Cardiac Ablation

High-precision techniques to diagnose and treat heart rhythm problems

Cardiac ablation is a procedure that can correct heart rhythm problems (arrhythmias). Cardiac ablation works by scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart and, thus, stops the arrhythmia. Ablation is a procedure to treat atrial fibrillation, thus helping maintain a normal heart rhythm.

Cardiac ablation usually uses long, flexible tubes (catheters) inserted through a vein or artery in your groin and threaded to your heart to deliver energy in the form of heat or extreme cold to modify the tissues in your heart that cause an arrhythmia. Cardiac ablation is sometimes done through open-heart surgery, but it’s often done using catheters, making the procedure less invasive and shortening recovery times.

Cardiac ablation is a procedure that’s used to correct heart rhythm problems. When your heart beats, the electrical impulses that cause it to contract must follow a precise pathway through your heart. Any interruption in these impulses can cause an abnormal heartbeat (arrhythmia), which can sometimes be treated with cardiac ablation.

What is arrhythmia?

Heart arrhythmias occur when the electrical impulses that coordinate your heartbeats don’t work properly, causing your heart to beat too fast, too slow or irregularly. Heart arrhythmias may feel like a fluttering or racing heart and may be harmless. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms.

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). Your heart rhythm is normally controlled by a natural pacemaker (sinus node) located in the right atrium. The sinus node produces electrical impulses that normally start each heartbeat. These impulses cause the atria muscles to contract and pump blood into the ventricles.

The electrical impulses then arrive at a cluster of cells called the atrioventricular (AV) node. The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood. When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body. In a healthy heart, this process usually goes smoothly, resulting in a normal resting heart rate of 60 to 100 beats a minute. Certain conditions may increase your risk of developing an arrhythmia. These include coronary artery disease or other heart problems and previous heart surgery, hypertension, congenital heart disease, thyroid problems, diabetes, obstructive sleep apnea and electrolyte imbalance.

Cardiac ablation

Catheter ablation is performed in the hospital. After your sedative takes effect, your doctor or another specialist will numb a small area near a vein on your groin, neck or forearm. Your doctor will insert a needle into the vein and place a tube (sheath) through the needle.

Your doctor will thread catheters through the sheath and guide them to several places within your heart. Your doctor may inject dye into the catheter, which helps your care team see your blood vessels and heart using X-ray imaging. The catheters have electrodes at the tips that can be used to send electrical impulses to your heart and record your heart’s electrical activity.

This process of using imaging and other tests to determine what’s causing your arrhythmia is called an electrophysiology (EP) study that is usually done before cardiac ablation in order to determine the most effective way to treat your arrhythmia. Once the abnormal heart tissue that’s causing the arrhythmia is identified, your doctor will aim the catheter tips at the area of abnormal heart tissue. Energy will travel through the catheter tips to create a scar or destroy the tissue that triggers your arrhythmia. In some cases, ablation blocks the electrical signals traveling through your heart to stop the abnormal rhythm and allow signals to travel over a normal pathway instead. The energy used in your procedure can come from extreme cold (cryoablation), heat (radiofrequency) or lasers.

Patients with atrial fibrillation patients benefit the most

Ablation is a procedure to treat atrial fibrillation. It uses small burns or freezes to cause some scarring on the inside of the heart to help break up the electrical signals that cause irregular heartbeats. This can help the heart maintain a normal heart rhythm.

For ablation, a doctor puts catheters (thin hollow tubes) into a blood vessel in the groin and threads it up to the heart giving access to the inside of the heart. The doctor then uses the catheters to scar a small area of the heart by making small burns or small freezes. In the burning process, a type of energy called radiofrequency energy uses heat to scar the tissue. The freezing process involves a technique called cryoablation. Scarring helps prevent the heart from conducting the abnormal electrical signals that cause atrial fibrillation. Some people have unpleasant symptoms from atrial fibrillation, like shortness of breath and palpitations. Atrial fibrillation also greatly increases the risk of stroke. Anticoagulant medicines used for preventing stroke pose their own risks, and people on certain anticoagulation medicines require extra blood draws and monitoring. The main reason for ablation is to control symptoms. It is not intended to eliminate the need for blood thinners for stroke prevention.

Many people with atrial fibrillation take medicines to help control their heart rate or their heart rhythm. Some people respond poorly to these medicines. In such cases, the doctor may suggest ablation to correct the problem.

In atrial fibrillation, blood can pool in the heart’s upper chambers and form blood clots. If a blood clot forms in the left-sided upper chamber (left atrium), it could break free from your heart and travel to your brain. A blood clot can block blood flow to your brain and cause a stroke. Blood clots can also block blood flow to other organs. The risk of stroke from atrial fibrillation rises as you grow older. The following health conditions also increase your risk: high blood pressure, diabetes, heart failure, some valvular heart disease and stroke. To reduce your risk of stroke or damage to other organs caused by blood clots, your doctor may prescribe a blood-thinning medication.

Living a healthy lifestyle can improve your heart health and reduce your risk of developing atrial fibrillation. Aim to include healthy habits in your life such as exercising regularly, eating heart-healthy foods, keeping a healthy weight, avoiding smoking, limiting or avoiding alcohol and keeping blood pressure and cholesterol levels under control. Managing your atrial fibrillation and any other conditions you have that increase your risk of stroke also can help you reduce your risk of stroke.