What to Expect Before, During, & After Cardiac Ablation

What Tests Are Done Before Cardiac Ablation?

Your cardiologist may recommend a cardiac ablation if you have an irregular heartbeat (arrhythmia). The procedure sends heat or cold through thin, flexible wires (catheters) to the damaged heart tissue. The heat or cold destroys the tissue that causes the arrhythmia.

Before cardiac ablation, you’ll need some tests:

Blood test—You get a blood draw to check your kidney health. You need to have this blood test about one month before your MRI.
Cardiac MRI—MRIs use magnets and radio waves to take pictures of the inside of your body. This test gives us useful information about the structure of your heart and provides a roadmap of where to ablate. On the day of the test, a technologist places an IV in your arm that contains contrast dye so your tissues show up clearly on the test. You lie on your back on a table that moves you into the MRI machine. The machine looks like a large donut. We give you a ball that you can squeeze to let the technician know if you feel uncomfortable. The machine is loud, so we give you headphones to hear the technologist’s instructions. They may tell you to breathe in, out, or hold your breath for certain parts of the scan.
Cardiac CT scan—You may get a cardiac CT scan if you can’t have an MRI. CT scans use X-rays and special computers to take pictures. The test is painless and noninvasive.
Transesophageal echocardiogram (TEE)—In some cases, you might need a transesophageal echocardiogram to check for blood clots in your heart on the day of your ablation. A TEE uses sound waves to record images of your heart from inside your esophagus (food pipe). We spray your throat with numbing medicine. You may also get an IV with medicine that helps you relax. You lie on your side. We gently insert a tube into your mouth and into your esophagus. Some people can feel the tube moving but don’t report pain or breathing issues. The test takes about 20–40 minutes. You will need someone to drive you home afterward.

How to Prepare for Cardiac Ablation

Your electrophysiologist (doctor specializing in treating arrhythmias) will give you specific instructions to prepare for your cardiac ablation:

Avoid eating or drinking after midnight on the day of your procedure.
Avoid wearing fragranced lotion or perfume.
Remove makeup and nail polish.
Take prescribed medications with a small sip of water only as directed.

What to Bring to Your Appointment

You should bring several items with you to your appointment:

Cases for your contacts, glasses, or dentures if you wear any of these items
List of current medications, including the drug name, dose, and how often you take it
Picture ID and insurance card, if you have one
Work release form, if needed

What Happens on the Day of Cardiac Ablation?

Your medical team members follow several steps on your procedure day:

Insert an IV to give you medications and fluids.
Place a thin, flexible tube into your bladder to drain urine, if needed.
Shave your groin area and neck where your electrophysiologist will insert thin, flexible wires (catheters).
Place patches on your chest and back that monitor your heart rhythm.

You go into the procedure room and move to an X-ray table yourself, if you are able. If you’re not able to do so, your team will assist you. The room can be cold due to maintaining an appropriate temperature for medical equipment, so we will give you blankets to stay warm.

The nurse covers your body with a cloth to keep the areas on your groin and neck clean (sterile). You will still be able to see the nurse.

A nurse or anesthesiologist (doctor specializing in giving anesthesia) will give you medication through the IV. You may get general anesthesia so you remain asleep or light sedation so you are slightly awake. You and your electrophysiologist and anesthesiologist will decide which medicine is right.

How Is a Cardiac Ablation Done?

Your electrophysiologist inserts thin, flexible wires (catheters) into one of your blood vessels. They direct these catheters to your heart with the help of X-ray imaging. You will feel a little pressure when the electrophysiologist inserts the catheter. Most people don’t report feeling any pain.

Your electrophysiologist can use a mapping catheter first. The mapping catheter locates the part of your heart sending irregular signals. It marks those areas on a 3D mapping system.

Your electrophysiologist uses the mapping system to direct another catheter to specific areas of your heart. Then they use cold energy (cryoablation), heat (radiofrequency), or pulse field ablation (pulses of electrical signals) to create scar tissue (lesions) on your heart. These lesions disrupt the irregular electrical signals in your heart.

Where Is the Catheter Inserted for Cardiac Ablation?

Where we place the catheters depends on the part of your heart we’re treating. Your electrophysiologist usually inserts the catheter into one of the blood vessels in your groin. They occasionally use a blood vessel in your neck.

How Long Does a Cardiac Ablation Take?

A cardiac ablation usually takes about 2–6 hours. The specific length of your procedure depends on multiple factors:

How deep an arrhythmia is in your heart tissue
How stable your arrhythmia is
Number of arrhythmias you need to have treated
Which heart chamber the arrhythmia comes from

What to Expect After Cardiac Ablation

You will need to lie flat for up to six hours to make sure any bleeding stops. Your electrophysiologist might use a closure device to plug the insertion sites.

You may stay in the hospital overnight for monitoring or you may go home the same day. Your doctor may also give you a prescription to take during recovery.

Cardiac Ablation Risks & Side Effects

Cardiac ablation is a low-risk procedure. You should discuss any possible problems or side effects with your electrophysiologist:

Bleeding and infection
Blood vessel damage where the catheter was inserted
Damage to your heart, its electrical system, or nearby structures
Heart attack
Irritation around your heart
New arrhythmias
Stroke

Groin Cardiac Ablation Scar

A cardiac ablation leaves little to no scarring on your groin. Your electrophysiologist uses needles to insert the catheter, so the scars are small.

Cardiac Ablation Recovery

You’ll return to your usual activities gradually after the procedure. A typical recovery time is about one week.

The evening of your procedure: You should start walking.
2–3 days: Avoid driving for at least 48 hours. You can usually return to office work in 2–3 days. You may need to wait longer if you have an active job.
7 days: Refrain from exercise, sex, and lifting anything heavier than 10 pounds. For reference, a gallon of milk is usually about 10 pounds.

It takes up to 8 weeks for the scars in your heart to heal. You may still experience irregular heartbeats during this time. Your doctor may prescribe medications or other treatments to regulate your heartbeat during recovery. Some of the following symptoms are common:

Faster heartbeats
Mild chest aches
Skipping heartbeats

When to See Your Doctor for Problems After Cardiac Ablation

Call your electrophysiologist if you experience any concerning symptoms after your cardiac ablation:

Bleeding
Chest pain or shortness of breath
Coldness, numbness, or swelling near where the catheter was inserted
Fever over 100 F
Severe bruising or pain where the catheter was inserted
Stroke symptoms, including confusion, difficulty speaking, numbness on one side of your body, or a severe headache