Ablation involves the precise removal (or ablation) of specific portions of the heart muscle. These areas are carefully chosen by your doctor for treatment. Small amounts of energy are then applied to these selected regions, leading to the formation of beneficial scars on the heart muscle.

Ablation can be performed through either a surgical procedure or a catheter-based approach. In the catheter method, a flexible tube is inserted into a blood vessel.

The decision between catheter ablation and surgical ablation is determined by your doctor based on your specific condition. This section provides an overview of both catheter and surgical ablation techniques.

Ablation is also referred to by various names including cardiac ablation, catheter ablation, cryoablation, microwave ablation, radiofrequency ablation, and surgical ablation.

How is it done? Catheter ablation

Catheter ablation is a minimally invasive procedure that doesn't require chest incisions. It commences with a catheterization. In this process, a small, flexible tube (catheter) is inserted through a blood vessel, usually in your groin (or occasionally in your neck). Your doctor skillfully guides the catheter into your heart, aided by real-time imaging on a video screen or moving x-rays known as fluoroscopy.

The electrode at the catheter's tip senses the electrical signals of your heart and records electrical measurements. Your doctor conducts tests on your heart and then selectively removes sections of muscle tissue using the catheter. Catheter ablation can be performed using either intense cold (cryoablation) or high-frequency energy (radiofrequency ablation). In certain instances, particularly when ablation is performed in specific regions of the heart, you may require a pacemaker following the procedure.

Surgical ablation

Minimally invasive surgical ablation involves making six small incisions on the sides of your chest, each measuring between 1/2 to 3/4 inches. These incisions are significantly smaller compared to those required for traditional open-heart surgery. Through these incisions, your doctor introduces a tiny camera to visualize the heart. They then use small instruments to conduct tests on your heart and perform the necessary tissue ablation.

In contrast, open-heart surgical ablation necessitates a longer incision down the middle of the chest, cutting through the breastbone (sternum). This form of ablation is typically undertaken when you also require another type of treatment, such as a valve replacement or bypass surgery.

Irrespective of the type of surgical ablation, your doctor creates lesions (scars) on the heart muscle tissue by delivering energy to specific areas of the heart. This can be accomplished using:

• Intense cold, referred to as cryoablation
• Microwave energy, known as microwave ablation
• High-frequency energy, termed radiofrequency ablation
• Ultrasound energy
• Laser energy

What can I expect?

Typically, you'll receive instructions to refrain from consuming any food or beverages for a specified number of hours prior to the procedure. Catheter ablation is conducted in a specialized facility known as a "cath lab," while surgical ablation is carried out in an operating room. You'll be positioned on an examination table, and a small intravenous (IV) line will be inserted into your arm to administer fluids and medications.

Now, let's delve into a bit more detail about each of these procedures and surgeries.

Catheter ablation

The medications administered through the IV induce a state of grogginess, though you remain conscious throughout the procedure. To introduce the catheter, a small incision is made in the groin (or alternatively, in the neck), rather than the chest. The area is numbed, ensuring you shouldn't experience pain, although there might be some sensation of pressure as the catheter is inserted. Throughout the ablation process, your doctor or nurse may inquire about your well-being. Following the procedure, an overnight hospital stay may be required.

Minimally invasive surgical ablation

Throughout a surgical ablation, you will be administered medication that induces unconsciousness. As a result, you won't be conscious of the incisions made on the sides of your chest, or of the ablation procedure itself. Following the surgery, you can anticipate a hospital stay lasting one to two days.

Open-heart surgical ablation

In the course of a surgical ablation, you will be given medication that induces unconsciousness. Consequently, you won't have any awareness of the incision on your chest or the ablation procedure. Post-surgery, it's likely you will remain in the hospital for several days. You may experience discomfort at the incision site for a few weeks. Your recovery timeline will, to some extent, be influenced by any additional heart surgery you underwent concurrently with the ablation.