Arrhythmias or heart rhythm problems are becoming increasingly common. This is due to irregular electrical signals emanating from a small area of tissue. Cardiac ablation is a procedure that uses either heat or cold energy to create minute scars in the heart which will block the irregular signals and restore normal heart rhythm. When heat (similar to microwave oven heat) is used to create the scars, the procedure is known as radiofrequency ablation. The procedure is done using thin flexible tubes called catheters that are inserted through veins or arteries to reach the heart. Since no major incisions are made, it is a minimally invasive surgery.
Why It Is Done
The beating of the heart is controlled by electrical signals that cause the heart to contract and relax and by doing so, push blood through the body. The signals must follow a specific path through the heart so that the contractions occur at exactly the right moment. When the path the signals follow is disrupted, the heartbeat may become irregular. The medical term for this condition is atrial fibrillation (AFib).
The normal adult heart rate is between 60 to 100 beats per minute. When atrial fibrillation is present, the rate could increase up to 175 or more beats per minute or it could drop below 60. AFib is not life-threatening by itself, but when the condition is present, the risk of stroke or heart failure is greatly increased.
After the condition is diagnosed and evaluated, a cardiologist will decide on whether medication to resolve the problem should be tried first (and only if the medication does not produce the desired results will ablation be done), or if the use of ablation as the first choice itself is the best course of action. The decision will be based on the severity of the condition and other factors affecting the patient’s health.
Diagnosis
A range of tests are used to diagnose AFib. These include:
- Chest x-rays.
- Echocardiograms with high-frequency sound waves to create an image of the heart.
- Electrocardiograms (ECG) to measure the electrical activity of the heart.
- Event monitors that are like ECGs, but which measure heart activity over a much longer period of time.
- Stress tests which evaluate heart functioning during physical activity.
- Various laboratory tests may be done to check both heart condition and other health factors that may affect cardiac functioning.
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Preparing for the Procedure
Radiofrequency ablation is an inpatient procedure that is done in a hospital. Before a patient is admitted to the hospital, he or she will be given a list of steps to be taken to prepare for the procedure. This may include discontinuing any ongoing medications, diet control and other such actions. The patient will not be able to eat or drink anything starting from the night before the procedure.
How Cardiac Ablation Is Done
- After the patient is taken to the operating theatre, an intravenous line is used to administer a sedative to help the patient relax. The amount of sedation and whether general anaesthesia is used will depend on the severity of the problem and other health factors affecting the patient.
- One or more catheters are inserted into a blood vessel in the groin, shoulder or neck and moved towards the heart. The place where the catheters are to be inserted will be decided by the surgeon. The groin is the most common.
- Dye is injected via the catheters to increase visibility of the blood vessels on the x-ray images that are used to guide the catheters into position.
- Once the catheters are in place, sensors at the tips send electrical impulses and record the heart’s response. This data is used to identify the specific area of the heart that is causing the arrhythmia so that the ablation can be done. This is known as an electrophysiology study.
- Heat in the form of radiofrequency energy is then used to create minute scars in the tissues that disrupt the signals. The scars will block the irregular signals and allow the heart to regain its normal rhythm.
- It is normal for the patient to feel some minor discomfort while the ablation is being done. If the discomfort is significant, the surgeon will increase the sedation/anaesthesia to put the patient at ease.
- The procedure typically takes 3 to 6 hours to complete, but the actual time taken will depend on the type and extent of the arrhythmia.
Recovery
- Being a minimally invasive procedure, the surgical trauma is insignificant and the recovery period is very short.
- Once the procedure is done, the patient will be taken to a recovery room where his or her condition will be monitored for a few hours.
- Depending on the speed of the recovery, the patient may be able to return home the same day or may be asked to stay in the hospital overnight.
- No special transportation is required and the patient may be driven home in a normal passenger car.
- There may be some lingering soreness for a few days after the procedure. If the discomfort is severe, the doctor should be informed and medication to control it will be prescribed.
- Most patients are able to return to normal activities within a week of the procedure.
- Strenuous exercise may be started in stages under the supervision of the doctor.
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The Result
Patients can expect to see a major improvement in their quality of life after the procedure. However, there is a possibility of the problem returning in the future. If that happens, the doctors may advise repeating the procedure or may consider other treatment options, depending on the specifics of the case. In some cases, patients may be advised to take heart medication to prevent the recurrence of the problem.
No surgical procedure, even a common minimally invasive one should be taken for granted. That said, minimally invasive radiofrequency ablation for irregular heartbeat is a routine cardiac procedure. If AFib is diagnosed and the procedure is performed at a leading multispecialty hospital with a cardiology department that has the leading cardiologists and cutting-edge medical technology and equipment, patients can confidently undergo the procedure with the assurance that they will be able to return to their normal lives, in a healthier state, in a few days.