Ablation in cardiology is a surgical method of treating cardiac arrhythmias, i.e. arrhythmias. It consists in destroying with the use of heat (RF current) or cold (cryoablation) the sites responsible for arrhythmia. Such procedures are performed under local anesthesia, in a hospital setting in a cardiology department.
It is usually performed percutaneously, i.e. without opening the chestby inserting catheters into the heart through the blood vessels (veins or arteries) in the inguinal or neck area.
- Immediately after the procedure, the patient remains in bed for about 8 hours. A day or two after ablation, the patient is usually discharged from the hospital.
In the early postoperative period, special attention should be paid to the cleanliness of the injection site. See a doctor if you experience any disturbing symptoms (pain, thickening, bleeding, lack of pulse).
- Immediately after the ablation procedure, the patient may exercise little. The patient may return to a moderate level of physical activity in approx 2-3 weeks after surgery.
According to the guidelines of the European Society of Cardiology (ESC), a patient after ablation of arrhythmias such as nodal tachycardia (AVNRT), recurrent atrioventricular tachycardia (AVRT), atrial flutter (AFl), atrial tachycardia (AT) or pre-excitation syndrome may return to full recovery. range of physical effort, and professional athletes to train, about a month after the surgery, if there are no recurrences of arrhythmia.
- Following ablation of atrial fibrillation and other complex ablations, the patient may return to full physical activity after 1-3 months after treatment.
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The condition for returning to physical effort and sports is the patient’s fitness, general condition, no recurrence of arrhythmia and comorbidities, and not the procedure itself.
For ablation of the most complex and serious arrhythmias, such as ventricular tachycardia and ablation of patients after an electrical storm, the recovery period usually takes longer – about 3-6 months and also largely depends on the underlying disease leading to the development of cardiac arrhythmias, and therefore usually on the advancement of heart failure and cardiomyopathy.
The first follow-up visit at a cardiology clinic is usually scheduled one month after ablation. During it, an ECG examination is performed as well as an assessment of the patient’s condition and history, in particular regarding the recurrence of arrhythmia. Another visit takes place 3-6 months after surgery and its timing depends on the patient’s condition and the ablated arrhythmia.
Then the first Holter EKG check is performed very often. The subsequent checks and tests performed depend on the arrhythmia that caused the ablation, the general condition of the patient and any comorbidities.
- Immediately after the ablation, the patient may experience palpitations. They are related to the fact that, as a result of the procedure, the places responsible for the arrhythmia were damaged and, as a result, they heal after the procedure. Recurrence of arrhythmia in the period up to 3 months after ablation, it is usually not considered a surgical failure.
This is called „blanking period” that is, the period of blindness, and arrhythmias may still appear during this time, due to the postoperative healing process of the tissues in the heart damaged as a result of the procedure. Only after 3 months the occurrence of an arrhythmia that has been ablated is considered a recurrence of the arrhythmia after surgery. In such a situation, the doctor assesses the patient’s clinical condition individually and may, after considering the benefits and risks, qualify the patient for another procedure or for pharmacological treatment.
It happens that a patient after one arrhythmia ablation requires another similar procedure due to recurrence of arrhythmias.
- Immediately after the ablation procedure, the patient usually requires support with antiarrhythmic drugs. Such drugs are usually used in patients before the ablation procedure, and are appropriately modified after it.
They are usually applied over a period of time 3-6 months after ablation, and then modified or discontinued depending on the effectiveness of the procedure. In addition, maintenance or discontinuation of the drug depends on the type of ablated arrhythmia and the underlying disease.
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Due to the fact that atrial fibrillation is an arrhythmia that may lead to a stroke, patients with this arrhythmia always require the assessment of the risk of a stroke according to the commonly used CHA2DS2-VASc scale. Even despite successful ablation, patients with a sufficiently high risk of stroke according to the CHA2DS2-VASc scale require anticoagulation.
An extremely important factor influencing the effectiveness of the ablation procedure, in particular atrial fibrillation ablation, is the modification of risk factors for cardiovascular diseases, such as hypertension, hyperlipidemia, diabetes, smoking, obesity, low physical activity or stress. One of the conditions associated with atrial fibrillation is hypertension.
Both diseases often coexist with each other. Atrial fibrillation is more common in hypertensive patients, and high blood pressure, especially if poorly controlled, is a condition that can exacerbate episodes of atrial fibrillation.
Therefore, an important aspect is the use of appropriately selected antihypertensive drugs and proper blood pressure control.
Another important issue is proper diet and maintaining a healthy body weight. Studies have shown that the effectiveness of ablation in patients with atrial fibrillation is lower in obese patients and higher in patients with normal body weight.
The optimal solution is to lose weight before the atrial fibrillation ablation procedure, because it has been proven that not only the effectiveness of ablation is higher, but also the risk of complications of the procedure is lower in patients without concomitant overweight or obesity.
You should also take care of the proper hydration of the body. Dehydration and low blood levels of potassium and magnesium promote the recurrence of arrhythmias.
- In the case of ablation of arrhythmias associated with concomitant heart failure, i.e. arrhythmias such as ventricular tachycardia or electrical storm, a very important element is the appropriate pharmacological treatment of heart failure. Medicines used in heart failure have an antiarrhythmic potential by influencing the function of the left ventricle. The effectiveness of the ablation procedure in patients adequately treated for heart failure is higher.
Non-cardiac disorders, if any, in a patient with ablated heart rhythm disturbances also require appropriate treatment.
The most important of them include any disorders of the thyroid gland. Both hyperthyroidism and hypothyroidism can worsen arrhythmias. Appropriate treatment of lung diseases such as chronic obstructive pulmonary disease and bronchial asthma is also important.
In the aspect of surgical treatment of atrial fibrillation, extremely important is the effective treatment of obstructive sleep apnea, which is manifested, inter alia, by snoring.
This disease may affect the effectiveness of antiarrhythmic treatment, both pharmacological and surgical.
Finally, but no less important than the above aspect, is to avoid stress and use appropriate medications in the case of coexisting diseases, such as anxiety and depressive disorders.
Stress is conducive to episodes of cardiac arrhythmias, and constant anxiety, e.g. before an arrhythmia attack, it drives a vicious cycle that ultimately leads to the recurrence of the arrhythmia and even greater anxiety. In treatment, not only psychotherapy is useful, but also anti-anxiety and antidepressant drugs selected by a specialist.
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Author: Dr hab. Ewa Jędrzejczyk-Patej, med
Department of Cardiology, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases in Zabrze
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