Catheter Ablation

A catheter ablation, also known as cardiac ablation, is a procedure used to treat cardiac arrhythmias such as atrial fibrillation, atrial flutter, and Wolff-Parkinson-White syndrome. It is performed by guiding a thin tube to the heart that uses energy to create tiny scars in the heart. This is done to block abnormal electrical signals and restore a normal heart rhythm. The procedure can take two to four hours, and the patient is given medication to relax. Whether or not the patient is conscious during the process depends on the individual case.

Like any procedure, catheter ablation can have risks. However, they are extremely rare. Medical professionals perform catheter ablation in a hospital setting, and the patient is heavily supervised the entire time; the patient's safety is a top priority. Cardiac ablations target only abnormal heart tissue. There is no significant impact on heart function.

Rapid electrical impulses from the pulmonary veins usually trigger atrial fibrillation or AFib. These are veins coming from the lungs that drain into the left atrium. Heart muscle-type cells in those veins with different properties than the rest of the heart allow such rapid electrical activity. When we ablate atrial fibrillation, we either burn or freeze around the openings of those pulmonary veins to make a firewall that keeps those impulses from irritating the heart. In many situations, that is all that is required. However, ablation may be needed in more advanced atrial fibrillation in other areas.

AFib ablation is usually done with general anesthesia. Simple pulmonary vein isolation typically takes about two hours but can take significantly longer if additional ablation is required.

In general, you can expect an 85% reduction in atrial fibrillation. This may be a complete elimination or just a drop in atrial fibrillation. Recurrences can be due to triggers from outside the pulmonary veins or to reconnection of the pulmonary vein muscle fibers to the left atrium. Depending on the severity of the recurrence, a repeat ablation procedure may be required.

Major complications are rare but can be serious. The most concerning are stroke, atrial esophageal fistula, and death. Blood clots usually cause strokes in the heart, and therefore, we prescribe anticoagulants around the time of ablation. A risk peculiar to atrial fibrillation ablation is damage to the esophagus, which passes directly behind the left atrium. In rare cases, a hole can form between the atrium and the esophagus, which can be lethal. We, therefore, monitor the esophageal temperature during ablation and prescribe acid blockers afterward to protect the esophagus.

Plan to stay overnight. You'll rest for three hours after the ablation. You can move around afterward but avoid heavy exertion for a week. Ablation aims to prevent atrial fibrillation, yet it may irritate, leading to irregular heartbeat. Depending on risk assessment, we may prescribe an antiarrhythmic drug. Expect mild chest discomfort for 2-3 days, managed with anti-inflammatory meds. Antacid therapy is provided for a month to protect the esophagus. Bruising at the puncture sites is common, usually local, but can extend down to the knee occasionally. Progressive pain or swelling at the sites may indicate continued bleeding. Immediate attention is needed for late-onset chest pain or pain on swallowing to prevent atrial esophageal fistula.