17801 Ablation Therapy

Overview

Ablation therapy is a procedure, not a medicine. It uses heat, cold or another type of energy to make tiny scars in a small area of tissue that is causing a problem. Those scars stop the tissue from sending out the signals or growing in the way that is causing trouble. The word 'ablation' simply means removing or destroying tissue. It is most often used for heart rhythm problems, but it is also used for some small tumours, varicose veins, endometriosis, overactive thyroid nodules, an enlarged prostate and some types of long-term pain.

Yes. Catheter ablation for heart rhythm problems is one of the most common heart procedures worldwide, with hundreds of thousands performed each year. Other types of ablation, such as for varicose veins, endometriosis or small tumours, are also routine in many hospitals.

It depends on the type of ablation. Heart ablation is most common in adults over 50 and in people with atrial fibrillation (an irregular heartbeat), but teenagers and children can also need it for certain fast heart rhythms. Tumour ablation is usually offered to adults who are not able to have surgery. Vein and prostate ablation mostly affect older adults.

Symptoms

Common symptoms

• Palpitations — a fluttering, pounding or racing feeling in your chest
• Feeling dizzy or lightheaded
• Breathlessness, especially when active
• Tiredness or low energy that is new for you
• Chest discomfort during an episode
• Fainting or nearly fainting
• Episodes that start and stop suddenly, sometimes lasting minutes and sometimes hours

Symptoms in children

• Babies may feed poorly, sweat a lot or breathe fast during a fast heartbeat
• Older children may say their heart is racing or 'fluttering' in their chest
• Some children feel dizzy, sick or faint during an episode
• A fast heart rhythm in a child is sometimes first noticed at a routine check-up
• Children may simply seem more tired or less willing to play than usual

Symptoms in older adults

• An irregular or racing heartbeat, which is often atrial fibrillation and becomes more common with age
• Breathlessness and low energy during everyday tasks
• Swelling in the ankles or legs
• Feeling unusually tired, sometimes with no chest symptoms at all
• Dizziness or lightheadedness when standing up

Causes

Main causes

• In the heart: extra electrical pathways or misfiring tissue that cause fast or irregular heartbeats, such as atrial fibrillation, atrial flutter or supraventricular tachycardia
• In the heart: small areas of muscle in the lower chambers that trigger dangerous fast rhythms (ventricular tachycardia)
• In the liver, kidney, lung or bone: small tumours that can be destroyed with heat or cold when surgery is not suitable
• In the legs: leaky valves in veins that cause varicose veins
• In other areas: overactive thyroid nodules, endometriosis patches, enlarged prostate tissue, or nerve tissue carrying long-term pain

When to see a doctor

See a doctor urgently if:

• You have a racing or irregular heartbeat that will not settle
• You feel faint, dizzy or breathless during an episode
• You notice new swelling in your legs or ankles
• You have a fast heartbeat together with feeling unwell, sweaty or sick

Book a routine appointment if:

• You have repeated palpitations, even if they pass quickly
• You feel more tired or breathless than usual over weeks or months
• Medicines for your heart rhythm are causing side effects that bother you
• You have had an ablation and your old symptoms are coming back
• You want to talk through whether ablation might be an option for you

Diagnosis

Your doctor will start by asking about your symptoms: what they feel like, when they happen, how long they last and what brings them on. They will examine you and arrange tests. For heart rhythms, the key test is an ECG (electrocardiogram) — a quick, painless recording of your heart's electrical activity. Because episodes often come and go, you may be given a portable monitor to wear at home. If ablation is being considered for something other than the heart, scans such as ultrasound, CT or MRI are usually used to look at the area and plan the procedure.

Tests that may be done

• ECG — a quick, painless recording of your heart's electrical activity
• Holter or event monitor — a small wearable device that records your heart for a day or longer to catch episodes
• Echocardiogram — an ultrasound scan that shows the heart's size, valves and pumping action
• Exercise or stress test — recording your heart while you walk on a treadmill or cycle
• Blood tests — to check your thyroid, salt levels and general health
• Electrophysiology (EP) study — a procedure using thin tubes to map the heart's electrical signals before treatment
• Imaging such as ultrasound, CT or MRI for ablation of tumours, veins, thyroid nodules or prostate tissue

What to expect at your appointment

Testing is usually done over a few appointments, and it is common to need more than one test before the picture is clear. Wearing a monitor for a day or two can feel awkward, but it gives your doctor the information they need. Once the results are in, your team should explain what they found, what the options are and what each option involves — including doing nothing for now. You are always free to ask questions or take time to decide.

Treatment

Ablation is one option among several, and the right choice depends on your condition, your symptoms, your age and your general health. For heart rhythm problems, the aim is to stop or greatly reduce the abnormal rhythm so you feel better and, in some cases, need fewer medicines. For tumours and other conditions, the aim is to destroy or shrink the problem area without open surgery. Your doctor should talk you through the benefits, the risks, the alternatives and what happens if you wait.

Self-care at home

• Keep a simple symptom diary — what happened, how long it lasted and what you were doing
• Learn to check your own pulse, and note whether it feels regular
• Cut back on alcohol and caffeine if they seem to trigger episodes
• Stay as active as feels comfortable, and build activity up gradually
• Take any prescribed medicines exactly as directed, and never stop them on your own
• Follow the preparation instructions before your procedure, such as when to stop eating and drinking
• Arrange a lift home and a quiet few days afterwards if you are having sedation

Medical treatments

Doctors usually consider other treatments first, or alongside ablation. For heart rhythm problems these can include medicines that slow the heart rate, medicines that steady the rhythm, and medicines that lower the risk of blood clots. For other conditions, treatment may include hormone treatment, pain control, or compression stockings for vein problems. Your doctor will explain the likely benefits and possible side effects of each option and help you decide what suits your life. Never start, stop or change any medicine without talking to your prescriber or pharmacist first.

When is surgery considered?

Ablation itself is usually a minimally invasive procedure rather than open surgery. Most heart ablation is done by passing a thin, flexible tube (catheter) through a small cut in the groin and guiding it to the heart using X-ray or ultrasound pictures. You are usually awake but relaxed with sedation, and the area is numbed so you should not feel pain. Some types of ablation, such as for certain tumours, are done by passing a thin needle through the skin under scan guidance. Open surgery is only needed in particular situations, and your team will tell you if that applies to you.

Living with this condition

Most people go home the same day or the next day after a catheter ablation. You may have bruising or mild soreness where the tube went in, and you will usually be asked to avoid heavy lifting and vigorous exercise for about a week. Many people feel tired for a few days. Some notice their old palpitations for a short while after the procedure — this can happen as the heart settles, but tell your team if it worries you. Follow the written instructions you are given about wound care, medicines and driving.

Lifestyle tips

• Build activity back up gently over the first couple of weeks
• Keep alcohol within low levels — it is a common trigger for atrial fibrillation
• Aim for regular, moderate exercise such as walking, swimming or cycling
• Keep your blood pressure and weight in a comfortable range
• Get help for loud snoring or poor sleep, as sleep apnoea affects heart rhythms
• Attend your follow-up appointments, even if you feel completely well

Diet and exercise

There is no special diet after ablation, but a heart-friendly pattern of eating helps the underlying problem. That means plenty of vegetables, fruit, wholegrains, beans and lean protein, less salt, and fewer processed and sugary foods. Regular moderate exercise — enough that you are warm and slightly out of breath but can still talk — is good for the heart and for mood. If exercise triggers symptoms, note it down and mention it at your follow-up rather than stopping activity altogether.

Mental health and emotional wellbeing

It is very common to feel anxious about your heart, especially if you have had frightening episodes or are waiting for a procedure. Some people find themselves checking their pulse constantly or avoiding exercise and social plans. These feelings are understandable and worth mentioning to your doctor — support such as talking therapy, relaxation techniques or a cardiac rehabilitation programme can help a lot. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your area straight away, and tell someone you trust how you are feeling.

Prevention

You cannot prevent every condition that leads to ablation, but you can lower your risk of the most common one — heart rhythm problems — by looking after your heart. Keeping blood pressure in a healthy range, staying active, limiting alcohol, not smoking, treating sleep apnoea and keeping to a comfortable weight all make a real difference.

Screening programmes

There is no single screening test for ablation itself. Routine checks such as having your blood pressure measured and having your pulse felt can pick up an irregular heartbeat early, which is one reason to attend regular health checks. If you have a family history of heart rhythm problems or a condition such as an overactive thyroid, mention it to your doctor.

Complications

If left untreated

• Symptoms such as palpitations, breathlessness and tiredness may continue or get worse
• Some heart rhythms raise the risk of stroke over time if they are not treated
• An untreated fast rhythm can, in some people, weaken the heart muscle over months or years
• Symptoms may limit work, exercise, driving and social life
• Some conditions, such as certain tumours or varicose veins, can slowly worsen if left alone

Long-term outlook

For most people, ablation is a well-established procedure with good results. Many people have far fewer symptoms afterwards, and some are able to reduce or stop certain medicines with their doctor's guidance. Not everyone is cured by one procedure — a second ablation is sometimes needed, and some people still need treatment afterwards. Your team will talk honestly with you about what is realistic in your case, and there is support available at every stage.

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