Heart ablation: Why is cardiac ablation done, by whom, types, advantages, risks
Cardiac ablation is a type of procedure performed by cardiologists to treat the problem of abnormal heart rhythms aka arrhythmias. Here's all you need to know about radio frequency ablation, also known as heart ablation or cardiac ablation.
An arrhythmia is an abnormal heart rhythm which causes the heart to beat either too fast or beat irregularly in a disorderly manner and such abnormal rhythms if persisted for long can lead to fall in BP causing fainting or syncope and may also cause cardiac arrest in dangerous rhythm disorders like ventricular fibrillation, ventricular tachycardia. Cardiac ablation is a type of procedure performed by cardiologists to treat the problem of abnormal heart rhythms aka arrhythmias and this procedure uses either heat or cold energy to produce tiny scars in your heart, in the areas responsible for producing abnormal beats or rhythm.
Why is cardiac ablation done?
In an interview with HT Lifestyle, Dr Pradeep Kumar D, Senior Consultant - Interventional Cardiology at Aster CMI Hospital in Bangalore, explained, “Radio frequency ablation (RFA) is a technique that is used to deliver Radio frequency energy to a tissue which heats the tissue and causes cell death. This type of treatment is done in cardiac conditions where there is disturbance in the electrical rhythm.”
He elaborated, “RFA is done in conditions like paroxysmal supraventricular tachycardias, atrial tachycardias, atrial flutter and atrial fibrillation, right ventricular outflow tract ventricular tachycardias and scar related re entrant tachycardias. In all these conditions there is abnormal conduction of electrical impulses due to re entrant circuits (like short circuits) or due to automatic foci in the heart. In short these procedures are done to prevent conduction of electrical signals through short circuits. By delivering RF energy the tissues that conduct abnormal electrical currents are burnt and rendered electrically unable to conduct electricity and thereby preventing such short circuits.”
Dr Mohit Tandon, Consultant Non Invasive Cardiologist at Fortis Escorts Hospital, in New-Delhi's Okhla, revealed that you may be advised cardiac ablation if -
- You have been prescribed medicines earlier and they are not able to control the condition.
- If you are facing intolerable side effects of the rhythm control medicines.
- Certain specific types of arrhythmic conditions like SVT and wolff parkinson white syndrome where the ablation gives good results.
- If you are at high risk of complications of arrhythmia like cardiac arrest.
Talking about the types of cardiac ablation, Dr Mohit Tandon highlighted:
1. Catheter ablation-- This is the commonest type of procedure in which a flexible wire (catheter) is inserted via a vein and is used to deliver hot or cold energy to the desired area.
2. Surgical ablation-- In this procedure also known as maze procedure, if you are undergoing a heart surgery like bypass surgery or a valve related surgery and you require an ablation procedure also then the cardiac surgeon during the time of cardiac surgery creates a maze-like scar pattern in your heart chambers (atria) to prevent abnormal signal generation and yet allows normal signal to pass through leading to a normal heart rhythm. This is used commonly for a type of arrhythmia called atrial fibrillation in which the heart beats in an irregular manner.
3. Hybrid ablation-- In hybrid ablation, the heart is not opened but a small incision is made in your chest, through which a catheter is passed and the area of interest is ablated.
Who does these procedures?
Dr Pradeep Kumar D answered, “Usually an electrophysiologist who is a cardiologist trained in electrical problems of the heart conducts these procedures. Sometimes special equipment like a 3 d mapping system may be required. The procedure may take upto hours to perform at times depending on the complexity.”
He added, “Procedural success varies from 70 to 95 percent based on the type of procedure that is been done. The procedure is done through catheters inserted through the veins in the groin or neck under local anaesthesia and sedation. Complications of the procedure can be bleeding, infection, conduction abnormalities needing pacemaker and rarely cardiac tamponade (due to perforation of the heart).”
What are the advantages and risks associated with heart ablation?
According to Dr Mohit Tandon, the advantages of cardiac ablation are:
- It can be lifesaving for dangerous arrhythmias where drugs cannot control the condition.
- The success rate of the procedure is very high. Studies report a success rate in upwards of 70%.
- It is minimally invasive and can be undertaken in the majority of people.
- It restores normal rhythm of heart in majority of cases thus allowing a person to stop taking antiarrhythmic drugs.
As for the risks associated with the procedure, he said, “Like any procedure, this too carries some risks however in experienced , high volume centers complication rates are very less with catheter ablation. Studies suggest that complication rates can be up to 6%. Common complications being bleeding from puncture site, infection, arrhythmia, stroke or TIA, Pericardial tamponade (collection of blood in space around heart), Atrio esophageal fistula (serious complication, rarer, tract between heart chamber and food pipe), Arrhythmia during or after the procedure.”
He concluded, “Catheter ablation allows you faster recovery and to return to your functional and productive life in a few days. Sometimes you may need to undergo ablation more than once if your arrhythmia recurs, this is commoner in long standing atrial fibrillation. You may also be asked to continue antiarrhythmic medicines for sometime after the procedure till the doctor is assured of successful termination.”