It’s amazing when you stop to think about it: A short, relatively pain-free procedure that can steady heartbeats by disrupting the electrical signals causing it to beat irregularly.
It’s called cardiac ablation, and it’s a common treatment for an irregular heartbeat, or arrhythmias, like atrial fibrillation or ventricular tachycardia. An irregular heartbeat increases the chances of a blood clot breaking off, entering the bloodstream, and leading to a stroke. Fifteen to 20 percent of all stroke sufferers experience irregular heartbeats beforehand.
Enter cardiac ablation. IVs or intravenous catheters inserted in the groin or legs make their way through blood vessels, where they map electrical signals and get to the heart of the problem – literally.
“The catheters used in cardiac ablations have electrodes on the tip,” explains Dr. Jeffrey Arkles, electrophysiologist at the Hospital of the University of Pennsylvania and Pennsylvania Hospital. “We use them to find short circuits, then apply heat or freezing energy that clips the short circuit or takes care of an abnormal cell. More often than not, this is enough to steady the heartbeat.”
Cardiac ablation is on the rise in the United States, meaning more and more people wonder what to expect – not only during the procedure, but afterward.
Cardiac Ablation: Fact vs. Fiction
The biggest misconception about cardiac ablation is that it’s long and requires lengthy hospital stays.
“The procedure used to be really long–around ten hours–which is why this myth persists,” Dr. Arkles explains.
Thanks to advances in technology and expertise, ablations today generally last between 2 and 3 hours. Ninety percent of ablation patients go home the next day.
“Longer hospital stays in years past were attributed to the amount of liquid that patients received over the course of those longer procedures,” Dr. Arkles says. “Patients used to encounter a lot of fluid-related complications.”
When patients do require longer hospital stays, it’s typically because of preexisting, high-risk conditions, like heart failure or a weak heart.
Will I Be in Pain Afterward?
Most post-ablation discomfort has nothing to do with the heart itself. For a good number of patients, lying stationary for a few hours leads to a stiff lower back.
“We’re really aggressive about moving patients as much as we can during the procedure to mitigate stiffness and minimize discomfort,” Dr. Arkles says.
Some patients experience sore throats from the intubation used for anesthesia. Less frequently, they develop urinary tract infections or pneumonia (“Which is generally very mild and can be treated as outpatient with antibiotics,” Dr. Arkles notes), or have excessive bleeding at the procedure’s access site. Doctors discharge patients with orders to keep an eye out for a golf ball-like lump or excessive bruising.
Chest discomfort can occur from inflammation caused by the procedure, but is generally mild.
“The most extreme discomfort following cardiac ablation is usually limited to the standard side effects of anesthesia,” says Arkles. “Most people feel tired for a few hours after the waking up, but start to feel better once they can get up and walk around, usually 3 to 4 hours later.”
When Can I Go Back to Work?
“If they’re feeling well and if their work isn’t too strenuous, I tell most patients that it’s okay to go back to work 3 to 4 days after their ablation,” Dr. Arkles says. For strenuous jobs like nursing or law enforcement, he recommends a two-week wait.
“I always remind patients that their balance might not return until they’re out of anesthesia for 48 hours, so they should definitely refrain from activity at least through then – and definitely shouldn’t drive until 48 hours after waking from anesthesia.”
When Will I Know if My Ablation Worked?
If you’re still experiencing arrhythmia in the weeks following an ablation, don’t give up hope. It might be part of the healing process.
“Because ablations irritate and inflame the heart a little, many patients experience short runs of arrhythmia in the weeks afterward,” Dr. Arkles says.
In other words, the weeks after an ablation shouldn’t be used to determine whether the procedure was a success – though more often than not, it is.
“About 80% of the time, the first procedure is enough to steady the heartbeat. For more persistent AFib, that number is about 60 to 70 percent.”
And if the first procedure isn’t successful, a second procedure may be needed. “The second ablation has a higher success rate – about 80 to 90 percent.”