Heart ablation is a procedure used to treat heart conditions that include a number of heart rhythm problems or in some cases enlargement of the heart known as hypertrophic cardiomyopathy. Heart ablation is in general a catheter-based procedure (such as TAVR for aortic stenosis or Mitraclip for mitral regurgitation) that means it is performed through small tubes usually inserted through the arteries or veins of the leg. These tubes are then passed up to the heart. In some cases however heart ablation can be performed as part of an open-heart surgery. The most common use of heart ablation is for rhythm disturbances known as SVT (supraventricular tachycardia from the upper chambers of the heart) a common cause of palpitations, or atrial fibrillation. The use of heart ablation has advanced over the years and is now commonly applied to heart rhythm problems from the lower part of the heart known as ventricular tachycardia. Another procedure known, as a heart ablation is alcohol septal ablation, a procedure used to treat enlarged heart tissue known as hypertrophic cardiomyopathy, a form of structural heart disease. In this article we will discuss the commonly performed heart ablation procedures.
What Happens in a Heart Ablation?
When used for heart rhythm problems such as palpitations, the goal of a heart ablation is to get rid of the tissue that is causing the problem. For example, lets say palpitations are being caused by a small focus of tissue in the upper chamber of the heart. A small tube known as a catheter is passed up to the heart and directed to the area where the palpitation are arising. Electrical energy is then passed through the tube to the end by a wire, essentially burning away the affected area. If successful, this will serve to stop the palpitations.
An alcohol septal ablation for a thick heart is different. In this condition the thick heart obstructs blood that is trying to leave the heart. A catheter is advanced into the coronary arteries that supply the heart with blood. The artery that supplies the thick area is located and alcohol delivered to that area to kill it off so it shrinks. If successful, this will allow blood to flow normally again.
Heart ablation for SVT
SVT is short for supraventricular tachycardia, a common cause of palpitations with a fast heart rate. An SVT can be thought of as a short circuit within the heart, usually near one of the pacemakers of the heart. An impulse can get enter the short circuit and essentially get trapped in there, basically firing off heartbeats in a fast and regular fashion. In a heart ablation for SVT, burning an area through the circuit preventing it from conducting the impulses disrupts the short circuit. Heart ablation for SVT is a successful procedure with a low risk of recurrence.
Heart Ablation for Atrial Fibrillation
Atrial fibrillation is a common heart rhythm problem and can lead to palpitations and associated symptoms, and increases the risk of stroke. In those patients with symptoms, especially in those who have not found anti-arrhythmic medications to be helpful, catheter heart ablation can be useful. The main triggers for atrial fibrillation are felt to arise from the veins known as the pulmonary veins that empty into the heart. Heart ablation is usually performed in those areas to prevent the triggers that start the atrial fibrillation. In carefully selected patients this can be a remarkably effective treatment. In some cases, heart ablation for atrial fibrillation is performed as part of a surgical open-heart procedure, usually when mitral valve surgery is also being performed.
Heart Ablation for Atrial Flutter
Atrial flutter is a form of heart rhythm problem where a short circuit in the top chamber of the heart often causes a rapid regular heart rate. Catheter ablation for most forms of flutter is remarkably successful, approaching 100%.
Heart Ablation for PVC’s
PVC’s are common and harmless in most people. Some people have remarkably high numbers of PVC’s and are also symptomatic from these. Heart ablation for PVC is increasingly being used as a successful treatment strategy. PVC’s arise from an irritable focus of tissue in the heart. If this area can be identified and is felt in a good location for heart ablation, then it can work to stop the PVC’s.
Heart Ablation for Ventricular Tachycardia (VT)
VT is a dangerous heart rhythm that can lead to sudden death if not treated. The treatment of VT depends on the underlying cause. There is increasing use of catheter ablation for VT, particularly in those who have not responded to medicines. In a VT ablation, the area of the heart where the dangerous rhythm is starting is identified and then energy applied to that area to prevent it from occurring.
Heart Ablation for Hypertrophic Cardiomyopathy
This is different from the other described heart ablations. In hypertrophic cardiomyopathy there is a thick area of tissue that obstructs the flow of blood out of the heart. In a procedure known as alcohol septal ablation, a small wire is passed into the artery that supplies the thick area of the heart with blood. A balloon is passed up to that artery and expanded to prevent blood flow beyond that point and alcohol injected through the balloon into that area, basically killing the thick area. This results in it shrinking over time and improving the blood flow out of the heart. It is now a widely used alternative to open heart surgery in many patients.
I was meant to have the Ablation done but when they were in my heart ready to go the Cardiologist couldn’t do the procedure as I had over 10 different mythologies, could you explain this please. An ICD was put in. I have Cardiomyopathy.
I have had a pace maker with a defibrillator approximately one year ago. Is it possible to now do an ablation. I believe that all of of the medications I am taking are causing me to have difficulty breathing. I also have a low energy threshold and feel light headed.
This is more a question for which I need some insight. I was told that I need a cardiac ablation for multiple rhythm irregularities. For this procedure, it was explained to me that they need to enter from the left side of my heart. Therefore, advising me that this is more complicated and dangerous. Can you answer me why this is so, and help me to understand the process and concerns. Thank You.
Left sided ablations are a little more involved as they involve crossing over from the left to the right side however in experienced hands and competent operators they are done regularly with low complication rate. Also the process of finding the focus if arrhythmia and ablating is more complex on the left. What rhythm is being ablated?
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I had a cardio (avnrt) ablation just over six weeks ago. I am still having episodes of arrythmia & high resting pulse rates (to 185). I was put on an event monitor & after reviewing episodal results, my cardiologist has determined that a retake ablation is in order. As I understand it, even if just 1 or 2 tiny fibers escape cauterization, symptoms can continue. How often does this occur, & is it safe & advisable to undergo this procedure a second time?
Recurrence of symptoms are not common however it may happen. The need for a repeat procedure is dictated by persistence of symptoms and an opinion from the treating electrophysiologist. Basically its uncommon, but it happens on occasion and if advised by a specialist a repeat procedure may be required.
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I have been diagnosed with svt… Doctors are recommending an ablation…. They have not given me any details of which side the fault is on…. But like with most people suffering from this condition the anxiety that comes with diagnosis is extremely high… I have been to several cardiologists who all gave me different answers…I also except that they have different degrees of knowledge… My concerns are that one cardiologist says an svt episode of 247 BPM is too high and dangerous for your heart to stand.. (mine lasted about 60 minutes).. Where as another cardiologist (EP) says I can go on living life normally and to ignore episodes and not to worry.but have an ablation. Easily said then done, but their we go…. If the latter is true why are people with svts being rushed to hospital and their heart restarted with the drug adenosine… surely the ambulance team would turn up diagnose svt and tell the patient its not life threatening and to ride it out. Also why are the hospitals offering people with SVT operations with potential complications for a non-life threatening condition… I have been quoted so many times the success rate of ablations at the hospital .. But what they do not say is or they do not know, when you have your operation and walk out of the hospital complications can occur several weeks or months after the ablation.. This data would not be recorded.. E.g if I have a heart attack/stroke/blood clot 2 months after the ablation this would be recorded as cause of death as a heart attack/stroke/blood clot and not a complication from surgery.
I was considering the ablation at first as SVTs do effect your daily life not just because of the uncomfortableness of them but mainly the fear of damage to the heart or the possibility of dying, but now I’m not sure. Cardiologists state that SVTs are benign and non life threatening, if this is the case why offer people operations that could possibly have such serious outcomes…. say 1 in 400 suffer a stroke etc etc.. to me thats still quite high.. Many sufferers on the internet post their own stories of successes and not so successful operations begs to differ the true statistics…Too many seem to get reoccurrence of SVT after an ablation and even worse go from SVT to AF.
Statements online say ‘ in most cases SVTs are not life threatening’… I want to emphasise on the words ‘most cases’ as this does not mean all cases. This little grey area is the reason why sufferers are anxious and possibly the reason why we end up in A & E or emergency departments with our SVT episodes. If we didn’t have this ‘what if its life threatening’ hanging over our heads i am sure most sufferers anxieties having another
SVT would also dissipate which would improve their lives dramatically, more so than having an ablation procedure.…
What I would really like answer to is
If I had an SVT of e.g 300BPM and stayed at home without intervention for hours/days and no matter how uncomfortable or symptomatic, would it kill me or damage my heart?And that all the symptoms from an SVT e.g tight chested, breathlessness, etc would disappear.
If the answer is yes… then the statements that it is not life threatening is false but would encourage me to have an ablation.
If the answer is no, then I possibly wouldn’t put my health at risk with an operation thats not complication free. Also the anxiety of having another SVT would mostly disappear due to the confirmation that it will cause no harm whatsovever to my heart which would be the reason for having the ablation in the first place.. If I chose to have an ablation knowing that the SVTs are not life threatening or damaging my heart, and just for the reason that its effecting my life due to anxiety and worry, surely then just the confirmation of the above would resolve this issue then their would be no need for an ablation. Of course in some peoples cases they would have the ablation as they have SVTs too frequently.
Even if a persons SVT was around the 160 BPM this doesn’t mean that their next wont be much higher. And if the cardiologist says that this rate is not life threatening and not to worry about it and go home, maybe the next time this person is sitting at home with an SVT of 250 BPM or more, they would stay at home as the cardiologist advised and this potentially could be dangerous. So we have to look at the worst case scenario for all sufferers and get the information out their as to relieve peoples worries and stress.
hospital and their heart restarted with adenosine… surely the ambulance team would turn up diagnose svt and tell the patient its not life threatening and to ride it out. Also why are the hospitals offering people with SVT expensive operations for a non-life threatening condition… I have been quoted so many time the success rate of ablations at the hospital and also my own research online.. But what they do not say is or they do not know, when you have your operation and walk out of the hospital complications can occur several weeks or months after the ablation.. This data would not be recorded.. E.g if I have a heart attack due to a svt 2 months after the ablation this would be recorded as cause of death as a heart attack and not a complication from surgery… I was considering the ablations at first as SVTs do effect your daily life. But now I’m not sure, as you all keep saying that SVTs are benign and non life threatening why offer people operations that could possibly have such serious outcomes…. say 1 in 400 suffer a stroke.. to me thats still quite high.. Also a lot of sufferers on this internet posting their own stories of successes and not so successful operations begs to differ the true statistics…Too many seem to get reoccurrence after an ablation and even worse go from SVT to AF. But again these would not be recorded. Again e.g if i had a blood clot several weeks after the op i would be sent to A & E and come under their statistics not the cardiologists.
I understand your frustration entirely. Ive not heard of things being so unclear. In general most SVT are curable by ablation. Some however are more difficult to ablate. For this reason the trend over recent years has been toward ablation of the easily ablated. Its not possible for me to tell you its nto dangerous without knowing a lot more about it, every case is different.
I would recommend the following:
Get an opinion by a well known specialist at a good center so you are comfortable with the decision.
Ask clarification regarding whether the SVT is one that is easily amenable to ablation or has the characteristics of a more complex one.
Ask if an EP study may help answer the question above.
I like to think that any benefit treatment offered by a medical professional should outweigh the risks of the procedure or it should not be performed.
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If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Hi there. I had the ablation 6 years ago after suffering about 4 episodes a year since I was 12. Mine could last hours until finally I would call an ambulance, have them IV me with the medication and then argue with them that I was not going to the hospital because all they would do is an ekg, recommend the ablation, and then give a bill for over 3000 dollars. I a pre exsisting so I could not get insurance. Did this my whole life. Then I got married and boom, I had insurance. Did the surgery right away and could not recommend it any higher! It has changed my quality of life. I did not realize how much until after my surgery. I was dealing with SVT daily but because it wasn’t an episode it didn’t really register. The feeling of it about it to get in and me stopping it with a deep breath was gone. It’s been such a relieve not having to deal with this anymore. But now I suffer from anxiety attacks from all the years of having SVT, but that’s minor compared to a 240 beat heart rate. If your questioning yourself, don’t, just do it.
Just came home from hospital had a stent put in my heart tool 3 sx until they finally got stent in right lalve had a palpitation this am which lasted about an hour took med metoprolol which is med I take 2x a day seemed to help heart rate went down to. Normal I am90 years old would u recommend I go for the sx to stop palpitations Have bad th for many years
I understand that ablation basically destroys the part of the heart muscle that malfunctions. Is this treating the symptom and not the root cause of the irregular heart beat? My friend was recommended to cardiologist for an ablation, but decided to go to a Functional Medicine Cardiologist. This cardiologist found numerous vitamin, mineral and amino acid deficiencies that basically were causing parts of the heart muscle to weaken and beat abnormally. Within one month of supplementation the symptoms were slmost gone. In addition to these deficiencies, my friends gut flora was total out of control.
The goal of ablation is to treat the root cause arrhythmic focus, the faulty tissue.
I just had an EP study done 5 days ago for SVT episodes and woke up in recovery just to be told that the ablation couldn’t be done, due to the fact that the short circuit was too close to the good area of my heart. If the doctor were to go ahead with the ablation, I was told that I would have needed a pacemaker. I’m only in my early 30s, so the thought of a pacemaker so early in life, didn’t sound ideal to me. I’m really thankful that the cardiologist/electrophysiologist knew what my best interest was and stopped the procedure, after he saw that it was probably impossible to burn the tissue that had to be destroyed to stop or cure the sudden palpitations.
Hi Sara, the exact same thing happened to me. They changed my medicine after the EP study and I am doing much better but it was very frustrating. How are you doing?
I have had 3 episodes of ad in the last year and half. 1 was corrected with Coreg. The other 2 times an antiarithmia medication was used and I went back to normal within a couple days. However, with these 2 different drugs I got pneumonia. Of these 2 episodes, only one was with 125+ heart rate. Ablation has been mentioned. Stress test is normal. However,each time these episodes seem to come after extreme pushing physical work. Is ablation really the answer?
It depends on the location and character of the arrhythmia.
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I’m currently in and out of arrhythmia and I’m not sure what kind it is, not having seen a physician or cardiologist yet. I can get somewhat lightheaded and short of breath, but that’s only when it’s at its worst level. I have dealt with arrhythmia occasionally throughout my life and I think my dad said he had a little of that himself. He’s now 83 years old so I’m not too worried in general, but I have to admit that, at it’s worst, it’s a little scary to experience. My question is about a possible diagnosis of arrhythmia – how simple or extensive is the testing for an accurate diagnosis and what may be involved in the testing? Thanks in advance Dr Ahmed!
The initial testing is simple and all non invasive, start with a visit to the Dr, an EKG and a heart monitor to characterize the heart rhythm.
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I had an ablation for pvcs wich was successfully still have a couple aday but right after surgery i was showing symptoms of pots so i was put on metoprolol and given a tilt table test which was positive for pots but before the ablation i had no pots symptoms are the two related?
Hi, I am a 46 year old female, no contraception medications used, I am a smoker, I have not been on bed rest. But I have just had my 2nd Pulmonary Embolism within 10 months. The first PE was massive went thru heart then became stuck surgery and an IVC filter placed. 4 months later, IVC filter was removed. Thought all was good.. and I was fine just completed writing out bills etc. out of no where bam it hit again, my chest felt like a bomb went of of, BP when paramedics arrived 190/96, but within 20 mnts it stabilized. Taken to hospital Dr was shocked I had blood clots in both lungs. No surprise to me. So I had to fight my insurance company to be covered for 5mg Eliquis x2 daily, after the high dosage for the first week. I’ve been thru hell, I left the hospital this time with more questions than ever. I didn’t damage my leg nothing, so they checked back of leg and sure enough a large clot that yet again attached and parts broke off. When I left the hospital this time they never rechecked my lungs, didn’t check the heart, only thing the did was put me on heparin. And I was sent on my way to figure out the rest on my own. None of this makes sense, I’m still dizzy, low energy, just low function.What are your ideas, thougti? I did schedule an appt with a pulmonologist.
I just had a cardiac ablation for A FIB. I am 65 and have diabetes. For the first three I thought that every bit of life was drained out of me. I felt that every one of my ribs were broken, and I was a human punching back. Never felt any where near this bad after surgery. No one explained on how bad I would feel after surgery.
I am a 45 year old female having PVC’s at a rate of about 27%. My doctor is recommending I have an ablation. I am other wise healthy and I do not drink or smoke. I have cut out caffeine, exercising more often, watching my diet more closely and have lost 25 pounds. I still have about 50 more pounds I would like to loose. I rarely feel an irregularity in my heart. I am on medication which now has my BP at around 95/65 (often lower than that) and normally runs around 115/75. Does it sound like this is a procedure that I need to have done?
Depends on a number of things.
1) Symptoms
2) Location and predicted success
3) Heart function and potential for improvement
4) Association with any ventricular tachycardia
Have you discussed these?
If you aren’t fully sure of the rationale for proceeding then you should make another appointment to discuss the procedure. I personally wouldnt want to perform any procedure unless the person having the procedure was fully on board.
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I have seen a cardiologist and he recommended meeting with another cardiologist who does ablations. I have been told I have PVC’s at a rate of 33%. I am now on the lowest dose beta blocker and feeling better. I have been under much stress and recently quit my job when I found I could not sleep waking up to a hard pounding chest feeling. I am now sleeping better. He said that I could live another 10 years or more if nothing is done, but if ablation is done it could cure the PVC’s. Do you agree with what I have been told?
Depends on symptoms, the characteristics of the PVC’s, and the heart function.
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I have heart palpitations that started recently. Do you recommend an ablation? I went to the hospital was admitted in with sinus tachycardia. I have been experiencing a lot of flutter and heart palpitations. In the ER they said it was striking flutter but then next day the head of cardio told me it looked more like sinus tachycardia. After that the next day when I was admitted they did a echocardio and said I had a dilated left ventricle but then the report was conflicted following and MRI with contrast that said it was normal but I had week outflow on the bottom. So reports where conflicting. The hospital doctors then recommend I get an Cardio ablation but after talking to my regular cardiologist he recommmed I check out of the hospital to see him and he did a holter monitor for a month and did his own echogram with contrast that he said was normal. The holter monitor after 30 days month showwd some pvc/pac but not to frequent he thought and looked ok. I still feel daily Palpations and heart flutters. He put me on metoprolol 25mg daily from which was cut to 12.5 since my blood pressure is in normal range. I still suffer from Palpations everyday and don’t know what to do or what the next step should be. I appreciate your input. Thanks
I would recommend consultation with an electrophysiologist.
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Hello, Dr. Ahmed, I had an ablation and was awake during the procedure, I was burned 3 times in the wrong place 🙂 Is that normal or what happened to the places I got burned?
Erica, how do you know it was the wrong place, do you know specifics?
Hello, I just had an SVT ablation done yesterday. I’m 31 years old female no history of heart-related issues until February of this year 2019 first episode with heart rate in 180s but by the time I got to the hospital, my heart rate was normal. I did not have another episode again until April. These episodes started to become more frequent and my cardiologist recommended ablation. However, the ablation was not successful. The EP could not get my heart rate up with maneuvers or adrenalin. I feel helpless at this point as it has changed my quality of life. It still blows my mind that I decided to do this and came out the same. I also wonder now if I am at risk for complications or more arrhythmias etc. just because I had the EP Study done. I am not a candidate for medication as my bp and heart rate stay so low until I have an episode. This is so frustrating and I have no idea what to do next. I have been under much stress with a big move coming up and family issues. I’m just wondering if diet and stress could have started this whole thing.
He did say to increase my sodium and iron, but nothing more was said. It just was not successful. I was very nervous and was heavily sedated before the procedure started. Will a second procedure be necessary or will I just live with this forever?
I think the fist place to start is an extensive discussion regarding these issues with the treating electrophysiologist. EP studies may well fail to find a culprit and in general there should be no long lasting effect from the study.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Dr Ahmed,
Question has to do with recurrence of atrial flutter following successful ablation in 2016. How likely is that to happen and would a 2nd catheter ablation be required. Since then a 1st degree rt. bundle branch block has occurred which is not being treated. Other than mild SOB I have no symptoms.
Thank you for the consideration.
It depends on the type and nature of the flutter. In general in typical flutter and the absence of other anatomical contraints ablation result should hold long term.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Dr Ahmed,
I have had 2 ablations done this year. The first one was done on May 7th and the second was on October 8th. Both were done at NYU Langone Health in NY. Its now been almost 5 weeks since my last ablation. I have had palpations for the past 2 weeks (bpms between 120-160). Yesterday I had to get electro cardioverted because I consistently had palpatations lasting almost 3 days straight. I am now back on Multaq as of today (had just finished my 30 day supply this past weekend). I am also on blood thinners,Eliquis. Anyway, I wanted to know if this is normal. I understand they say the heart is inflamed and it usually takes about 6-8 weeks for the heart to heal and then there is the 3 month blanking period. Should I be concerned? Or should I just let this run its course. Thank you
Hi Eddie,
I think given the proximity to the recent procedures, this is something that needs to be addressed by the treating team.
Hopefully this situation improves for you.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I’ve had an ablation about a month ago because I had SVT and my heart rate was going into the 260’s and I still feel burning in my chest I was wondering if that was normal from the procedure another thing they now told me I have inappropriate sinus tachycardia was wondering if that’s dangerous ? And also been diagnosed with pots … it seems like I was better before the ablation just my heart rate was so high any thoughts ?
I went into have ablation last week and was woken up to tell me that the ablation didn’t happen.
I was told the next day in the hospital that there was to many areas of cells to ablate and if he had made attempt to proceed would have damaged the heart.
I spent five days in hospital and put on Dofetilide 250 MCG and still having long bouts of arrhythmias.
Have you heard of such a problem as I am confused by it.
Thank you