Cardiac ablation

Cardiac ablation for afib

Introduction

Atrial fibrillation is a rapid and irregular heartbeat (arrhythmia) that can form blood clots in the heart. It enhances the risk factors for heart failure, stroke, and other complications. Cardiac ablation is used to treat atrial fibrillation; in this procedure, cold or heat energy applies to the heart to stop irregular electrical signaling connections and restore a normal heartbeat. Cardiac ablation is used for arrhythmias (irregular heartbeats). 

Explanation:

A heart consists of four chambers. The top two chambers are referred to as atria and the two lower chambers are referred to as ventricles. Generally, cells located at the sinoatrial node of the heart’s upper atrium give signals to initiate the heartbeat. The signals to initiate the heartbeat are not started in the sinoatrial node in atrial fibrillation. The signals are sidetracked and begin at the other region of the atria, causing them to fibrillate. Usually, the atria do not contract to transfer blood into the ventricles. During this condition, the disordered signals spread into the ventricles and contract them quickly and irregularly. Therefore, ventricles cannot move enough blood into the body. 

Why is it necessary to conduct cardiac ablation?

Cardiac ablation is used to re-adjust the heartbeat. The specialist will evaluate the symptoms of atrial fibrillation, such as fluttering or fast heartbeat, fatigue, breathing difficulty, or chest pain, and may recommend cardiac ablation. Mostly, patients with atrial fibrillation take medications to restrain their heart rhythms or heart rate. These medications are ineffective for some patients. When the medications and other treatments do not improve the fast heartbeat, cardiac ablation may use for the treatment. 

Possible risk factors:

The patients have specific risk factors according to their medical conditions. Discussing all the concerns with the specialist before cardiac ablation is better. These are the risk factors of cardiac ablation for atrial fibrillation, which may include:

  • Infection and bleeding from a catheter insertion site
  • Blood vessel destruction 
  • Damage to the heart valve
  • New irregular heartbeats
  • Heart attack or stroke
  • Blood clots within the lungs or legs (venous thromboembolism)
  • Radiation exposure
  • Pulmonic stenosis (a pulmonary valve that controls the blood flow from the right ventricle of the heart to the pulmonary artery becomes narrow)
  • Kidney damage through contrast dye that is used in the procedure
  • Older age people have more complications 
  • Sometimes  may cause death

How to prepare for cardiac ablation?

During cardiac ablation, an individual is advised to avoid drinking or eating before midnight of the procedure day. Follow the specialist’s instructions about taking medicines before ablation. Furthermore, the doctor recommends some tests before this procedure, which may include:

  • Electrocardiogram (ECG): This quick test detects electrical signals and the heart’s rhythm. Sensors (electrodes) are attached to the chest at different points to examine heart rhythms. Wires with electrodes are connected to the computer that displays the ECG results.  
  • Echocardiography: Echocardiography is used to check heart function. It creates images of the heart using sound waves and shows heartbeats and blood flow.
  • Blood tests: Blood tests help the doctor to check thyroid levels or detect other problems. 
  • Stress test: It is often called an exercise test or treadmill test and helps to evaluate heart functions during exercise. 
  • CT scans: CT scans use X-rays to give more detailed heart images.
  • Cardiac MRI uses radio waves and magnetic fields to evaluate the heart structure. 
  • Cardiac catheterization: During this procedure, a thin tube (catheter) has inserted in the groin and guided through the blood vessel to the heart. Cardiac catheterization is used to treat arrhythmias (irregular heartbeats). 
  • Coronary angiography: Doctors use this procedure to obtain information related to coronary arteries. 

What to expect before cardiac ablation?

A cardiac ablation procedure is done at the hospital. The doctor inserted an IV in hand or forearm of the patient and gave medication for relaxation. Only a cardiologist will do the procedure with the help of trained nurses or a team. They may provide numbing medicine before the process; the patients may receive local or general anesthetic. The patients can be lightly sedated or fully awake. 

What to expect during cardiac ablation?

The doctor will insert a thin tube (catheter) into the groin and guide it within the heart for cardiac ablation. Then the specialist scars the heart using catheters and makes small freezes or burns. In this burning procedure, radiofrequency energy applies heat energy to scarring within the heart, stops periodic electrical signals, and restores a normal heartbeat. Furthermore, the cryoblation technique is used for the freezing process. Cryoblation also damages the affected region within the heart, causing an arrhythmia. Generally, this procedure has completed in 3-6 hours. The complicated procedures can take a long time, as usual.  

Anesthetic medicine may apply to the patient’s skin to form a small lesion. The specialist formed tiny holes in the blood vessels and put some tapered tubes (sheaths) from the hole. Then he adds flexible and long tubes (catheters) in the blood vessels by sheaths. Then he put catheters in a proper place within the heart. Furthermore, a specialist located the abnormal tissue by sending electrical signals from a catheter. The doctor may place a catheter on a site where abnormal cells present and scar it by freezing or burning. After this, the team will remove the tubes and close the vessel. 

What to expect after cardiac ablation?

After the cardiac ablation, the patient will shift to the recovery room for several hours. During this resting phase, the healthcare providers monitor the breathing and heart rate. They also measure the blood pressure to highlight the complications. After cardiac ablation, patients feel chest tightness. Therefore, they may spend the night at the hospital. The specialist evaluates that condition and recommends medications, such as blood thinners.

Results:

After cardiac ablation, people feel improvements in their life. It significantly improves cardiac functions and exercise capacity. If the irregular heartbeats (arrhythmias) return, the specialist repeats this procedure, or May suggests different treatments. The cardiac ablation may eliminate atrial fibrillation permanently in these patients. Furthermore, blood thinners are used to reduce the risk factors of stroke. 

References:

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/atrial-fibrillation-ablation#:~:text

https://www.mayoclinic.org/tests-procedures/atrial-fibrillation-ablation/about/pac-20384969 

https://www.mayoclinic.org/tests-procedures/cardiac-ablation/about/pac-20384993#:~:text 

https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/drc-20350630 

https://www.bhf.org.uk/informationsupport/treatments/ablation

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