What is cardiac ablation?
Cardiac ablation, also known as catheter ablation, is a procedure used to treat certain heart rhythm abnormalities called arrhythmias. It is performed using very thin catheters guided into the heart, through which energy (heat, cold or electrical) is applied to the affected area to remove it and restore a normal heartbeat.
The heart functions through an electrical system that regulates the rate and coordination of heartbeats. If this system does not work properly, arrhythmias may occur, which means the heart beats too fast, too slowly or irregularly. These disturbances can lead to symptoms such as palpitations, dizziness, shortness of breath or fatigue.
Cardiac ablation is used to correct problems affecting the rate and coordination of the heartbeat. This is done using very fine catheters inserted into the veins and guided into the heart. These catheters make it possible to accurately identify the area responsible for the arrhythmia and deliver controlled energy to correct the problem.
The types of energy currently used to perform ablation are:
- Radiofrequency ablation, to produce heat.
- Cryoablation, using cold.
- Electroporation or Pulsed Field Ablation (PFA), using high-intensity electrical pulses.
These techniques form very precise lesions in the heart tissue responsible for the arrhythmia in order to restore normal heart rhythm. They are commonly used to treat different types of arrhythmias, including atrial fibrillation, various supraventricular tachycardias and, in selected cases, ventricular tachycardias.
When is cardiac ablation recommended?
Cardiac ablation is often the first-line treatment for certain types of arrhythmias. In other situations, it is recommended when antiarrhythmic medications have not adequately controlled the condition or have led to side effects.
An electrophysiologist, a cardiologist specialising in heart rhythm disorders, assesses each case individually and discusses the most appropriate treatment option with the patient.
The aim is to select the treatment with the greatest safety and effectiveness in controlling the arrhythmia and improving quality of life.
How should I prepare for cardiac ablation?
The medical team will provide specific instructions before the procedure, covering the following general points:
You should fast for at least 6-8 hours before the procedure.
In some cases, you may have to temporarily stop antiarrhythmic medication, as well as anticoagulants or antiplatelet drugs.
It may be necessary to shave the groin area, which is usually where the catheters are inserted.
You must inform the medical team of any allergies you have to the medications or iodinated contrast.
Depending on the type of arrhythmia, additional testing may be required beforehand, such as blood tests, a CT scan or a cardiac MRI scan.
How is cardiac ablation performed?
Cardiac ablation is carried out in a specialised cardiac electrophysiology unit equipped with advanced diagnostic and cardiac mapping technologies.
The patient may be admitted on the same day as the procedure via the Cardiology Day Hospital or may already be in hospital following a prior admission.
Before the procedure begins, the nursing team checks the patient’s details, reviews their medical history and confirms any allergies. An intravenous line is also placed in the arm to administer medication if required.
During the procedure, several catheters are inserted through the veins in the groin and guided to the heart. These catheters allow the cardiac electrical system to be studied and the area responsible for the arrhythmia to be accurately identified.
At certain points during the procedure, controlled arrhythmias may be triggered to determine their origin. Once the appropriate area has been located, energy is applied to it to remove the tissue causing the arrhythmia.
Depending on the type of arrhythmia, the procedure may be relatively straightforward or more complex. In some cases, it is performed under local anaesthetic with sedation, while in others may require general anaesthesia and the use of advanced 3D cardiac mapping systems.
What will I feel during the procedure?
In procedures performed under sedation, you may notice palpitations during the study, as controlled arrhythmias are sometimes triggered to identify their origin.
When the ablation energy is applied, you may have a sensation of heat or pressure in the chest. This is usually brief and well tolerated.
In procedures carried out under general anaesthesia, you will remain sleeping throughout.
The medical team will explain what is happening at all times and will administer medication to ensure you are comfortable.
What is the postoperative period like?
Once the procedure has been completed, you will need to remain at rest for a few hours to prevent bleeding at the puncture site.
In straightforward cases, you may be able to return home the same day. For more complex procedures, an overnight stay in hospital may be required.
In the days following the procedure, you may notice some mild discomfort in the groin area or occasional episodes of palpitations as the heart recovers.
The medical team will advise you when you can resume your normal activities.
How long does the procedure take?
The procedure duration depends on the type of arrhythmia.
Simpler cases may last about an hour, while more complex procedures may take several hours.
What are the possible complications?
Cardiac ablation is a safe procedure; however, as with any medical procedure, there are risks.
The most common complications are related to the puncture site in the groin, such as bruising or minor bleeding.
Less common complications are:
- Infection at the puncture site.
- Accumulation of fluid around the heart.
- Heart rhythm disturbances requiring additional treatment.
- Allergic reactions to the medication or contrast agents.
- Formation of blood clots, which may lead to thrombosis or embolism.
These complications are uncommon, and the medical team takes all necessary measures to minimise the risks.
Who performs the procedure?
Cardiac ablation is performed by cardiologists specialising in cardiac electrophysiology.
During the procedure, specialised nursing staff, healthcare technicians and biomedical engineers are also involved. In more complex cases, the anaesthetics team works alongside the cardiology team.
Where is the procedure performed?
This procedure is carried out in specialised cardiac electrophysiology theatres equipped with advanced technology, so the procedures can be performed to a high level of precision and safety; these include radiology systems, 3D cardiac mapping, continuous heart rhythm monitoring and advanced ultrasound equipment.
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