flat and still to prevent bleeding from where your skin was cut. Plan to have someone drive you.
The doctor will prescribe a medication to prevent blood clots and another to prevent AFib. You’ll probably take them for 2 months. A shower is OK once you’re home, but keep the water on the cooler side. Don’t take a bath, swim, or soak for 5 days or until the cuts have healed.
For the first week:
- Don’t lift more than 10 pounds.
- Skip activities that make you push or pull heavy things -- don’t shovel show or mow the lawn.
- If you get tired, stop and rest.
- Don’t exercise -- you can go back to normal in week two.
Maze procedure: You’ll probably be in the hospital about a week. You’ll spend the first couple of days in an intensive care unit (ICU), then move to a regular room before you go home. Full recovery takes about 6-8 weeks, but you should be able to return to normal activities within 2-3 weeks. You should start to feel better in about 4 weeks. You’ll probably take a blood thinner for about 3 months.
Mini maze: You'll be in the ICU for a few hours to a day. You’ll probably stay for 2-4 days total.
Open-heart maze: This is major surgery. You'll spend a day or two in intensive care, and you may be in the hospital up to a week. At first, you'll feel very tired and have some chest pain. You can probably go back to work in about 3 months, but it may take 6 months to get back to normal. Once you’re home:
- You may need someone to drive you for a while -- the doctor will tell you when you can drive again.
- You’ll probably need help at home.
- You’ll need to go back in about 10 days to get stitches out.
- Don’t lift anything heavy for several weeks.
Convergent procedure: Usually requires a 2- to 3-day hospital stay. Recovery is similar to catheter ablation.
Are There Risks to Cardiac Ablation?
Any procedure has risks. Problems with cardiac ablation can include:
- Bleeding or infection where the catheter went in
- Damaged blood vessels if the catheter scrapes them on its way through
- Arrhythmias caused by damage to your heart’s electrical system
- Blood clots in your legs or lungs
- Heart damage, like punctures or damaged valves
- Stroke or heart attack
- Narrowing of the veins between your lungs and heart
- Kidney damage from the dye
How Well Does Cardiac Ablation Work?
Catheter ablation may not cure your AFib, but it will often relieve your symptoms. You could still have AFib episodes during the first 3 months, because that’s how long it takes for the scars to form.
If you've had AFib a long time, you'll likely need a repeat treatment to keep your heartbeat normal. You may also need medicine to control your heart rhythm for a few months after the procedure.
Most people who have the maze procedure get long-term relief from their symptoms. And many don't need to take heart rhythm medicine afterward.