Cardiac ablation is a procedure used to treat heart arrhythmia, such as rapid or irregular heartbeat. It is the procedure of choice if medication or electrical cardioversion treatments either were not an option or were not effective. Catheters are passed to the heart through blood vessels. The abnormal electrical conducting area is located, and a form of energy is delivered. The energy may be radiofrequency (heat), laser or cryo (very cold). The area is scarred, stopping the abnormal path of conduction.
A cardiac electrophysiologist (a doctor trained in the electrical system of the heart) performs the procedure, which usually takes two to four hours. Prior to the surgery, the doctor does electrical mapping of the heart to see in which part the unusual activity is occurring. During the procedure, your doctor will move several catheters (long flexible tubes) slowly toward your heart. You may have catheters placed in both groins. Your doctor will decide this during the procedure. The doctor watches the movement of the catheters using an X-ray type of camera above the procedure table, then will stimulate your heart to locate the abnormal area. A machine will send energy (heat, laser or cryo) targeted to the exact area. The physician destroys the malfunctioning tissue, scarring the area to prevent it from sending incorrect electrical signals that speed up your heart rate. You may feel your heart beat differently or faster than usual, and may have lightheadedness, discomfort or burning in your chest.
The types of cardiac ablation are:
- Radiofrequency ablation (catheter ablation) – When an electrophysiology study reveals an arrhythmia, radio waves can be used to silence the abnormal activity. This type of ablation also is called a transcatheter approach, and it is done under mild sedation with local anesthesia. During radiofrequency ablation, a catheter with an electrode at its tip is inserted into the heart through a vessel in the groin or arm and moved to the site where the problem is occurring. Very high frequency yet virtually painless radio waves, similar to microwaves, heat the tissue until the site is destroyed (electrocautery). Patients sometimes are given anti-arrhythmic drugs during the procedure. Because the procedure is minimally invasive and low-risk, it is successful in about 90 percent of people who undergo it, and patients need less recovery time.
- Laser ablation – This minimally invasive procedure involves a tiny incision through which the laser ablation probe is placed to deliver laser energy to heat the diseased regions. This focused approach eliminates damage to healthy tissue.
- Cryoablation – Cryoablation is a minimally invasive procedure involving the freezing of abnormal tissue in the heart, lessening radiation exposure and the complexity of the procedure. A catheter is inserted into the heart through a vessel in the groin or arm, and moved to the site where the problem is occurring. An ultra-cold substance is then applied, freezing the tissue and destroying the site.
There are few risks with catheter ablation. Fewer than 5 percent of people who have the procedure develop any problems. The most common problems result from the use of catheters – long, thin tubes doctors insert into your arteries or veins. Inserting the tubes can occasionally damage your blood vessel or cause bleeding or infection. These problems are rare.
Your doctor will discuss the risks, benefits and choices with you and ask you to sign an informed consent giving permission to perform the procedure. Do not eat or drink anything after midnight the night before the test.