Ablation – types, indications, course. How to prepare for ablation?

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Ablation is by far the most effective treatment for heart problems such as atrial fibrillation. The effectiveness of the procedure depends mainly on the experience of the hospital and the doctor performing the ablation. This method uses radio frequency current to change the conductivity of the heart’s electrical impulses.

In a healthy person, the heart rate is regular. Disturbances in its rhythm can be dangerous to the health and life of the patient. In this case, doctors use ablation procedure. What is ablation and when should it be performed? How should you proceed after the procedure?

Ablation – what is it?

Ablation is a medical procedure to restore the heart to normal rhythm. Normally the heart beats 60 to 80 times a minute. The pumping action of the heart is triggered by electrical impulses. Ablation can be used to treat a heart that beats too fast (above 100 beats per minute, a condition known as tachycardia) or a heart that beats so that it contracts in an uncoordinated fashion known as flicker.

Also read: Heart failure – symptoms, diagnosis, treatment methods. Heart failure prophylaxis

Ablation – indications

The heart has its own natural pacemaker, the sinoatrial node. It is thanks to him that our heart beats calmly and steadily. If there is an additional source of electrical signal conduction causing contraction, or its focus, then arrhythmia occurs and the normal work of the heart is disturbed. Ablation is a procedure that destroys this path of additional signal.

The indications for ablation are:

1. supraventricular arrhythmias such as atrial fibrillation
2. atrial flutter
3. ectopic atrial contractions,
4. post-infarction ventricular tachycardia,
5. paroxysmal unexplained palpitations and fainting
6. fainting and unconsciousness associated with attacks of tachycardia
7. ventricular arrhythmias in patients without organic heart disease (extrasystolia from the cardiac outflow tract and elsewhere)
8. pre-excitation syndromes (Wolff-Parkinson-White syndrome, Mahaim syndrome, etc.).

Also read: Atrial fibrillation as a social disease

Surgical ablation – characteristics

While this is less common, Surgical ablation may be combined with other open heart surgerysuch as bypass surgery or repair or replacement of a heart valve.

Surgical ablation is performed under general anesthesia. In order to reduce the risk of vomiting during anesthesia, you should stop eating and drinking fluids after midnight the night before surgery. If you smoke, you should stop smoking at least two weeks before surgery, as smoking can contribute to blood clotting disorders and breathing problems.

There are two main types of surgical ablation. Some medical procedures require cardiac arrest and placement of the patient on the heart-lung (the so-called “on-pump” ablation). Others can be performed on a beating heart and do not require the use of the heart-lung machine (“off-pump” ablation):

1. Cox-Maze procedure: Doctors will make a precise pattern of incisions inside the upper chambers of the heart (right and left atrium). The cuts will then be sewn together. This creates scars that stop electrical activity from passing through the upper chambers. The heart must be stopped, and the heart lung must be used. This procedure is also referred to as atrial fibrillation ablation. While various techniques exist, it is the most common surgical ablation technique.
2. Mini Maze procedure: the physician uses minimally invasive surgical techniques to electrically isolate the pulmonary veins from the left atrium and remove the left atrial appendage. This is done through small incisions on either side of the chest between the ribs. The doctor is video assisted with a small fiber optic camera. Nerve tissue clusters believed to contribute to atrial fibrillation are identified and destroyed.

See: Chest pain – causes, diagnosis

Catheter ablation – characteristics

Catheter ablation is a non-surgical procedure in which thin, flexible tubes called catheters are inserted into the heart. This type of ablation does not require general anesthesia or cardiac arrest. This technique is more commonly used in newer technologies.

In order to perform the procedure, one or more catheters are inserted into the blood vessels, which are then used through a fluoroscope (a form of a moving X-ray image) are inserted into the heart. Catheters called diagnostic catheters will be used to study abnormal heart rhythms and determine the location of the problem.

Once the location of the abnormal heart tissue is identified, a special ablation catheter will be placed nearby. The tip of the ablation catheter will emit high-frequency electricity to destroy the abnormal tissue, causing scarring. The scar tissue is unable to initiate the electrical signal causing the arrhythmia.

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Ablation – contraindications

Contraindication to ablation is pregnancy and blood clotting disorders. Ablation is also not performed if the electrodes cannot be inserted from the peripheral vascular access and there is a thrombus in the heart.

Ablation – how to prepare?

Talk to your doctor about what needs to be done to prepare for the ablation procedure. Avoid eating or drinking anything before midnight on the day of surgery. Follow your doctor’s instructions on what medications to take before surgerym. Do not stop taking any medications unless your doctor tells you to.

Your doctor may order some tests to be performed before the procedure. They can be:

1. an electrocardiogram (EKG) to analyze the rhythm of the heart
2. echocardiography (Echo) to assess the structure and function of the heart,
3. exercise tests to see how your heart responds to exercise
4. blood tests (for example to check the level of the thyroid gland)
5. cardiac catheterization or coronary angiography to find out more about the coronary arteries
6. computed tomography of the heart to further evaluate the anatomy of the heart

Please inform your doctor before the procedure if you are pregnant. Ablation uses radiation that may be harmful to the fetus. J.If you are a woman of childbearing age, your doctor may order a pregnancy test to make sure you are not pregnant.

Read also: Cardiologist: a person is as old as his blood vessels

Ablation – the course of the procedure

The patient should be on an empty stomach when he comes to the hospital for ablation. A complete set of current laboratory tests prescribed by a doctor is also necessary. Before ablation, the doctor also recommends discontinuing arrhythmia medications or changing the dose taken.

Ablation is performed under local anesthesia. Some patients are also given sedatives and painkillers. It also happens that the patient has a cannula, if it is necessary to administer additional painkillers.

The ablations are performed by a cardiac surgeon. It inserts a catheter with an electrode in the groin area into the femoral vein or artery. Electrode insertion can now be monitored at all times with an x-ray image.

When the doctor finds the source of an additional signal, he burns this fragment of the heart with a radio wave. This prevents the formation of further impulses. The described procedure is RF ablation, which uses heat. You can also cryoablate by applying cold. The ablation may take up to several hours.

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Ablation – complications

Ablation is a safe procedure. Although the procedure is performed on the heart, the mortality rate is only 0,2%. So let’s remember that this method is not only effective, but also safe.

However, the success of the procedure is influenced by many factors, especially the condition of the entire heart muscle. For this reason, complications after ablation are more common in elderly people with various cardiological diseases. Possible complications include:

1. hematomas at the injection site,
2. valve damage,
3. cardiac tamponade,
4. piercing the wall of the heart,
5. pulmonary embolism,
6. bleeding into the pericardium
7. thrombosis,
8. infections,
9. stroke.

Ablation – convalescence

The effectiveness of ablation depends mainly on the skill of the doctor performing the procedure. If all goes well, however, the patient must wait several weeks for full recovery. Immediately after the procedure, it must lie down for 48 hours. Even 3 months after the ablation, the patient may still experience symptoms of arrhythmia, which is due to the healing of the heart muscle tissue.

After ablation, patients are often recommended cardiac rehabilitation. However, it all depends on the condition and age of the patient.