Overview

This information is for people using cardiac services at:

Harefield Hospital

Royal Brompton Hospital

St Thomas' Hospital

An ablation procedure is a treatment for a heart condition called atrial fibrillation. This is an irregular heart rhythm, which starts in the upper chambers (atria) of the heart. 

We can do an ablation procedure to treat areas of the heart involved in heart rhythm problems. If you have atrial fibrillation, we will target the atria with ablation treatment. 

The information covers:

• the benefits of the procedure 
• the risks of the procedure 
• how to prepare for a cardiac ablation 
• what happens during the procedure 
• what happens after the procedure 

If you have any questions, please contact the arrhythmia clinical nurse specialists who treat heart rhythm problems.

About atrial fibrillation

Atrial fibrillation is an irregular heart rhythm, which starts in the upper chambers (atria) of the heart. It is caused by disorganised electrical activity from different places in the atria. This makes the atria flutter or quiver (fibrillate) instead of contracting regularly.

In turn, the chambers that pump blood out of the heart (ventricles) beat rapidly and irregularly.

The symptoms of atrial fibrillation can include:

• palpitations (when your heart feels like it is pounding, fluttering or beating irregularly)
• shortness of breath
• tiredness

Atrial fibrillation also increases the risk of having a stroke.

About ablation

Ablation is a procedure that we can use to treat areas of the heart involved in heart rhythm problems. If you have atrial fibrillation, we will target the atria with ablation treatment. 

The aim of ablation is to destroy the faulty electrical tissue that causes your irregular heart rhythm (arrhythmia) using thin tubes (electrode catheters). This is done as a keyhole (minimally invasive) procedure through several small 3mm (0.12 inch) cuts in your groin.

We pass the catheters through the groin into the veins at the top of your leg and up to your heart. Then, we guide the catheters to a specific area inside your heart that needs to be treated.

When the catheters are in position, they use energy to destroy (heat or freeze) the tissue that is causing the problem. 

There are different types of ablations, including:

• cryoablation, which uses extreme cold to freeze and destroy tissue
• radiofrequency ablation, which uses heat energy to destroy tissue
• pulsed field ablation, which uses high energy electrical pulses to destroy tissue

Your health professional explains which type of ablation is most suitable for you.

Benefits of the procedure

We usually recommend ablation to treat atrial fibrillation if:

• your irregular heart rhythm is not well controlled with medicines
• you cannot take the medicines

After ablation, many people find that their symptoms (such as palpitations, shortness of breath or tiredness) improve or disappear completely.

Risks of the procedure

As with all medical procedures, ablation involves some risks. Your health professional believes that the benefits of the procedure are greater than the risks for you.

The risks of the procedure are listed in this section. All of these risks are small. We have balanced them carefully against the possible benefits of the treatment for you.

If you have any concerns, please speak to the arrhythmia clinical nurse specialists. You can also talk to the health professional who asks for your permission (consent) on the day of the procedure.

Bleeding or bruising

The most common risk of an ablation procedure is associated with putting the catheters in the veins of your leg. We do this under ultrasound guidance. The aim is to reduce the risk of significant bleeding or bruising when we remove the catheters at the end of the procedure. 

However, heavy bleeding or bruising still affects up to 1 in 50 people.

Stroke

A stroke can happen at the time of the procedure or afterwards. This affects about 1 in 250 people. You would then need to stay in hospital to be treated.

Fast heartbeat

After the procedure, the heart can sometimes start to beat too fast but regularly. This condition is called atrial tachycardia. It affects up to 1 in 10 people, although the exact risk depends on what type of ablation you have.

If your heart beats too fast, this may feel worse than the atrial fibrillation. However, the condition often settles in the first few months after an ablation. 

In the meantime, you can manage the condition by:

• taking medicines
• having a treatment called cardioversion to correct your heartbeat
• having another ablation procedure, if needed

Nerve damage

The equipment used during cryoablation (which freezes tissue) may damage the right phrenic nerve for about 1 in 100 people. This nerve goes near the heart and supplies part of the body's main breathing muscle called the diaphragm. 

If the phrenic nerve is damaged, this may cause shortness of breath (particularly if you bend forward or do exercise).

In most cases, the phrenic nerve is expected to work fully again without treatment. This usually takes from a few days up to 9 months.

Heart infection

Infection in the heart or of the heart valves (called endocarditis) is a very rare but recognised complication. It affects about 1 in 10,000 people who have the procedure.

We can usually treat the infection with antibiotics but sometimes need to do surgery.

Damage to a heart valve

In rare cases, a valve in the heart may be damaged from the ablation or from one of the catheters getting tangled in the valve. This does not usually need treatment, but in very rare cases we may need to do surgery. 

Serious complications

There is a very small chance of death in about 1 in 1,000 cases. This may be because of:

• a stroke
• cardiac perforation (a ruptured or perforated heart)
• a very rare complication called an atrial-oesophageal fistula (an abnormal connection between the food pipe and the left atrium of the heart)

The symptoms of an atrial-oesophageal fistula include:

• pain when swallowing
• chest pain
• sweats
• flu-like symptoms
• changes to your sight, speech or power in a limb

Other treatment options

You have been referred for ablation because other treatments have not stopped your irregular heart rhythm.

You might have already tried medicines or a treatment called direct current (DC) cardioversion to restore your heart rhythm and ease symptoms.