A heart ablation procedure is sometimes used to resolve heart arrhythmias, but if you experience an arrhythmia recurrence, how many times can you have a heart ablation? The area of arrhythmia recurrence and effective techniques to stop them is still the object of study, but research does indicate a number that’s effective for most patients, after which further ablations don’t usually help.
How Many Heart Ablations? The Magic Number
Technically, there isn’t a limit on the number of times you 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 don’t solve the problem, further ablations probably won’t help—although there may be very rare cases in which a cardiologist might make up five or six attempts.
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 that focused on pulmonary isolation and the ablation of non-PV triggers.
- The remaining patients (those for whom the second procedure was ineffective in the long term) continued to treat 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 to stop the electrical signals in the heart that are causing arrhythmias (irregular heartbeats). The most common arrhythmias that are 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 without 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.
- Ventricular tachycardia (v-tach). The 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, but severe cases could lead to cardiac arrest.
While they’re not always life-threatening, arrhythmias increase the risk of stroke (a blood clot that inhibits blood flow to the brain) and heart attack (a blood clot or other blockage that inhibits blood flow to the heart) and may increase the risk of 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 traveling properly around the body.
Upon diagnosis, doctors usually try antiarrhythmic drug therapy first (because it’s less invasive) and may recommend a cardiac ablation procedure if the patient’s arrhythmia isn’t responding to the medication or the patient wants to avoid the side effects of the medications—which can include headache, nausea, tinnitus, constipation, dizziness, and more. As mentioned above, persistent atrial fibrillation is 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
In catheter ablation procedures, small sheaths (tubes) are inserted into the patient’s veins in the groin area under general or local anesthesia, and electrode catheters are threaded through the sheaths and up the blood vessels into 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 so that the catheters can destroy these signals using hot energy (radiofrequency ablation) or cold energy (cryoablation).
After the procedure, the patient will usually stay in the hospital overnight for recovery and observation and will be instructed to rest from physical activity for around one week. The patient may be instructed to take blood thinners and/or antiarrhythmic medications until the heart tissue heals. The heart should be fully healed in around three months.
Surgical ablation uses the same hot or cold energy as catheter ablation 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 recovery room in the hospital and 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 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 that experience arrhythmias again after a few months may opt for a repeat catheter ablation. The aim of this second procedure is to find pulmonary veins that have reconnected and isolate them to stop the arrhythmia.
Pulmonary Vein Isolation
In the study on atrial fibrillation recurrence that was cited earlier on, 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, indicating that this is an effective approach 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 if you have an irregular heartbeat is that addressing your cardiac risk factors can help you reduce the risk of 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 and, over time, may even begin to reverse heart disease that’s contributing to the arrhythmias.
When deciding on a course of action—whether to have a cardiac ablation or a second or third cardiac ablation, work on your diet and lifestyle, or try (different) medications—it’s important to talk with your cardiologist about the potential benefits and risks of each option and how much time you should spend on each strategy before trying something else.