What to Know About Arrhythmia Surgeries

A doctor may recommend surgery for arrhythmia when medications and lifestyle changes haven’t been effective. The different types of arrhythmia surgeries each aim to restore a regular heart rhythm.

Arrhythmia refers to a condition affecting the rate or rhythm of your heartbeat. If you have an arrhythmia, your heart can beat faster or slower than normal or irregularly. Experts estimate that 1.5% to 5% of people have an arrhythmia.

Treatment for arrhythmias often includes a combination of medications and lifestyle changes. However, if these aren’t effective at managing your arrhythmia symptoms, your doctor may recommend surgery.

Curious about what surgery for an arrhythmia entails? Keep reading as we explore three types of arrhythmia surgeries.

Cardiac ablation for arrhythmia

Arrhythmias happen due to issues with your heart’s electrical system. One way this can occur is if an area of cells other than your heart’s natural pacemaker starts making electrical signals. This can interfere with the heart’s regular rhythm .

If the location of these cells is known, doctors can use ablation to destroy them with heat or cold. This can help correct the arrhythmia.

Doctors most often perform ablation using a thin, flexible tube called a catheter. This is a minimally invasive procedure.

It’s also possible for doctors to perform ablation as an open surgery. It’s uncommon, but a doctor may opt for it if they can’t safely access your heart using a catheter.

There’s also a specific type of open ablation surgery doctors use to treat atrial fibrillation (AFib) called a Maze procedure. We’ll go over that one in more detail in the next section.

Preparation

Your doctor will want to ensure you’re healthy enough to undergo the procedure. To do this, they’ll order several tests, such as:

• an electrocardiogram (EKG)
• blood tests, like complete blood count , metabolic panel , and tests of liver and kidney function
• imaging, such as X-ray and echocardiogram

You’ll also get specific preparation instructions in the days leading up to your procedure. These will likely include:

• guidance on which medications, both prescription and over the counter, to adjust and when to do so
• details on when to start fasting the evening before your procedure
• what items to bring with you to the hospital on the day of your procedure

It’s important to follow all of these instructions carefully to ensure that your procedure can proceed as scheduled.

Procedure

Catheter ablation involves the following steps:

1. Your doctor inserts a catheter into a blood vessel through a small incision, which they typically make in your groin.
2. They use imaging to guide the catheter through your blood vessels and to your heart.
3. Your doctor uses electrodes associated with the catheter to locate the area making abnormal electrical signals.
4. Once they locate the area, your doctor uses heat or cold to destroy the cells.
5. Afterward, they withdraw the catheter and close the small incision.

Doctors typically use general anesthesia or conscious sedation during catheter ablation. This means you’ll be awake during the procedure but won’t feel pain. However, you may feel some pulling or pressure.

Recovery

You may be able to return home the same day as your catheter ablation. However, depending on how the procedure went, your doctor may want you to stay overnight in the hospital for monitoring.

Most people can return to many of their regular activities after a few days, although you may have restrictions on certain activities for longer. For example, your doctor may advise you to avoid:

• strenuous activity
• heavy lifting
• driving
• bathing
• swimming

Risks and side effects

The potential risks and side effects after an ablation procedure can include :

• a reaction to the anesthesia
• excessive bleeding
• blood clots , which can lead to a heart attack or stroke
• infections
• damage to the heart or blood vessels
• kidney damage
• narrowing of the veins between your heart and lungs, called pulmonary vein stenosis
• a new arrhythmia or failure to control the existing arrhythmia
• paralysis of the phrenic nerve, which controls your diaphragm and is involved in breathing
• damage to your esophagus

There’s also a minimal risk of cancer due to radiation used during catheter ablation. One 2017 study estimates that the lifetime risk of cancer from a single ablation procedure is 1 in 21,700.

Maze procedure for arrhythmia

The Maze procedure is a type of open surgery doctors use to treat AFib , the most common type of arrhythmia. Researchers estimate that at least 3 to 6 million people in the United States have this type of arrhythmia.

During the Maze procedure, a surgeon makes scars on the atria (upper chambers) of the heart. These scars can then interfere with the abnormal electrical signals associated with AFib, helping restore a regular heart rhythm.

Preparation

Preparation for the Maze procedure is similar to that for ablation. Your surgeon will want to make sure you’re fit enough to have the surgery. They’ll order tests like an EKG and a variety of blood and imaging tests.

Your surgeon will also give you instructions on what to do before your surgery. This includes which medications to adjust, when to start fasting, and what you’ll need to bring to the hospital with you.

Procedure

Surgeons use general anesthesia for the Maze procedure. That means you’ll be asleep during your surgery and won’t feel any pain.

The Maze procedure involves the following basic steps:

1. Your surgeon makes an incision over your breastbone.
2. They connect you to a heart-lung machine . This keeps your blood circulating while your surgeon operates on your heart, which will have been stopped.
3. Your surgeon makes several specifically placed scars on the tissue of your atria using heat or cold. This creates a “maze” that blocks abnormal electrical signaling while allowing your heart’s regular electrical signaling to go through.
4. After making all the scars, your surgeon restarts your heart and removes the heart-lung machine.
5. Your surgeon closes the incision in your chest.

A surgeon can also use a minimally invasive approach to a Maze procedure. This involves a right mini-thoracotomy , which is where your surgeon operates through small incisions made on the right side of your rib cage.

Doctors may also perform a new “hybrid convergent” procedure , which involves performing catheter ablation alongside the Maze procedure for improved results.

Recovery

You’ll need to stay in the hospital for several days after your Maze procedure. If you had a minimally invasive procedure, your hospital stay may be slightly shorter.

You may also notice that you still have AFib symptoms after your surgery. This is typical and due to the inflammation and irritation from the surgery. As such, you may still need to take your AFib medications for a little while longer.

Generally , you can resume all regular activities in around 6 weeks. If you had an open procedure, you may still have some restrictions on strenuous activities or lifting heavy objects for about 3 months.

Risks and side effects

There are a variety of risks and side effects associated with the Maze procedure. These may include:

• a reaction to the anesthesia
• excessive bleeding
• blood clots, which can lead to a heart attack or stroke
• infections
• damage to the heart or surrounding tissue
• kidney failure
• a new arrhythmia or inability to control the existing arrhythmia
• the need for a pacemaker

Implantable devices for arrhythmia

A doctor may also recommend an implantable device to help manage your arrhythmia. They may recommend one of two types of implantable devices .

A pacemaker delivers regular electrical signals to your heart, helping it beat at a regular rhythm and rate. Doctors often recommend pacemakers for people with an arrhythmia that leads to a slow heartbeat ( bradycardia ).

An implantable cardioverter defibrillator (ICD) sends electrical signals to return your heart to a regular rhythm when you have arrhythmia symptoms. Doctors typically recommend them for people with potentially life threatening arrhythmias, like ventricular tachycardia and ventricular fibrillation .

An ICD can also restart your heart if it suddenly stops, which can happen in people with life threatening arrhythmias. Some ICDs can also serve as a pacemaker.

Preparation

Preparation for the placement of a pacemaker or ICD is similar to that of cardiac ablation and the Maze procedure. Your doctor will perform tests to ensure you can have the procedure.

They’ll also discuss the details of the procedure with you and give you instructions regarding medications, eating and drinking, and what to bring to the hospital.

Procedure

You often have a pacemaker or ICD implanted while under local or general anesthesia. A pacemaker or ICD is typically fitted using a transvenous method:

1. Your doctor makes a small cut below your left collarbone.
2. They insert the wires of the device into a vein.
3. They use imaging to carefully guide the wires and implant them into one or more chambers in your heart.
4. Your doctor places the device in a pocket created under the skin of your chest.

Some pacemakers are wireless, and surgeons place them using a catheter. They typically insert the catheter into a blood vessel in the groin area and carefully guide it into the heart using imaging.

Lastly, a surgeon can place a pacemaker directly onto your heart. This is called an epicardial pacemaker and is less common. This procedure involves general anesthesia and an incision made below your ribs.

Recovery

You may need to stay in the hospital overnight for monitoring after you’ve had a pacemaker or ICD implanted. Sometimes, you can go home the same day.

As with other surgeries, your care team will give you instructions on how to take care of yourself and when you can return to daily activities. You can typically do most of your usual activities about 4 to 6 weeks after your procedure.

Risks and side effects

Some of the possible risks and side effects of placing an implantable device for an arrhythmia include:

• a reaction to the anesthesia
• excessive bleeding
• blood clots, which can lead to a heart attack or stroke
• infections
• damage to the heart or blood vessels
• trapped air or fluid in the chest
• scarring around the device
• a new arrhythmia
• malfunction of the device
• pacemaker syndrome
• interference from devices or procedures associated with strong magnetic fields

Frequently asked questions about arrhythmia surgery

Is ablation a serious surgery?

Catheter ablation is a common procedure that’s typically very safe. A 2023 study estimates the rate of complications is 4.51% .

Open ablation procedures like the Maze procedure can have a higher complication rate. One 2017 study found that the rate of major complications for the Maze procedure was 17.4%, compared with 5.6% for catheter ablation.

How many times can you have cardiac ablation?

There isn’t a limit on the number of times you can have a cardiac ablation. However, some preliminary data presented at a 2023 research conference suggests that the success rate is lower after the third procedure.

Why do I feel so tired after my cardiac ablation?

An ablation can cause irritation and inflammation around your heart. Because of this, it’s typical to feel more tired as you recover.

What is the life expectancy after cardiac ablation?

Cardiac ablation may extend your life by correcting potentially life threatening arrhythmias.

A 2019 study found that the early mortality rate for ablation was 0.46%, about 1 in 200 people. The majority of these deaths happened when people were readmitted to the hospital within 30 days of their ablation.

Takeaway

Arrhythmia is a common condition that affects millions of people around the world. While you can often treat it with medications and lifestyle changes, a doctor may recommend surgery if these methods aren’t effective.

A few types of arrhythmia surgeries are available. All aim to help restore a normal heart rhythm.

Each type of arrhythmia surgery is different. Be sure to have an open conversation about the specifics of the recommended surgery, including its risks and benefits, what the procedure entails, and what recovery is like.