Cardiac Ablation

Written by Susan Bernstein, Timothy Gower
Medically Reviewed by Shruthi N, MD on October 03, 2024
10 min read

This procedure uses energy to make small scars in your heart tissue. These scars stop unusual electrical signals that move through your heart and cause an uneven heartbeat (your doctor might call it arrhythmia). Cardiac ablation can also treat atrial fibrillation (AFib), a type of irregular heartbeat. If this is the case, your doctor might call it AFib ablation.

The doctor may try cardiac ablation if medications and resetting your heartbeat — also known as cardioversion — don't work.

There are two ways your doctor can do ablation. Catheter ablation is the more common procedure.

Types of cardiac catheter ablation

Catheter ablation, also called radiofrequency or pulmonary vein ablation, isn't surgery. Your doctor puts a thin, flexible tube called a catheter into a blood vessel in your leg or neck and guides it to your heart. When it reaches the area that's causing the arrhythmia, it can destroy those cells. This helps get your heartbeat regular again. There are two kinds:

Radiofrequency ablation. The doctor uses catheters to send radiofrequency energy (similar to microwave heat) that makes circular scars around each vein or group of veins.

Cryoablation. A single catheter sends a balloon tipped with a material that freezes the tissues to cause a scar.

Types of cardiac surgical ablation

Surgical ablation involves cutting into your chest. There are three kinds:

Maze procedure. Your doctor will usually do this while you're having open heart surgery for another problem, like a bypass or valve replacement. They make small cuts in the upper part of your heart and stitch them together to form the scar tissue that stops unusual signals.

Mini maze. Most people with AFib don't need open heart surgery. That's where this less-invasive type comes in. Your doctor makes several small cuts between your ribs and uses a camera to do catheter ablation. Some hospitals offer robotic-assisted surgery that uses smaller cuts and makes the procedure more precise. Your doctor will put a video camera or tiny robot into your chest. It'll guide the creation of scar tissue that may help keep your heartbeat at the right pace.

Convergent procedure. This pairs catheter ablation with a mini maze. The doctor uses radiofrequency ablation in the pulmonary vein, and a surgeon makes a small cut under your breastbone to use radiofrequency energy on the outside of your heart.

Any procedure has risks. Problems with cardiac ablation can include:

  • Bleeding or infection where the catheter went in
  • Damaged blood vessels if the catheter scrapes them
  • Arrhythmias caused by damage to your heart's electrical system
  • Blood clots in your legs or lungs
  • Heart damage, like punctures or damaged valves
  • Stroke or heart attack
  • Narrowing of the veins between your lungs and heart
  • Kidney damage from the dye
  • Radiation
  • Death

Weight gain after cardiac ablation

During your cardiac ablation, the surgical team pumps saline fluid into your body, which helps improve the outcome of the procedure. Your body may retain some fluid, which could cause weight gain. This weight gain is usually temporary. Your doctor may prescribe a medication called a diuretic, which will help remove the fluid you retained after your cardiac ablation.

If you don't treat AFib, your odds of blood clots, heart failure, or a stroke go up. These could be life-threatening.

The doctor will take your risk factors into account before they suggest a treatment. If you have no symptoms or if they're mild, the doctor may watch and wait. But they might prescribe warfarin or another blood thinner to protect you from strokes.

Cardiac ablation may be right for you if AFib symptoms are more severe and make it hard to do daily tasks.

Your doctor will talk with you about AFib treatments, including ablation. The plan will depend on:

  • The cause of your AFib
  • Whether you have symptoms
  • Your chance of having heart disease

Different types of ablation target different parts of your heart. You may be able to go home the same day, or you may need to stay a night or longer in the hospital.

Drugs can treat AFib and keep your heart at a regular rhythm, but they may have side effects or stop working after a while. Cardiac ablation might be the next option. This treatment could last longer or cure the AFib.

Nonsurgical and less-invasive ablation are successful for many people with AFib. If the first procedure isn't successful, a second often will be. With those options, you'll be able to recover and get back to your routine quickly.

Your medical team will probably tell you to:

  • Stop eating or drinking the night before the procedure.
  • Stop taking medications to treat arrhythmia several days before.
  • Ask the doctor if you should stop any other medications.
  • Ask the doctor about precautions if you have a pacemaker or implanted defibrillator.

The doctor will give you any other specific instructions.

A member of the medical team will put a needle into your forearm or hand that's attached to a tube called an IV line. They'll use it to give you a sedative to relax you or general anesthesia to put you to sleep.

If you're having catheter ablation, your doctor will numb an area near a vein on your groin, neck, or forearm. They'll put a needle into the vein and run a small tube called a sheath through the needle. Catheters go through this sheath and into your veins to your heart. Your doctor can use electrodes or dye to find the cause of your arrhythmia and destroy unusual tissue.

You may feel some minor discomfort. Tell the medical team if you have severe pain or shortness of breath.

Surgical ablation is more complex. During a maze procedure, your doctor will cut down the center of your chest and separate your breastbone. They'll attach a heart-lung bypass machine to keep your blood flowing. For other types, they'll make one or more small cuts on your chest for the ablation instruments.

Cardiac ablation used to be a very long procedure — it could take up to 10 hours. Thanks to improvements in surgical techniques, your cardiac ablation is now likely to last about 2-3 hours. Most patients can go home the next day.

What is recovery like?

It depends on the type of procedure you have:

Catheter ablation. You may need to spend a night in the hospital, but most people can go home the same day. If so, you'll rest in a recovery room for a few hours while a nurse closely watches your heart rate and blood pressure. You need to lie flat and still to prevent bleeding from where your skin was cut. Plan to have someone drive you home.

The doctor will prescribe a medication to prevent blood clots and another to prevent AFib. You'll probably take them for 2 months. A shower is OK once you're home, but keep the water on the cooler side. Don't take a bath, swim, or soak for 5 days or until the cuts have healed.

For the first week:

  • Don't lift more than 10 pounds.
  • Skip activities that make you push or pull heavy things, like shoveling or mowing the lawn.
  • If you get tired, stop and rest.
  • Don't exercise. You can go back to normal in week 2.

Maze procedure. You'll probably be in the hospital for about a week. You'll spend the first couple of days in an intensive care unit (ICU) and then move to a regular room before you go home. Full recovery takes about 6-8 weeks, but you should be able to return to normal activities within 2 or 3 weeks. You should start to feel better in about 4 weeks. You'll probably take a blood thinner for about 3 months.

Mini maze. You'll be in the ICU for a few hours to a day. You'll probably stay for 2-4 days, total.

Open-heart maze. This is a major surgery. You'll spend 1 or 2 days in the ICU, and you may be in the hospital for up to a week. At first, you'll feel very tired and have some chest pain. You can probably go back to work in about 3 months, but it may take 6 months to get back to normal. Once you're home:

  • You may need someone to drive you for a while. The doctor will tell you when you can drive again.
  • You'll probably need help at home.
  • You'll need to go back in about 10 days to get the stitches out.
  • Don't lift anything heavy for several weeks.

Convergent procedure. This usually requires a 2- to 3-day hospital stay. Recovery is similar to catheter ablation.

Life after cardiac ablation

Catheter ablation may not cure your AFib, but it will often ease your symptoms. You could still have AFib episodes during the first 3 months because it takes that long for the scars to form.

If you've had AFib for a long time, you'll probably need another treatment to keep your heartbeat regular. You may also need medicine to control your heart rhythm for a few months after the procedure.

Most people who have the maze procedure get long-term relief from their symptoms. And many don't need to take heart rhythm medicine afterward.

Your doctor may recommend lifestyle changes to keep your heart healthy, including:

  • Eat a good diet with less salt and alcohol.
  • Quit smoking.
  • Keep a healthy weight.
  • Get more physical activity.
  • Try to manage stress and strong emotions.

Whether your cardiac ablation is successful depends on several factors, including what's causing your heart to beat irregularly. Some hospitals report success rates of 90% or higher, though there's a chance you will need a second procedure to treat your AFib. If cardiac ablation doesn't eliminate the problem, you may still need to take medication to keep your heart beating in a steady rhythm.

How long you live after cardiac ablation will depend on many factors, such as your age and whether you have other health problems. However, studies show that people with AFib who undergo cardiac ablation are significantly less likely to have strokes (which can be fatal) or die prematurely of any other cause than those who take medication for the condition.

It's very important to continue taking any medication your doctor prescribes after the procedure, such as anticoagulants (blood thinners). In rare cases — less than half of 1% — patients die within 30 days of undergoing cardiac ablation. However, that figure includes people who die of any cause, including those unrelated to heart disease.

There are several alternatives to cardiac ablation, including:

Electrical cardioversion. Your heartbeat is controlled by electrical signals, which get out of sync when you have AFib and certain other cardiac conditions. This procedure "resets" those signals by delivering a modest pulse of electricity to your heart through electrodes attached to your body.

Medications. Doctors prescribe several types of medication to treat AFib, including:

  • Blood thinners: These drugs, also known as anticoagulants, help prevent blood clots, which can cause strokes. Examples include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin. In rare cases, doctors may prescribe aspirin.
  • Heart rate-controlling drugs: This group of drugs helps slow a rapid-beating heart. The three categories are beta-blockers (such as atenolol and metoprolol), calcium channel blockers (diltiazem and verapamil), and digoxin.
  • Heart rhythm-controlling drugs: AFib can cause the heart to beat erratically. These drugs steady your heartbeat. They include sodium channel blockers (such as flecainide and propafenone) and potassium channel blockers (amiodarone and dofetilide).

Pacemaker. In some cases, your doctor may recommend having a pacemaker implanted to help control your heart rhythm. This battery-operated device connects to your heart by wires, though newer versions are wireless. Sensors on the wires can detect when your heart is beating abnormally. When that happens, your pacemaker sends pulses of energy to get your heart beating normally again.

New methods for ablation. Traditional cardiac ablation uses either heat or cold therapy to destroy tissue that's causing erratic heart rhythm. A new method called pulsed-field ablation (PFA) uses pulses of high electrical energy to treat the problem, instead. PFA is not yet widely available.

Your heart relies on electrical signals to keep beating and pumping blood to nourish every cell in your body. Conditions such as AFib can interfere with those signals, which can make your heart beat too fast, too slow, or erratically. Cardiac ablation can block abnormal electrical signals in the heart that cause irregular heartbeat. Be sure to tell your doctor about any new symptoms such as fatigue, chest pain, or dizziness.

How serious is cardiac ablation?

Any medical procedure involving your heart carries potential risks. However, cardiac ablation is relatively safe. One survey of 89 studies found that serious complications occurred in 2.4% of cardiac ablation cases.

How long does it take to fully recover from cardiac ablation?

You will probably feel well enough to resume normal activities within a few days, though your doctor will likely tell you to avoid lifting heavy objects for at least 1 week.

Are you awake during cardiac ablation?

In most cases, prior to cardiac ablation you will be given general anesthesia, which puts you to sleep.

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