What Is an Ablation?

Mark Gurarie is a freelance writer covering health topics, technology, music, books, and culture. He also teaches health science and research writing at George Washington University's School of Medical and Health Sciences.

Angela Ryan Lee, MD, FACC, is a board-certified cardiology and internal medicine physician. She also holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography.

An ablation is a minimally invasive surgical procedure that involves using extreme heat, cold, or lasers to create scar tissue or remove unwanted growths. This procedure can treat a range of conditions, including irregular heartbeat, chronic pain, cancer, varicose veins, and migraine, among others. Healthcare providers such as radiologists, cardiologists, neurologists, or surgeons perform this procedure.

Purpose

An ablation procedure uses extreme heat, cold, and laser to destroy abnormal tissue that may be causing symptoms of a variety of conditions. This treatment may help treat:

• An irregular heartbeat (cardiac arrhythmia ) caused by heart diseases like atrial fibrillation or ventricular tachycardia
• Varicose veins or chronic venous insufficiency (a blood circulation disorder)
• Early stages of brain, liver, pancreatic, prostate, kidney, lung, skin, or bone cancer
• Trigeminal neuralgia (a facial pain condition)
• Chronic migraine
• Chronic pain in the joints due to arthritis, ankylosing spondylitis , slipped disc, and other types of nerve pain
• Excessive blood flow during menstruation
• Enlarged prostate

Types of Ablation

Because an ablation can treat so many health conditions, there are a variety of specific ablation procedures—all of which come with their own set of risks and benefits. Common types of ablation include:

• Radiofrequency ablation (RFA): Relies on radio waves to produce heat to treat conditions like heart arrhythmia, varicose veins, chronic venous insufficiency, excessive menstrual bleeding, or cancerous tumors, among other conditions.
• Cryoablation: With this type of ablation, nitrogen and argon gas cause extremely cold temperatures to freeze targeted areas of tissue. Cryoablation can sometimes help treat heart arrhythmia or cancer tumor growth, among other conditions.
• Laser ablation: Lasers can also perform ablation to remove cancer growths and tissue in the prostate, brain, liver, and pancreas.

How Does It Work?

The goal of ablation is to target and apply intense heat or cold to small, and specific areas of your tissues or nerves. Generally, this involves image-guided minimally invasive surgery. Depending on which specialist is performing your procedure, your cardiologist, neurologist, or interventional radiologist makes a small incision (cut) to place small electrodes and catheter into targeted tissues or nerves.

Before the Procedure

Depending on the type of procedure you're receiving, an ablation may use general anesthesia (while you are asleep) or local anesthesia to numb the pain. If you're receiving general anesthesia, your procedure may take place in a hospital. For local anesthetic procedures, you'll likely receive treatment at an outpatient center or medical office.

When you arrive for your appointment, your provider will evaluate you once more to check your vital signs, such as your heart rate, blood pressure, and temperature. If your healthcare team doesn't see any problems with your vital signs, you are in the clear to start treatment. How long your procedure lasts will also depend on the type of ablation you're getting. Some ablation procedures can be as short as 20 minutes, while others can last up to four hours.

During the Procedure

The exact process of your ablation will depend on the procedure you're receiving. Here's what you can expect during each of the common types of ablation:

• Cardiac ablation: Your healthcare team cleans the site of the incision (cut). Using an imaging scan, your cardiologist makes a small cut in your groin and positions the catheter into your heart. They then place small electrodes in the heart to find the source of the problem. Once found, the electrodes will deliver heat or cold to the target site to destroy growths or create scar tissue.
• Tumor ablation: Your provider can directly apply freezing nitrogen to remove tumors or growths on the skin. For organ or bone cancer, your provider will first clean the incision site. Then, using imaging scans such as an ultrasound or magnetic resonance imaging (MRI), your surgeon will put a specialized tube in position to deliver the heat or cold to the tumor. You'll likely need local anesthesia for this procedure.
• Radiofrequency neurotomy: X-ray fluoroscopy—a type of continuous imaging—helps your provider position a needle to the affected nerve. They then deliver an anesthetic and heat to areas near the nerve to attack the tissue that is responsible for carrying pain signals.
• Laser ablation: Laser ablation techniques also require imaging scans to help guide a surgeon's work. For example, if you're receiving an ablation for an enlarged prostate, a small tube with a camera on it (known as a cystoscope) will be inserted through the penis to the prostate. This helps them direct a laser beam to destroy specific tissues.

After the Procedure

Many types of ablation surgeries are outpatient procedures—meaning you’ll be able to go home the same day. But, if your provider thinks you may need to stay overnight, they'll tell you beforehand. It's a good idea to also ask your insurance provider or hospital billing department if the cost of the overnight stay will be covered.

After the ablation is complete, your provider will monitor you for up to six hours as you recover. If you’ve had general anesthesia, you may feel the effects of the anesthesia for up to 24 hours afterward. If you're receiving anesthesia, it's also important to arrange a ride home after the procedure is complete.

How long it'll take for you to recover will depend on the procedure you underwent. Generally, ablation procedures are well-tolerated. In most cases, you can resume normal activity within two to three days. However, you may need to avoid sex, strenuous exercise, or lifting heavy objects for up to a week—as getting enough rest is important for recovery.

Your provider will also schedule a follow-up appointment after the ablation to ensure there are no complications or problems. This appointment will usually take place 1 to 2 weeks after the procedure. However, if you experience any side effects or symptoms of a complication, it's important to talk to your healthcare provider right away.

Risks and Precautions

Ablation procedures are generally well-tolerated and safe for most people. That said, it may not always be safe if you’re pregnant, have a history of bleeding problems, or blood clots. Let your healthcare provider know if you are pregnant or have a history of blood clots, as you may require special precautions before the procedure. Regardless of the type of ablation you undergo, there’s always a risk of side effects or complications. These include:

• Excessive bleeding at the incision site
• Blood clots
• Cramping
• Scarring
• Damage to a heart valve or a coronary artery (a blood vessel in the heart)
• Heart attack or fluid buildup around the heart (known as cardiac tamponade)
• Stroke
• Swelling
• Tissue damage
• Nerve damage
• Erectile dysfunction after a prostate ablation
• Damage to or infection of the womb, uterus, or cervix after an endometrial ablation

Ablation procedures can also cause certain side effects. For instance, a cardiac ablation may cause fatigue, chest pain, and heart palpitations for several days. After an endometrial ablation, it's possible to experience excessive bleeding and cramps. For radiofrequency neurotomy, you may temporarily feel weakness, numbness, or bruising at the insertion site.

How to Prepare for Ablation

Getting an ablation, like any other type of procedure, can seem worrisome. But, your healthcare provider will give you instructions on how to prepare. It can also help to keep the following things in mind:

• Ask about your medications: Let your provider know what medications you’re taking and ask them if you need to stop taking any medicines before the procedure. Your provider may tell you to stop taking Aspirin or blood thinners, like Plavix (clopidogrel), Effient (prasugrel), and Coumadin (warfarin).
• Take any prescribed medications: Your provider may prescribe you an antibiotic, anti-anxiety medication, or other pill to take before the procedure.
• Fasting: Before the procedure, ask your provider if you should stop eating or drinking. Your provider may recommend limiting food and drinks for 6 to 8 hours before the ablation.
• Attire: You’ll be wearing a hospital gown during the procedure, so it's best to wear loose-fitting and comfortable clothes and avoid wearing any jewelry.
• Documents: Though the outpatient center, clinic, or hospital may already have the information they need, it’s always a good idea to bring along insurance information, your ID, and a list of medications you're taking.
• Emotional support: If you'd like to bring someone to the appointment with you, ask your healthcare team where your loved one can sit during the procedure.
• Cost and insurance: Depending on the condition you have, ablation procedures may be covered by insurance. Talk to your healthcare provider’s office staff and your insurance carrier to understand what is and isn’t covered. This is also a good time to ask them about financial support or payment plans.

A Quick Review

An ablation is a minimally invasive procedure that uses extreme heat, cold, or lasers to destroy growths or create scar tissue to treat conditions like cancerous tumors, irregular heartbeats, chronic pain, migraine, and other conditions. If your condition requires an ablation procedure, your healthcare provider will perform the surgery in a hospital or outpatient center. In most cases, you can go home on the same day of the procedure. But it's important to rest as you recover.

Sukhman is an editor at Health. She currently produces health content about conditions, nutrition, and wellness. She also writes stories covering public health, psychology, and women's issues.