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. This article will help you understand the different types of cardiac ablation procedures along with some signs and symptoms you may experience after your procedure. And as the title suggests, why you may see weight gain after a cardiac ablation AND what you and your healthcare team can do about it.
What is a Cardiac Ablation?
In general, there are two main 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 Arrhythmia Health Topics page on the American Heart Association website.
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Now, let’s get to the nitty gritty of this article and first talk briefly about the different types of cardiac ablation procedures.
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.
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. Whereas, 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 a 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, 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.
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 risk 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 of the risks 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 tube being in throat during procedure
- pericardial effusion
- generalized and pulmonary edema
- congestive heart failure (CHF)
- cardiac arrest
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 rate (64%-86%) for elderly patients compared to younger patients, which is promising for those over the age of 75 years.
However, another study reports that 50% of patients require a second ablation surgery.
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.
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.
To be honest, this is rare, with up to 22% of ablation cases presenting with even small cases of pericardial effusion. And the cause is not quite known as it relates to cardiac ablation surgeries.
The majority (89%) of individuals 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.
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 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.
Pulmonary edema is also often caused by CHF, 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.
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. And one thing to be mindful of is that the symptoms can easily be missed, as they may develop 1-2 days after being sent home.
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. And obesity is linked to an increased risk for cardiovascular disease, cancer, metabolic syndrome and other chronic diseases. Weight gain after a 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 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 intake of fruits, vegetables, whole grains, lower fat dairy products, nuts and legumes, lean sources of protein such as poultry and fish, and non-tropical oils. It also encourages limiting intake of added sugars, sodium, and saturated fat.
Sodium, Cholesterol, and Fat Recommendations
The recommended amount of sodium per day, according to the AHA, is 2,400mg for healthy adults and 1,500 mg for those with heart conditions and hypertension.
When it comes to recommended amount of total cholesterol each day, many health organizations used to 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:
- The DASH diet (Dietary Approaches to Stop Hypertension)
- The Mediterranean Diet
- USDA’s 2020-2025 Dietary Guidelines for Americans
- American Heart Association Guidelines
All of these diets follow similar dietary patterns to the heart healthy diet listed above.
And the recommended amount of saturated fat per day is ~13 grams if you are following a 2,000 calorie diet plan. This 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 states to limit saturated fat intake to 5-6% of total daily calories. Meaning if you are following a 2,000 calorie diet plan, only 120 of those calories (~13 grams) should be from saturated fats.
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 per day fluid restriction. The goal of this type of diet is to prevent water build-up in your body and around your heart.
However, it’s not necessarily that simple. And there is no one-size-fits-all diet to manage congestive heart failure.
In fact, current guidelines in the U.S. and in the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure, recommend limiting sodium but do not specify a target daily 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 still to stick with a lower sodium diet of under 2,400 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. You can also limit your serving sizes of higher sodium foods.
For more on foods high in sodium, take a peak at the American Heart Association’s Salty Six handout HERE.
You can also print off and follow these recommendations listed in the “Living With Heart Failure” guide, also from the American Heart Association.
And for additional handouts on sodium, created by yours truly, you can:
- purchase my Sodium: How Much is Too Much? handout
- purchase my Salt Substitutes: An Informational Guide handout
- grab the FREE Heart Healthy Shopping grocery guide
Medications to Manage Weight Gain
In addition to diet recommendations, you may also be prescribed medications to manage fluid weight gain after cardiac ablation surgery. While still in the hospital, they will likely be in IV form. These are 1) diuretics, 2) vasodilators, and 3) ionotropic medications.
The first type of medications are referred to as diuretics. The purpose of diuretics 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).
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 improvement in blood flow and blood pressure.
Nitroglycerin is often used to treat chest pain from angina, however it can also be used to treat CHF. And 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 muscle which decreases the workload on your heart.
And lastly, 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 will instructions for how to care for your surgical incisions, restrictions on physical activities, which vitals to monitor, signs and symptoms to watch out for, and what to do if you notice any concerns.
Continuing to follow a heart healthy diet after going home is always recommended, in addition to any other individualized diet instructions you may be given.
It’s important to take it easy for the first week or so to allow yourself to heal. Full healing will take 6-8 weeks.
Remember that some swelling and weight gain is 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 overload 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 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 incision site
- increasing chest pain or pressure
- high fever
FAQ About Cardiac Ablation Surgery
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.
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 you will likely 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 weeks.
Not necessarily. It’s normal to still 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.
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.
It depends. Studies show that for individuals with tachycardia-bradycardia syndrome (TBS), ablation does result in 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 this being said, you should talk with doctor to discuss which procedure is most appropriate for you and your heart condition.
Having a cardiac ablation is a big decision. It may be the best option for treating your arrhythmias when medications don’t work. Being informed about all risks and benefits can help you decide if you wish to proceed. And coming up with an appropriate plan after surgery is also important.
If you have any weight gain following your cardiac ablation, it may be only 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 more strict 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 for you and your specific condition.
And once you are safe to go home, it’s important to continue a preventative, heart healthy diet and monitor for any rapid weight gain or symptoms of fluid overload.
Kiran Campbell is a registered dietitian and entrepreneur with 13 years of experience. She has a degree in psychology as well as dietetics. She is also a proud member of the Academy of Nutrition and Dietetics’ and its Cardiovascular Health and Well-being Dietetics Practice Group among others. Kiran proudly presents and promotes the most up-to-date, science-based nutrition information on all things heart-related. She aims to serve not only individuals with heart disease, but also those wanting to protect against it. Learn more about Kiran by visiting her About Page.