What Is Ablation

Ablation is a procedure for restoring normal heart rhythm, particularly if the irregular rhythm has not responded to medication. Usually, the heart beats between 60 and 80 times a minute. The pumping action of your heart is triggered by electrical impulses. Ablation may be used to treat a heart that beats too quickly (more than 100 beats per minute, a condition known as tachycardia), or a heart that beats so it contracts in an uncoordinated fashion, known as fibrillation.

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Dr. Atul Verma, MD, FRCPC, Cardiologist, discusses the risks linked to having Ablation therapy done. Southlake Regional Health Centre

Quiz: Do You Understand the Ablation Procedure?

Test your knowledge by answering the following questions:

Questions
True
False
1

Patients generally take blood thinners up until the ablation procedure.

Explanation:
Patients generally take blood thinners up until the ablation procedure, and receive extra blood thinners during the ablation procedure to reduce the risk of a blood clot in the heart that could lead to a stroke.
2

Most patients will need to spend 3-5 days in the hospital after ablation.

Explanation:
Many patients will be able to leave the hospital the same day they undergo a cardiac ablation procedure.
3

The success rate of the ablation procedure is the same no matter what type of atrial fibrillation you have.

Explanation:
The success rate of ablation depends in part on the type of atrial fibrillation that you have. If you’re in and out of atrial fibrillation, known as paroxysmal atrial fibrillation, your success rate is going to be higher. If you’re in atrial fibrillation all the time, called persistent atrial fibrillation, then your success rate is going to be lower.
4

The majority of people can return to their regular activities the day after they leave the hospital.

Explanation:
Most people can return to their regular activities the day after they leave the hospital. You’ll receive written instructions on post-catheter ablation care.
5

During the procedure, the doctor will insert electrode catheters through a vein or artery in your arm.

Explanation:
During the procedure, the doctor will insert electrode catheters through a vein or artery in your groin. He or she will thread it to your heart and emit a pulse of radiofrequency energy that destroys the abnormal tissue to correct the irregular heartbeat.
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Dr. Paul Dorian, MD, CM, MSc. Cardiologist, St Michael’s Hospital, Toronto discusses the right atrial fibrillation patient for Ablation therapy treatment.

Ablation and Treatment Risks

Let’s talk a little bit about the risks and benefits of the ablation procedure. Let’s start with the risks. Fortunately all of the risks are very low, but there are some that you should be aware of. During the ablation procedure, for example, we could cause a blood clot in the heart, and this could result in a stroke.

That’s why we ask you to take blood thinners up until the ablation procedure, and we also give you extra blood thinners during the ablation procedure. So this risk is 0.2% or less. There’s also a risk that while we’re performing the burning in your heart that we could burn a hole in the heart, and cause bleeding, which might require urgent surgery to fix.

But that’s why we limit the amount of power that we use, and this risk is also less than 0.2%. There’s always a risk potentially of a fatal complication with any procedure that you have performed and ablation is no different. The esophagus, for example, is located very close to the left atrium, and there have been reports of burning in the left atrium causing damage to the esophagus, which could be life threatening. We however take precautions to avoid this from happening, like measuring the temperature in the esophagus, and the risk of a life threatening complication is one in a thousand or less.

In terms of the success rates, the success depends in part on the type of atrial fibrillation that you have. If you’re in and out of atrial fibrillation, which we call paroxysmal atrial fibrillation, your success rate is going to be higher. The chance of eliminating your atrial fibrillation after one attempt at the procedure is about 70 to 75%, and after two attempts at the procedure, 85 to 90%.

If you’re in atrial fibrillation all the time, however, we call this persistent atrial fibrillation, then your success rate is going to be lower. The chance of success after one attempt at the procedure is maybe about 65 to 70%, and after two attempts about 80 to 85%. Still quite good, but lower than the paroxysmal patients.

If you have further questions about your ablation procedure, feel free to ask your physician, nurse practitioner, nurse, or any other member of the atrial fibrillation team.

Presenter: Dr. Atul Verma, Electrophysiologist, Newmarket, ON

How Cardiac Ablation Surgery is Performed

So atrial fibrillation is due to triggers, abnormal triggers that are developing usually in the left atrium of your heart. And these triggers then set off the irregular and rapid heart beating, which you know as atrial fibrillation.

So when we talk about ablation, we’re talking about a minimally invasive procedure that allows me to go into your heart, identify where these abnormal electrical triggers are coming from, and then basically to either to burn them away or freeze them away. And that in a nutshell is what ablation is all about.

To give you a little bit more detail, we perform the ablation by inserting small little tubes into the veins of both of your legs, as well as potentially into a small vein in your neck. Through those little tubes, we can insert special wires, as well as special catheters, which are basically small little devices that allow us to record your heart rhythm, identify the abnormal areas and then deliver energy to eliminate them.

So this is an example of one of the catheters that we would be inserting through your veins and into the heart. And you can see that the tip of the catheter is metal, so it can record electrical signals from the heart, but at the same time this connects into an energy source which allows us to burn those abnormal signals away. The catheters are also capable of moving, and this is the way we control where in the heart the catheters are going.

The ablation procedure on average takes about two to three hours to perform, and you are usually very heavily sedated during the procedure. Sometimes it can be done under a full general anesthetic. During the procedure we then insert the tubes, place the catheters in your heart and complete the procedure. And after the procedure is finished, you’ll go to our recovery area, where the nurses will then pull the tubes out of your leg and out of your neck. At this point you’ll have to be in bed rest for four to six hours, and usually we’ll keep you in one night after the procedure, and then you go home early the next morning.

If you have any more questions about your atrial fibrillation or whether you may be a potential candidate for ablation for your atrial fibrillation, feel free to contact your local health professional, your cardiologist, or have them refer you to the heart rhythm program here at Southlake Regional Health Centre, where we’ll be happy to do a consultation.

Presenter: Dr. Atul Verma, Electrophysiologist, Newmarket, ON

Dr. Atul Verma, MD, FRCPC, Cardiologist, discusses how to stay relaxed before having Cardiac Ablation surgery. Southlake Regional Health Centre

It’s normal to feel stressed and anxious about undergoing a procedure for your atrial fibrillation. Everyone does. But keep in mind that we have a whole team of people involved in order to help reduce your stress and anxiety.

We will send you to our AF ablation school, where you’ll learn more about the procedure and become more educated about atrial fibrillation as a whole. You will meet a number of nurses, both before the procedure as well as on the day of the procedure, whose job it is to not only inform you but to take care of you and to help you feel at ease during the procedure.

And of course there are the anesthesiologists and the electrophysiologists, whose primary concern is your safety and having an excellent outcome. So, feeling nervous? Yes, you’re going to, but be assured that there’s a whole team of people to help you get through it.

Considering The Right Afib Patient for Ablation Treatment

What about atrial fibrillation ablation? This is a commonly discussed procedure for patients with atrial fibrillation. Let’s first explain what ablation means, and then we’ll talk about if it’s right – for which patients it’s the right procedure.

So what is atrial fibrillation ablation? Ablation is a procedure we do by putting tubes inside the heart and delivering small amounts of electrical energy to burn away the potential short circuits that lead to atrial fibrillation. These short circuits are on the back wall of the left collecting chamber, called the left atrium.

What ablation will do is it will cause the small electrical burns in the back of a patient’s heart, and if done appropriately and successfully, which is about 70, 80% percent of the time in most patients, making these burns will prevent these electrical short circuits in the heart from forming and leading to the next attack of atrial fibrillation.

Which patients with atrial fibrillation can benefit the most from an ablation procedure? In general, the main reason to do an ablation procedure is for quality of life. We don’t recommend it specifically to prolong life, or to prevent dangerous things from happening.

Why? Because fortunately, dangerous things in atrial fibrillation are very rare. Dying from atrial fibrillation is very, very rare. Heart attacks are very, very rare. Stroke in atrial fibrillation can be prevented with a blood thinner. Doing an ablation will not prevent stroke, but we already have a great treatment for stroke: prevention, which is anticoagulants, or so-called blood thinners.

So the reason to recommend an ablation, and the reason for a patient to want to have an ablation, is to improve their quality of life. What do we mean by that? Many patients with atrial fibrillation can’t exercise when they have atrial fibrillation, because they have palpitations or shortness of breath. They’re bothered by the attacks. The attacks are very uncomfortable or unpleasant. They may be on medications which are ineffective; don’t stop the attacks of atrial fibrillation.

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