Catheter Ablation for Heart Rhythm Disorders: What to Expect

Some heart rhythm disorders can be controlled with medication, but medicines are not always effective and can cause side effects over the long term. Catheter ablation is a treatment that targets the small areas of heart tissue responsible for the arrhythmia. For many rhythm disorders, it can offer a lasting solution.

What is catheter ablation?

A regular heartbeat depends on electrical signals travelling along specific pathways. Some people have an extra conduction pathway, a short-circuit loop or a focus that fires irregular signals. During ablation, thin catheters are guided into the heart, the problem area is located, and a small, controlled scar is created to block the abnormal electrical activity.

Different energy sources can be used:

• Radiofrequency ablation: Uses heat delivered from the catheter tip. It is the most established method.
• Cryoablation: Freezes the tissue. A balloon catheter is often used in atrial fibrillation.
• Pulsed field ablation (PFA): A newer technology that uses very short electrical pulses to selectively target heart muscle cells, with a lower risk of injury to surrounding tissue. It is being used increasingly.

Which arrhythmias can be treated?

Who is it suitable for?

• Patients whose symptoms affect daily life and who still have episodes despite medication
• Patients who cannot tolerate medication or prefer not to take it long term
• As a first-line treatment for SVT and WPW, especially in younger patients
• Selected patients with atrial fibrillation, particularly early in the disease or when heart failure is also present

The decision depends on the type of arrhythmia, the severity of symptoms, other health conditions and the patient's preferences, and is made together with an experienced heart rhythm team.

Before the procedure

• It is important that the arrhythmia has been documented on an ECG or Holter recording. Smartwatch recordings can also help.
• An echocardiogram is performed to assess the heart. In atrial fibrillation, additional imaging may be done to make sure there is no clot inside the heart.
• You will usually be asked not to eat for about 6 hours beforehand.
• Instructions about rhythm medications and blood thinners are given individually. Do not stop your medications on your own.

How is it performed?

1. The procedure takes place in an electrophysiology laboratory under sedation or general anaesthesia.
2. Thin catheters are usually inserted through a vein in the groin and guided into the heart.
3. The catheters record the heart's electrical activity, and a three-dimensional electrical map of the heart is created to locate the problem area.
4. Energy is delivered to the target area. The team then checks whether the arrhythmia can still be triggered.
5. Depending on the type of arrhythmia, the procedure usually takes 1 to 3 hours.

Recovery

• Patients usually stay in hospital overnight and go home the next day.
• Avoid heavy lifting and strenuous exercise for a few days. Most people return to normal daily activities within a week.
• Mild bruising and tenderness in the groin are normal; report any growing swelling or bleeding immediately.
• After atrial fibrillation ablation, blood thinners are continued for at least a few months. Whether they are continued after that depends on your individual stroke risk, not only on whether the procedure was successful.
• Short palpitations in the first 2 to 3 months after AF ablation are common. This is considered a healing period and does not necessarily mean the procedure has failed.

What are the risks?

In experienced centres, ablation is a safe procedure. The most common problems are bruising and bleeding at the insertion site. Serious complications, such as fluid around the heart (tamponade), stroke, or a conduction problem requiring a permanent pacemaker, are rare. The risks vary with the type of arrhythmia and your general health, and your doctor will discuss them with you in detail before the procedure.

Conclusion

Catheter ablation is an effective treatment that can reduce or remove the need for medication in many heart rhythm disorders, and in some cases offers a permanent cure. In atrial fibrillation, the best results are achieved when ablation is combined with good control of risk factors such as blood pressure, weight, sleep apnoea and alcohol. If you have recurrent palpitations, a cardiology evaluation can identify the type of arrhythmia and the treatment options available to you.

Frequently asked questions

Is catheter ablation a type of surgery?

No. Ablation is a catheter-based procedure performed without opening the chest, usually through a vein in the groin. It leaves no surgical scar, and most patients go home the next day.

Will I feel pain during ablation?

The procedure is performed under sedation or general anaesthesia, so pain is usually not felt. Mild tenderness in the groin and slight chest discomfort may occur for a few days afterwards.

How soon can I fly after ablation?

Many patients can travel within a few days to a week after an uncomplicated procedure, but this depends on the type of ablation and your recovery. If you are travelling to Istanbul for treatment, discuss your return date with your doctor before booking flights.

Can the arrhythmia come back after ablation?

For some arrhythmias, such as SVT, the risk of recurrence is very low. In atrial fibrillation, short episodes can occur in the first months, and some patients need a second procedure. Controlling blood pressure, weight, sleep apnoea and alcohol reduces the risk of recurrence.

This article is for general information only and does not replace a medical consultation, diagnosis or treatment. Please make decisions about your own health together with your doctor.

Dr. Vedat Çiçek Cardiologist · Acıbadem Atakent Hospital, Istanbul. Former clinical researcher in cardiac electrophysiology and artificial intelligence at Northwestern University, Chicago.