Weight Gain After Cardiac Ablation: Is This Normal?

If you are suffering from irregular heartbeats and medication is not working for you, your doctor may talk to you about a procedure called a cardiac ablation. However, there are special situations where you may see weight gain after a cardiac ablation.

This article will help you understand the different types of cardiac ablation procedures, some signs and symptoms you may experience after your procedure, and why you may experience weight gain after a cardiac ablation. I’ll also fill you in on what you and your healthcare team can do about it.

For more info on how to keep your heart healthy: 5 Things You Can Do to Support Heart Health NOW

What is a Cardiac Ablation?

In general, there are two types of cardiac ablation procedures: 1) catheter ablation and 2) surgical ablation.

Both techniques have the same goal. This is to use heat (radiofrequency energy) or freezing cold (cryoablation) to treat abnormal or irregular heart rhythms. The medical term for having irregular heart rhythms is arrhythmia.

For more information on arrhythmias including risks, symptoms, diagnosis, prevention, and treatment, you can visit the American Heart Association’s “Arrhythmia” health topics page which has many printable handouts on arrhythmia.

Related article: Can You Eat Before a Stress Test?

Now that you know what a cardiac ablation is and what condition it treats, let me briefly explain the different types of cardiac ablation procedures.

Catheter Ablation

A catheter ablation is a minimally invasive procedure. It is also the most common type of cardiac ablation.

Catheter ablation is done with either general anesthesia, in which you are not awake during the procedure, or with mild to moderate sedation.

The procedure requires a thin, flexible tube (called a catheter) to be threaded through one of your veins (usually starting in the groin) and into your heart.

Once guided to your heart, the surgeon will deliver hot or cold radiofrequency (heat) energy to specific areas of your heart to form scars. Creating this scar tissue will help prevent you from having future arrhythmias.

cardiac ablation surgical team

Surgical Ablation

Sometimes patients may need a more extensive heart procedure in addition to fixing an arrhythmia. For example, surgery, or an open heart surgery in addition to managing their arrhythmias. In these situations, a surgeon may suggest a surgical ablation called a maze procedure. This is also known as an open-heart ablation.

This differs slightly from a catheter ablation. During catheter ablation, the surgeon makes scars to destroy the tissue causing your arrhythmias. In comparison, during a maze procedure, the surgeon makes scars to redirect electrical impulses to correct your arrhythmias.

According to the Cleveland Clinic, the success rate for a maze procedure at fixing irregular heart rhythms is an astounding 80 to 90 percent.

During this type of procedure, you will be asleep with anesthesia.

The method of entry in this procedure is different than catheter ablation. Instead of going through the groin, your surgeon will make a vertical incision in your sternum or maybe through your ribs which is less invasive.

A maze procedure involves treating both the left and right atria of your heart (see Figure A below).

Your heart has 4 chambers: left atrium, right atrium, left ventricle, and right ventricle. The 2 chambers at the top are the atria. These are the areas in which the surgeon will make a pattern of scars using heat or freezing (cryoablation). The maze-like pattern of scarring that results is what gives the maze procedure its name.

chambers of heart involved in cardiac ablation surgery
Figure A: Diagram of the heart indicating the two out of four chambers of the heart (right and left atrium) that involve scarring in a maze procedure.

Why Would Someone Need a Cardiac Ablation?

When your heart beats, electrical impulses follow a specific pathway within the four chambers of your heart. This makes your heart contract and beat in a specific (and normal) sequence. If there is any disruption in this electrical pathway, it can result in an irregular heartbeat.

The main reason a cardiac ablation may be recommended is to treat problems with heart rhythms. Some conditions that are treated with cardiac ablation surgery include, but are not limited to:

  • Atrial fibrillation or atrial flutter
  • Supraventricular tachycardia (SVT)
  • Tachycardia-bradycardia syndrome
  • Hypertrophic cardiomyopathy
  • Heart rhythm conditions in which medication is not effective

Possible Cardiac Ablation Risks

Any medical procedure is going to have risks involved. Depending on the type of ablation procedure you have, you may have more or less risk. Your doctor and surgeon should fill you in on all the risks versus benefits to help you make the best decision for you. Some risks of cardiac ablation surgery include:

  • bleeding or infection at the surgical site
  • blood vessel damage
  • heart valve damage
  • new or worsening arrhythmias
  • chest discomfort
  • feeling of tiredness
  • sore throat due to the tube being in your throat during the procedure
  • pericardial effusion
  • generalized and pulmonary edema
  • congestive heart failure (CHF)
  • renal failure
  • respiratory infection
  • cardiac arrest
  • death

A few of the above risks will cause weight gain after a cardiac ablation.

It’s also important to know that in the event your surgery does not correct your arrhythmia, you may need another ablation surgery.

One study reports similar long-term outcomes and success rates for older patients compared to younger patients, which is promising for those over the age of 75 years.

However, this small study also reports that 62% of patients require a second ablation surgery.

surgeon after heart ablation
Image courtesy of Freepik

Reasons for Weight Gain After Cardiac Ablation

In the days and weeks after surgery, you may experience the unexpected aftermath of weight gain after your cardiac ablation. Any weight gained is likely NOT related to fat mass, but rather fluid gain.

There are symptoms and conditions that you and your healthcare team need to monitor and treat if needed. They are:

  1. pericardial effusion
  2. generalized edema
  3. pulmonary edema, and
  4. congestive heart failure

Let’s discuss these possible post-op causes of weight gain after a cardiac ablation.

Pericardial Effusion After Cardiac Ablation

The first reason you may encounter weight gain following a cardiac ablation is due to pericardial effusion.

A pericardial effusion is the build-up of extra fluid in the space surrounding your heart. This puts pressure on your heart and may cause your heart to beat faster or lower your blood pressure.

This is considered a rare occurrence, with up to 22% of ablation cases presenting with even small cases of pericardial effusion. The cause is not quite known as it relates to cardiac ablation surgeries.

The majority of individuals (89%) who develop pericardial effusions have no symptoms. A diagnosis for these individuals was made only after having an echocardiogram performed.

There are currently no specific treatment recommendations for pericardial effusions that develop after cardiac ablation surgery, but case studies report that it may be treated with colchicine, which is an anti-inflammatory drug often used for treating gout. Colchicine is also given after surgery to prevent episodes of post-op atrial fibrillation.

Generalized Edema After Cardiac Ablation

During and directly following your surgery, you may get additional fluids through an IV. This may cause some “puffiness” in certain areas of your body. You may notice it more in your extremities (arms, hands, legs, and/or ankles).

In medical terms, this water retention is known as edema.

Weight gain from fluids given during and after a procedure is usually not a concern. This is only temporary and will resolve once IV fluids are stopped and you get back into your normal routine.

Pulmonary Edema After Cardiac Ablation

The third reason you may see weight gain after your cardiac ablation is due to pulmonary edema. This is when excess fluid accumulates in and around your heart, causing fluid to back up into your veins and eventually into the air spaces in your lungs.

Research shows that severe pulmonary edema resulting from cardiac ablation may be due to a systemic inflammatory response syndrome (SIRS).

Pulmonary edema is also often caused by congestive heart failure, which we will discuss next.

One study specifically, states that pulmonary edema is a possible risk for those undergoing extensive radiofrequency ablation in the left atrium for chronic atrial fibrillation.

Congestive Heart Failure After Cardiac Ablation

The final reason you may see weight gain after your cardiac ablation is congestive heart failure.

As mentioned above, congestive heart failure (CHF), is a condition that leads to pulmonary edema. CHF is when your blood cannot pump into or out of your heart efficiently. This may cause symptoms such as shortness of breath, fatigue, and weight gain due to fluid retention in your limbs.

Research shows that older patients with pre-existing medical conditions, such as diabetes or reduced ejection fraction, are more likely to develop CHF after cardiac ablation.

According to the same study, this happens due to fluid overload during and after the procedure.

Another study reports that heart failure is a frequent complication following certain types of radiofrequency catheter ablation. One thing to be mindful of is that the symptoms can easily be missed, as they may develop 1 to 2 days after being sent home from the hospital.

plastic human heart model

Keeping a Stable Weight After Surgery

Maintaining a stable weight during the recovery period is important. It is widely known that weight gain leads to obesity. Obesity is linked to an increased risk of cardiovascular disease, cancer, metabolic syndrome, and other chronic diseases. Weight gain after heart surgery may even lead to new-onset atrial fibrillation, which is what you were trying to eliminate in the first place!

Factors such as physical inactivity, stress levels, and dietary changes can lead to weight gain. Surgery can impact all three of these areas.

Therefore, the best thing you can do to prevent weight gain after cardiac ablation surgery is to get back to your normal daily activities as soon as you are able.

Dietary Management Following Cardiac Ablation

If you don’t have any other medical conditions requiring dietary management, such as diabetes or kidney disease, a heart-healthy diet is best for you.

A heart-healthy diet is lower in sodium, fat, and cholesterol than the typical American diet and has a large emphasis on the intake of fruits, vegetables, whole grains, lower-fat dairy products, nuts, legumes, lean sources of protein such as poultry and fish, and non-tropical oils. It also encourages limiting the intake of added sugars, sodium, and saturated fat.

Sodium, Cholesterol, and Fat Recommendations

The recommended amount of sodium per day, according to the American Heart Association, is 1,500 mg for those with heart conditions and hypertension.

When it comes to the recommended amount of total cholesterol each day, many health organizations encourage limiting daily cholesterol intake to 300 mg per day. However, more and more research has uncovered that dietary cholesterol has minimal intake on your blood cholesterol levels.

Instead, interventions like limiting saturated and trans fats are recommended along with adequate amounts of physical activity to reduce blood cholesterol levels. If you would like to follow a specific dietary pattern for reducing cholesterol, the following are scientifically proven:

All of these diets follow similar dietary patterns to the heart-healthy recommendations listed above.

The recommended amount of saturated fat per day could be confusing for some people since the 2020-2025 Dietary Guidelines for Americans recommends limiting saturated fat intake to less than 10% of your total daily calories.

However, I highly recommend following the AHA guidelines instead, which state to limit saturated fat intake to no more than 5-6% of total daily calories. This means that if you are following a 2,000-calorie meal plan, only 120 of those calories (~13 grams) should come from saturated fats.

picture of healthy fresh vegetables and spices

Sodium and Fluid Restriction to Prevent and Manage CHF

Historically, a low sodium, limited fluid diet was recommended for managing heart failure. Most healthcare facilities will give a general guideline of 2 gm of sodium per day along with a 2 liter fluid restriction. The goal of this restrictive diet is to prevent water build-up in your body and around your heart.

However, it is not necessarily that simple. There is no one-size-fits-all diet to manage congestive heart failure.

In fact, current guidelines in the U.S. and the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure, recommend limiting sodium but do not specify a target daily sodium amount.

Likewise, restricting sodium can be at the expense of other nutrients. If not followed properly, it can result in poor dietary quality with inadequate macronutrient and micronutrient intake.

Even with fluid restriction, the best recommendation is to individualize care. In some cases, you may only need to limit fluid intake if your sodium level is low or if you have advanced heart failure. Having a low sodium blood level is also known as hyponatremia.

The bottom line here is to stick with a lower sodium diet of under 2,300 mg per day and restrict fluids only if your doctor thinks it is necessary. To make this easier, I’d suggest reading nutrition labels and choosing lower-sodium versions of the foods you enjoy. In addition, limiting your intake of higher-sodium foods will also be beneficial.

Any limitations to your sodium and fluid intake should be discussed with your care team and individualized to your medical condition.

For more on foods that are high in sodium, take a peek at the American Heart Association’s Salty Six handout.

You may also print off and follow the recommendations listed in this “Living With Heart Failure” guide.

For additional handouts on sodium, check out the following handouts:

Medications to Manage Weight Gain

In addition to dietary recommendations, you may also be taking medications to manage fluid weight gain after cardiac ablation surgery. While still in the hospital, these medications will likely be in IV form. These include:

  1. diuretics
  2. vasodilators, and
  3. ionotropic medications

Diuretics

The first type of medications is referred to as diuretics. The purpose of a diuretic is to get rid of excess fluid from your body, and in this case, out of the lungs and heart.

The most common diuretic used to treat both heart failure and pulmonary edema is furosemide (brand name Lasix). However, if you have kidney issues, furosemide may lead to further kidney injury.

Vasodilators

Other medications, called vasodilators, may also be given. If you have a history of high blood pressure, you may already be taking some vasodilators. These drugs promote smooth muscle relaxation and help dilate blood vessels. This leads to improvements in blood flow and blood pressure.

Two common vasodilators are nitroglycerin and sodium nitroprusside.

Nitroglycerin is often used to treat chest pain from angina, however, it can also be used to treat CHF.

Sodium nitroprusside is often used to treat acute hypertension, though acute decompensated heart failure can also be treated using this medication. Both of these medications work very quickly at relaxing vascular smooth muscles which helps to decrease the workload on your heart.

Ionotropic Medications

And lastly, there are ionotropic medications. These medications help preserve your heart’s blood flow and protect it from end-organ damage.

One common ionotropic medication is dobutamine. Dobutamine helps your heart contract and push blood out of the heart. This will be given through an IV, specifically if you have low blood pressure and lowered cardiac output.

Monitoring Symptoms at Home

Once you are discharged from the hospital, you, along with any caregivers will be responsible for monitoring your health. Your nurse should provide you with instructions on how to care for your surgical incisions, restrictions on physical activities, which vitals to monitor, signs and symptoms to watch out for, including fluid retention after your cardiac ablation.

Continuing to follow a heart-healthy diet after going home is always recommended, along with any other individualized diet instructions you may have been given.

It’s important to take it easy for the first week or so to allow yourself to heal. Full healing will take around 6-8 weeks or more.

Remember that some swelling and weight gain are normal due to fluids being given during and directly after your surgery, although it should resolve quickly once daily activities are resumed.

Knowing the signs of fluid retention will help you determine if you need to contact your doctor. Some signs of fluid overload include:

  • difficulty breathing
  • reduced exercise tolerance
  • edema in your extremities
  • changes in blood pressure
  • fast heartbeat
  • low sodium lab value (hyponatremia)
  • protruding jugular veins (located in the neck area)

Additionally, if you notice any of the following, you should call your cardiologist AND head to the ER immediately:

  • difficulty breathing or shortness of breath
  • continued bright, red bleeding from the incision site
  • increasing chest pain or pressure
  • high fever
  • palpitations

FAQ About Cardiac Ablation Surgery

How long does a cardiac ablation take to perform?

Depending on the type of procedure you have, you can expect to be in the operating room anywhere from 2 to 6 hours. You will also spend a few hours in the recovery area to be closely monitored before transferring to a general medical floor.

How long does it take for the heart to heal after cardiac ablation?

Full recovery takes about 6 to 8 weeks. After any heart procedure, you should follow your doctor’s recommendations so you don’t overexert yourself. You will likely be more tired than normal and have physical restrictions such as not being able to exercise or pull, push, or lift anything over 10 pounds for a few days. You should be able to resume regular daily activities after a couple of weeks.

Will my irregular heartbeat be immediately fixed following ablation?

Not necessarily. It is normal to experience bouts of irregular heartbeat following an ablation. This is because your heart was just irritated and inflamed by surgery. After recovery (a few weeks), you should notice a steady heartbeat. If your AFib persists, talk to your doctor. You may need another surgery or medication.

Do you still need blood thinners after cardiac ablation?

If you were taking blood thinners before your surgery, you will likely continue to take them after your surgery. This is to reduce your risk of stroke.

Is an ablation better than a pacemaker?

It depends. Studies show that for individuals with tachycardia-bradycardia syndrome (TBS), ablation does result in a lower number of heart-related hospitalizations and about 85% of patients can avoid having a pacemaker if they choose ablation to manage their atrial fibrillation. With that said, you should talk with your cardiologist to discuss which procedure is most appropriate for you.

Conclusion

Having a cardiac ablation is a big decision. It may be the best option for treating your arrhythmias when medications do not work. Being informed about all risks and benefits can help you decide if you wish to proceed. Coming up with an appropriate plan after surgery is also important.

If you have any weight gain following your cardiac ablation, it may only be temporary and managed while you are still in the hospital.

Nursing staff will be monitoring your progression along with your vitals, weight, bloodwork, and any signs of concern following your procedure. They will work with other members of your healthcare team to manage medications, pulmonary function, and nutritional status. This may include a stricter diet than you are used to.

Some dietary recommendations are not well-researched although most heart-healthy diets follow similar guidelines. Overall, you should speak with a dietitian about an individualized plan that works best for you and your specific condition.

Finally, once you are safe to discharge home, it’s important to continue a preventative, heart-healthy diet and monitor for any rapid weight gain or symptoms of fluid overload.

Need low-sodium recipe ideas? Visit the recipes page!

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