How Serious Is Heart Ablation Surgery?

Cardiac ablation, or surgically destroying some heart tissue to improve heart function, is a relatively minor procedure when performed via a catheter. When ablation is part of open surgery, however, you'll need some ICU time and at least a week in the hospital to recover.

Cardiac (heart) ablation is a minimally invasive procedure that uses radiofrequency energy to destroy small areas of heart tissue that cause irregular heartbeats.

Certain cells in the heart produce electrical signals that travel along pathways to the chambers of the heart, causing the heart’s upper and lower chambers to beat in the proper sequence. If these cells are abnormal, they may create disordered electrical signals that result in irregular or rapid heartbeats called arrhythmias. If this occurs, the heart can not pump blood effectively and patients may experience symptoms such as:

• Faintness
• Shortness of breath
• Weakness
• A sensation of pounding heartbeats

Cardiac (heart) ablation surgery is used to treat:

• Supraventricular tachycardia (SVT), an abnormally fast heartbeat that occurs because of abnormal conduction fibers in the heart
• Atrial flutter, in which the heart’s upper chambers (atria) beat too fast
• Arial fibrillation, which is an irregular and often rapid heartbeat that increases the risk for stroke and heart failure

Medications are often used to treat rapid and irregular heartbeats but when they don’t work, doctors may recommend cardiac ablation. 

In cardiac (heart) catheter ablation, a doctor inserts a thin tube (catheter) with tiny electrodes attached to the end into the blood vessels in the groin or the neck which is then guided into the heart. When the catheter reaches the part of the heart causing the arrhythmia, the electrodes send electrical signals to destroy the abnormal cells and restore a regular heart rhythm. 

There are two main types of catheter ablation surgeries:

• Radiofrequency ablation, in which catheters send radiofrequency energy (much like microwave heat) to make circular scars around each vein or group of veins
• Cryoablation, in which a single catheter is used to thread a balloon that has a substance that freezes the tissues and cause scarring

In some cases, cardiac (heart) ablation must be performed surgically in what is called a maze procedure. There are three types of maze procedures: 

• Open-heart maze procedure 
  • Small incisions are made in the upper part of the heart that is then stitched together to form scar tissue that helps stop abnormal signals
  • This is usually done when a patient is having open-heart surgery for another heart problem, such as a bypass or valve replacement
• Mini maze procedure 
  • Less invasive
  • Several small incisions are made between the ribs, and a camera is used to guide catheters for either cryoablation or radiofrequency ablation
  • Robotic-assisted surgery may be used which is more precise and allows for smaller incisions 
• Convergent procedure 
  • Combines catheter ablation with a mini-maze procedure
  • Radiofrequency ablation is used in the pulmonary vein, and a small incision is made under the breastbone to use radiofrequency energy on the outside of the heart

In general, cardiac (heart) catheter ablation is a minimally invasive procedure and risks and complications are rare. 

• Catheter ablation may require an overnight stay in the hospital though most patients can return home the same day as the procedure. 
• Patients are usually advised not to bathe or swim for about 5 days, until the incisions have healed, and to wait up to two weeks before resuming exercise or heavy lifting.

However, maze procedures are a more serious surgery and if they are performed at the same time as another type of open-heart surgery, they require the use of a heart-lung bypass machine.

• A maze procedure usually requires about a one-week hospital stay, including a couple of days in an intensive care unit (ICU) before moving to a regular hospital room. 
• Full recovery can take up to 8 weeks, though patients usually start to improve in about 4 weeks. 
• If open-heart maze surgery is performed, patients may not be able to go back to work for 3 months, and it makes take 6 months to return to normal activities. 

Risks and complications of cardiac (heart) catheter ablation are rare and may include: 

• Damage the blood vessels
• Bleeding
• Infection

The risks and complications of open-heart maze procedures include:

• Bleeding
• Infection
• Damaged blood vessels 
• Stroke
• Pneumonia
• New arrhythmias
• Heart attack
• Heart damage, such as punctures or damaged valves
• Narrowing of the veins between the lungs and heart
• Need for a pacemaker 
• Blood clots 
• Kidney damage 
• Death (1%-2% of surgeries)