A heart ablation is a procedure that sometimes is used to resolve heart arrhythmias. These arrhythmias can reoccur, but how many times can you receive an ablation? Arrhythmia recurrence and effective treatments for this problem are still under qualitative study. However, research does suggest that after a certain number of procedures, they are no longer considered an effective mode of treatment.
How Many Heart Ablations? The Magic Number
Technically, there isn’t a limit on the number of times one can have a heart ablation—it’s ultimately the patient’s choice. However, research and doctors agree that if two (or sometimes three) heart ablations do not resolve the problem, most likely further ablations will not help.
In a study published in 2016 in the Journal of Atrial Fibrillation, the researchers observed that:
- Atrial fibrillation was resolved in 60-80% of patients with one heart ablation procedure.
- Of those patients who had a recurrence of atrial fibrillation after more than three months, 75% were resolved with a second heart ablation procedure, which focused on pulmonary isolation and non-PV triggers.
- The remaining patients (those for whom the second procedure was ineffective long-term) continued treatment for atrial fibrillation with antiarrhythmic medications.
What Is a Heart Ablation Meant to Achieve?
A heart ablation procedure (also called cardiac ablation) destroys tiny areas of heart tissue that disrupt electrical signals in the heart, causing arrhythmias (irregular heartbeats). The most common arrhythmias treated with a cardiac ablation are:
- Atrial fibrillation (a-fib). The top chambers of the heart (atria) quiver instead of beating, reducing blood flow to the body. This arrhythmia is not to be confused with ventricular fibrillation (a quivering of the lower chambers of the heart) which causes sudden cardiac arrest and death. V-fib constitutes an emergency that requires immediate chest compressions and an electrical shock from an automated external defibrillator such as the LIFEPAK CR2 or Philips HeartStart FRx.
- Atrial flutter. The atria or upper chambers of the heart beat so fast that the heart doesn’t have time to properly empty and refill for adequate output.
- Ventricular tachycardia (v-tach). This is a critical life-threatening rhythm. The larger ventricles are beating too fast to pump blood effectively around the body. This kind of irregular heartbeat can occur with or without a pulse. If there is no pulse, the patient can go into cardiac arrest and needs immediate chest compressions and defibrillation.
- Supraventricular tachycardia. This arrhythmia affects the upper chambers and causes a very rapid heartbeat—between 150 and 220 beats per minute, sometimes less or more. Mild cases of SVT pass in a few minutes or days[mfn]mayoclinic.org[/mfn], but severe cases could lead to cardiac arrest.
While arrhythmias are not always life-threatening, they do increase a person’s risks. The primary risks are stroke (a blood clot that inhibits blood flow to the brain) and heart attack (a blood clot or blockage that inhibits blood flow to the heart), which results in a risk for sudden cardiac arrest. Arrhythmias can also be uncomfortable for the patient, causing symptoms including palpitations, weakness, fatigue, fainting, and shortness of breath. These symptoms occur because oxygen-rich blood is not being circulated throughout the body properly.
After diagnosis, doctors usually prescribe an antiarrhythmic drug first (because it’s less invasive). They may recommend a cardiac ablation procedure if the patient’s arrhythmia isn’t responding to the drug treatment. Some patients want to avoid the side effects of medications—which can include headache, nausea, tinnitus, constipation, dizziness, and more. As mentioned above, persistent atrial fibrillation is usually resolved in around 90% of cases with one or two ablation procedures.
How the Cardiac Ablation Procedure Works
There are three kinds of cardiac ablation:
- Catheter ablation
- Surgical ablation
- Hybrid surgical/catheter ablation
Catheter Ablation
In catheter ablation procedures, small sheaths (tubes or catheters) are inserted into the patient’s veins in the groin area under general or local anesthesia, and electrode catheters are threaded through the small catheters up the blood vessels to the heart, guided by X-rays.
Once in the heart, technology is used to help the electrode catheters find the electrical signals that are causing the arrhythmia. The catheters can then destroy these disruptive signals using hot energy (radiofrequency ablation) or cold energy (cryoablation).
After the procedure, the patient usually stays in the hospital overnight for observation and monitoring. Then they will be instructed to rest from physical activity for around one week. The patient may be instructed to take (or continue) blood thinners and/or antiarrhythmic medications until the heart tissue heals. The heart is expected to be fully healed in about three months.
Surgical Ablation
Surgical ablation uses the same hot or cold energy as in the catheter ablation procedure to stop malfunctioning electric signals in the heart. However, the energy is applied directly rather than running catheters up from the groin.
Usually, surgical ablation is performed when the patient is already having open-heart surgery for other reasons. The patient will typically stay in the intensive care unit (ICU) for several hours to a few days after the procedure, followed by at least one week in a hospital recovery room, and then several weeks off work.
Hybrid Surgical/Catheter Ablation
In a hybrid surgical/catheter ablation, incisions are made in the chest, and electrode catheters are threaded up blood vessels from the incisions to the heart. The level of risk and recovery time vary but are somewhere between those of catheter and surgical ablation.
Repeat Catheter Ablation
In most cases, the initial ablation procedure is sufficient for stopping arrhythmias long-term. However, patients who experience arrhythmias again after a few months may opt for a repeat catheter ablation. The aim of this second procedure is to find the culprit pulmonary veins, isolate them, and stop the arrhythmia.
Pulmonary Vein Isolation
In the study on atrial fibrillation recurrence that was cited earlier, the researchers found that pulmonary vein reconnection was almost always responsible for the recurrence of previously ablated atrial fibrillation. The pulmonary veins are those that carry blood from the lungs to the heart.
When performed, pulmonary vein isolation combined with the ablation of other triggers in the “atrial substrate” stopped the arrhythmia long-term for 3 out of 4 of these patients, which indicates that this is an effective treatment for a second atrial fibrillation ablation. The authors also noted that further heart ablations were unlikely to be effective.
Risks of the Cardiac Ablation Procedure
While the heart ablation procedure usually stops the arrhythmia, it does come with some risks. Patients who opt for a repeat catheter ablation need to weigh the potential benefits with the potential risks.
- Exposure to radiation during the catheter ablation procedure
- Irregular heartbeat (arrhythmias), especially while the heart heals
- Blood clots, potentially causing a stroke or heart attack
- Infection or bleeding at the puncture site
- Damage to the vein in the groin from the sheath and catheter
- Damage to the heart, including a puncture or damage to the valves
- A narrowing of the pulmonary veins (pulmonary vein stenosis)
- Death (rare)
How to Reduce Your Risk of Recurrent Arrhythmias
The good news is: If you reduce your cardiac risk factors, you can help reduce the risk for recurrent arrhythmias. You can:
- Treat heart failure and coronary artery disease, if present
- Treat sleep-disordered breathing, if present
- Lose weight if overweight
- Lower high blood pressure
- Eat a heart-healthy diet
- Exercise regularly
- Stop smoking
- Reduce alcohol consumption
- Reduce stress
- Check your cholesterol, blood pressure, and blood sugar annually
- Take all heart medications as prescribed
It’s important to remember heart medications, including antiarrhythmics, only work if you take them as prescribed by your doctor. It’s also important to realize that dietary and lifestyle changes help heart medications to be more effective. Over time, these changes may even begin to reverse heart disease that contributes to any arrhythmias.
When deciding on a course of action, it’s important to discuss your treatment plan with your cardiologist. This could include things like choice of procedure, medications, diet, and possible lifestyle changes.
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