Cardiac ablation

Cardiac ablation is a medical procedure used to treat irregular heartbeats (arrhythmias) such as atrial fibrillation (AF). It works by using energy to remove small areas of heart tissue that cause the abnormal heart rhythm.

A fine tube (catheter) is passed through a vein in your groin or neck into your heart. An x-ray or ultrasound helps guide the tube.

There are 2 types of ablations:

• radiofrequency ablation — uses high heat
• cryoablation — uses extreme cold

Your doctor will explain which type is best for you.

Cardiac ablation is an invasive procedure (a treatment that involves going into the body), and has some risks, such as bleeding or damage to the heart. Not having the procedure if you need it also has risks. Talk to your doctor about the benefits and risks.

You may need a cardiac ablation if you:

• have an arrhythmia, such as atrial fibrillation or atrial flutter
• have symptoms that affect your daily life, such as palpitations, dizziness, fainting, shortness of breath or fatigue
• have symptoms that have not improved with medicines or have trouble with side effects from medicines
• have a higher chance of complications such as stroke

Cardiac ablation can restore your heart's normal rhythm. This may:

• reduce or stop symptoms like palpitations, tiredness and poor sleep
• improve your energy and ability to exercise or do daily activities
• reduce the need for long-term medicines, including blood thinners
• improve heart health and lower the risk of people developing heart failure

Cardiac ablation can greatly improve quality of life for many people with atrial fibrillation. Some people may need a repeat procedure if the irregular heartbeat comes back — especially if symptoms return and medicines are not helping.

Your cardiac ablation procedure will be performed by a specialist doctor and generally involves the following steps:

1. You will walk to a procedure room, where staff will help you onto a table and attach monitors that check your heart and vital signs (heart rate, blood pressure, breathing rate and body temperature).
2. Your doctor will recommend either a local anaesthetic with sedation, which lets you stay awake during the procedure, or a general anaesthetic. They will discuss the best option with you beforehand.
3. Your team will clean the area and place a sterile (clean) sheet over you.
4. Your doctor will insert a thin catheter into a vein in your groin (or sometimes your neck) and guide it into your heart.
5. Heat or cold energy is used through the catheter to make tiny scars in your heart tissue or in the vessels next to your heart. These scars block the abnormal electrical signals that cause an irregular heartbeat.
6. At the end of the procedure, the catheters are removed, and the wound site is sealed to stop the bleeding.

After the procedure, you will be taken to a recovery room for monitoring.

Before the procedure, your doctor will explain what you can expect. They may ask you to:

• stop taking certain medicines, such as heart rhythm medicines
• not eat or drink before the procedure
• arrange for someone to drive you home

You may also need tests such as blood tests or an electrocardiogram (ECG).

Your doctor will speak to you about what to expect before your procedure. Be sure to ask any questions you have — for example, how to prepare for the procedure, what to expect afterwards and if there are any costs involved.

It is common to have some bruising or mild discomfort after a cardiac ablation procedure, but most people recover within a few days and can return to work soon after.

Your doctor may discharge you to go home on the same day, or they may ask you to stay a night or 2 in hospital. They will most likely ask you to come back for a check-up within 3 months.

Treating other health issues, such as high blood pressure or sleep problems, can also improve long-term results.

Complications are rare, but can include:

• bleeding, pain or swelling at the wound site
• stroke
• fluid around the heart (cardiac tamponade)
• damage to the heart or blood vessels
• damage to the oesophagus (food pipe)

You may also need a pacemaker — a small device surgically placed under the skin of your chest that helps your heart beat at a normal rate and rhythm.

Depending on your condition, there are alternatives to having a cardiac ablation. They may include:

• medicines like beta blockers, calcium channel blockers, other heart rhythm medicines or digoxin
• electrical cardioversion (a controlled electric shock to reset your rhythm)
• a permanent pacemaker

Your doctor may also recommend lifestyle changes such as losing weight, reducing stress and avoiding alcohol.

Speak to your doctor about alternatives to a cardiac ablation and if they may be suitable in your situation.

If you choose not to have a cardiac ablation, your arrhythmia may continue to cause symptoms. Some arrhythmias, especially atrial fibrillation, can increase your risk of stroke or heart failure if not treated. Discuss your options with your doctor — they may suggest medicines or other treatments instead.

If your procedure is delayed for any reason, contact your healthcare provider to:

• manage any changes to your medicines
• reschedule your procedure

• The Heart Foundation website has information about different heart procedures.
• St Vincent's Hospital has a fact sheet on catheter ablation.
• Read the healthdirect article on eating well to protect your heart.

You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Information for Aboriginal and/or Torres Strait Islander peoples

• The Australian Indigenous HealthInfoNet has information about heart health.
• The Heart Foundation has a fact sheet on Aboriginal and Torres Strait Islander women's heart health.

Languages other than English

• Read more on heart health in your language from The Heart Foundation.
• Health Translations Victoria has a range of helpful resources on heart health in many community languages.