Cardiac ablation – ablation comes from the Latin word ablationem, meaning “to take away”. The aim of the procedure is literally to take away, or remove, an abnormal rhythm (arrhythmia) that has developed in your heart, and the unpleasant symptoms it may be causing, so that a normal rhythm can be restored. Heart rhythm is controlled by electrical impulses from our brains. Sometimes, however, the tissues inside the heart wall produce ‘rogue’ impulses that interfere with the process and disrupt the natural rhythm. Ablation works by generating a small scar in this defective tissue, which blocks or stops the impulses and allows the normal rhythm to resume.
We use ablation to treat a number of different heart rhythm problems, such as atrial fibrillation, atrial flutter and supraventricular (SVT) or ventricular tachycardia (VT). If we’re recommending the procedure for you, it may be because you’ve already tried rhythm-controlling medications and they haven’t worked or you prefer to undergo an ablation procedure initially. Other reasons might be because you can’t take the available medications, or that you have a high risk of developing complications from your abnormal heart rhythm. But it may simply be because we think your type of arrhythmia is likely to respond very well to ablation.
Cardiac ablation is performed with catheters. These are long, thin, soft wires that are carefully inserted into the blood vessels so they can travel up into the heart. The tip of the catheter can detect electrical impulses inside the heart and determine where the rogue signals are coming from. We then pass an energy source through the wires to destroy the very small area of tissue that’s causing the problem; the energy source is either a controlled blast of heat (high-frequency radio waves) or extreme cold (cryoablation). Scarring the tissue has a number of different potential effects on the heart rhythm. It can ‘disconnect’ the pathway of the abnormal rhythm, block the abnormal pulses or promote normal conduction of impulses, or disconnect the electrical pathway between the atria and the ventricles (the lower chambers of the heart).
Some cardiac ablations are quite quick to perform, others take several hours. The timescale for your own operation depends on a number of factors, such as the kind of heart rhythm problem you have, the technique we’re using to carry out the ablation, and whether you’ll be having it under a local or general anaesthetic. We’ll discuss these things in detail with you before your operation. If you’re going to be conscious during the procedure, we can also give you a sedative to help you relax. Once in theatre, we insert the catheter (usually through a blood vessel in the groin), locate the defective area and deliver the energy needed to create a small scar on the inner wall of the atrium. When the ablation is finished, you’ll be taken back to the ward to rest. You’ll need to lie still and flat for several hours to prevent strain on your groin.
At your preoperative assessment, we’ll explain whether you need to avoid food, drink or certain medications on the day of your ablation. Depending on where the catheters are being inserted, you may also need to shave your groin(s) before you come into theatre. You may like to bring something to read or listen to while you’re lying in the ward after the procedure, and some light luggage if you’re staying overnight. Driving isn’t possible for 48 hours after an ablation, so please bear in mind that you’ll need someone to collect you from the hospital, and to help you with your bags. To avoid causing damage to the groin, you shouldn’t carry anything, and you should avoid long flights of stairs.
When you arrive back home, it’s very important to rest and take things slowly so that you can give your body time to heal – it can take as long as three months for the heart to recover fully from the procedure. You’ll need to avoid doing anything strenuous for the first two weeks, even if you’re feeling well enough to do more. For this reason, you may like to consider asking someone to help you around the home, or with childcare if necessary. The general recommendation is to stick to short walks and only a single flight of stairs for the first fortnight, with a slow, gentle progression thereafter. You should avoid lifting anything heavy for at least two weeks. Some very fit or younger patients may find they can return to work quite quickly, but many others take much longer. Although ablations are usually very successful at restoring normal heart rhythm in most patients, it can take some time for the effects to be felt. You could also experience certain other symptoms in the early stages as the heart heals. These can include palpitations, ectopic beats, a fast heart rate, and migraines, but these symptoms should settle down over time, and they don’t mean the ablation has failed. Our team will stay in touch with you after the procedure so that we can check on your progress and provide advice and further help if you need it.