Are there Risks to Ablations?

Catheter ablations are known to be a safe procedure with very little associated risks. Most cases end successfully, making it a lot safer to undergo the procedure than not undergoing it at all. In 2010, the chances of experiencing any complications during the procedure fell to as low as 2%. The current rate of complications during an appendectomy is considered to be around 18%.

Having a catheter ablation is a better option compared to other medication options, such as anticoagulants and antiarrhythmic drugs. The procedure saves you the trouble of having to take drugs for the rest of your life to keep the heart complications in check.

 

The risks associated with ablation

However safe this procedure can get, there may be small complications involved in a few of the cases. They include:

• There is a small chance of damaging the arteries and/or veins when inserting the catheters. This is a complication that you may experience even when donating blood and can be fixed surgically. It is a common occurrence to experience some minor bruises on both access site points in each side of the groin. These bruises come with a minor soreness in most cases and they may sometimes extend all the way down to the legs. It is also normal to occasionally witness a small bump in the operated area. You should, however, contact your electrophysiologist if you experience significantly large swelling or increased pain in the area after the procedure.
• During the procedure, the doctor needs to pass the catheter between the left and right atria via the transseptal wall so as to access the left atrium, which is normally the source of a large percentage of a-fib signals. There are slightly higher chances of witnessing complications, such as pancuring of the heart and bleeding from the tamponade (heart walls) because of puncture technique plus the manipulation of the catheter involved. If bleeding occurs, blood can fill the pericardium (the sac around the heart) and it will have to be removed by use of a catheter and a needle. Some extreme and rare cases may require surgery to be fixed. The associated risks of catheter manipulation are mostly determined by the qualifications and the level of experience your doctor has.
• There are chances of blood clotting and stroke in a-fib. This explains why a blood thinner such as Heparin is used during the procedure. It helps reduce the risks of clotting of the blood during the execution of RF energy to the heart tissues. The doctor often checks for any signs of blood clotting or pooling in the atria prior to the ablation procedure. Certain medications may be used to dissolve the clotting, if any. The risk of experiencing a stroke (thromboembolic) during the ablation is lower than 0.5%, according to a study performed by the French Bordeaux group.
• There are chances of narrowing and damaging the pulmonary vein openings when they are isolated or ablated.  The doctors involved in the procedure may have to enlarge the narrowed area or put a stent into the vein to keep it open in case of stenosis (a huge swelling). The fact that stenosis can be easily corrected makes it less of a complication.

Stenosis was considered to be a major complication during pulmonary vein ablation. But it soon became less and less of a problem due to the using of irrigated-tip low wattage catheters and ablations outside the vein openings in the antrum area. You can consult your doctor for more information prior to the procedure. You should consider switching doctors or the medical facility if they can’t make such information available to you.

• The amount of exposure to x-ray during a catheter ablation procedure might also pose as a risk. In most ablation cases, a type of x-ray known as fluoroscopy is used to get a detailed view of interior of the heart especially when positioning the catheters. It is however not much of a risk since it is the doctor’s responsibility to know the maximum amount of fluoroscopy that you can be exposed to without putting you in danger of its effects.
• There are a number of unexpected complications that might also arise during the catheter ablation procedure. Some of them include infections, allergic reactions from the medications involved, and heart attacks during the procedure and valve damage, among others. However, this should not get you worried because the doctors and nurses involved in the procedure have been prepared to swiftly handle such complications when they arise.

 

What are the chances of dying during the ablation procedure?

The chances of a patient dying during the ablation procedure are significantly low. Actually no particular death cases have been heard in more than 2000 of the procedures in recent years. However, some significantly rare complication known as atrial-esophageal fistula has been responsible for a slight increase in death cases during the ablation procedure. It is a complication whereby a hole develops between the esophagus and the atrium in two to three weeks after undergoing the procedure. The esophagus may be irritated by heat from the catheter and acid reflex may slowly eat through this irritated part of the esophagus.

The irritation may be as a result of using high-wattage catheters near the esophagus during the procedure. The primary symptom associated with this complication is high fevers of more than a hundred degrees anytime during the first three weeks after the surgical procedure. It is important to immediately contact your doctor if you witness this symptom so as to avoid more severe complication that might eventually lead to death.

 

Other rare complications

The Phrenic nerve located in the pericardium surrounding the heart may be damaged in very rare circumstances as a result of heat produced by the catheter involved. This complication may result in difficulties in breathing. To prevent this complication from arising, many medical facilities now pace the diaphragm when undergoing the catheter ablation.

Another really rare complication is when the mapping/loop catheter gets seized in the mitral valve. An open heart surgery may sometimes be necessary to fix the problem. It is, however, very unlikely for it to occur if the doctors and staff involved are skilled and experienced. You might want to find out how often the doctor’s past patients have undergone an open heart surgery before you decide to get treated by him or her.

It is normal to experience some mild chest pains in the next few days after undergoing the procedure. It might get worse when leaning forward or when taking deep breaths. It is completely normal to experience this pericardial chest pain and should not get you worried. It should go away within a week or so but it may also increase in the first few days.

The long term risks of catheter ablations are still unknown since the procedure has not been practiced for long. According to a study, most of the unwanted remodeling effects associated with a-fib like contracting of the atria and enlargement of the left atria may be reversed after an effective catheter ablation procedure.

Despite the risks involved in the catheter ablation, it is considered to be very safe and effective procedure and is not enough reason to make you reconsider undergoing it if need be.