If you are suffering from irregular heartbeats and your medication is not working for you, your doctor may recommend a procedure called a cardiac ablation. However, in special situations, you may experience weight gain after a cardiac ablation.
This article will help you understand the different types of cardiac ablation procedures, the signs and symptoms you may experience after your procedure, and why you may experience weight gain after a cardiac ablation. I’ll also discuss what you and your healthcare team can do about it.
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What is a Cardiac Ablation?
Cardiac ablation is a procedure that uses heat (radiofrequency energy) or freezing (cryoablation) techniques to correct abnormal or irregular heart rhythms.
The medical term for irregular heart rhythms is arrhythmia, and the most common type of arrhythmia is atrial fibrillation.
Atrial fibrillation, or A-fib, is characterized by irregular and often abnormally fast heartbeats.
Cardiac ablation is not usually the first form of correction for arrhythmias. However, depending on the severity of your condition or if medication and other treatments have not helped, you may need a cardiac ablation.
For more information on arrhythmias, including risks, symptoms, diagnosis, prevention, and treatment, visit the American Heart Association’s “Arrhythmia” health topics page. This page has many printable handouts on arrhythmia.
Related article: Can You Eat Before a Stress Test?
Now that you know what a cardiac ablation is, let’s discuss other conditions that may require it.
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.
As I mentioned above, a cardiac ablation treats irregular heart rhythms. Conditions 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
Next, let’s talk about two different types of cardiac ablation surgery.
Types of Cardiac Ablation Surgery
In general, there are two types of cardiac ablation procedures:
- Catheter ablation
- Surgical ablation
Catheter Ablation
A catheter ablation is a minimally invasive procedure. It is also the most common type of cardiac ablation.
Catheter ablation is performed under 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.
Surgical Ablation
Sometimes, patients may need a more extensive heart procedure in addition to fixing A-fib. In these situations, a surgeon may suggest a surgical ablation called a maze procedure, also known as an open-heart ablation.
A maze procedure differs 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 maze procedure’s success rate for 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 your heart’s left and right atria (see Figure A below).
Your heart has four chambers: the left atrium, right atrium, left ventricle, and right ventricle. The two 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. The maze-like pattern of scarring that results gives the maze procedure its name.
Cardiac Ablation Risks
Any medical procedure involves some degree of risk. Depending on the type of ablation procedure, you may have more or less risk. Your doctor and surgeon should cover all the risks versus benefits to help you make the best decision. Some risks of cardiac ablation surgery include:
Why Does Fluid Build Up After Heart 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.
In some cases, weight gain may indicate a condition you and your healthcare team must monitor and treat. These conditions include:
- Pericardial effusion
- Generalized edema
- Pulmonary edema
- Congestive heart failure
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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 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.
Up to 22% of ablation cases present with even small cases of pericardial effusion. The cause is not well understood in relation to cardiac ablation surgeries.
Additionally, 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 they may be treated with colchicine, 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
Did you notice weight gain immediately after surgery? Don’t be alarmed. IV fluids are often administered during surgical procedures. This may cause some “puffiness” in some regions of your body. You may notice it more in your extremities (arms, hands, legs, or ankles).
Retaining water after surgery is very common. In medical terms, this water retention is known as edema.
This is only temporary and will resolve once you stop IV fluids and you return to your normal routine.
Pulmonary Edema After Cardiac Ablation
Another cause of weight gain after cardiac ablation is pulmonary edema. This occurs when excess fluid accumulates in and around the heart, causing fluid to back up into the veins and into the air spaces in the 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.
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 occurs when blood cannot pump into or out of the heart efficiently. This may can lead to shortness of breath, fatigue, and weight gain due to fluid retention in the limbs.
Older patients with pre-existing medical conditions, including diabetes or reduced ejection fraction, are more likely to develop CHF after cardiac ablation.
This happens due to fluid overload during and after the procedure.
One study reports that heart failure is a frequent complication following specific types of radiofrequency catheter ablation, and symptoms can easily be missed, as they may develop one to two days after being sent home from the hospital.
Keeping a Stable Weight After Surgery
Maintaining a stable weight during the recovery period is important. We know that weight gain leads to obesity, which increases your 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 way to prevent weight gain after cardiac ablation surgery is to return to your normal daily activities as soon as possible.
Dietary Recommendations Following Cardiac Ablation
If you don’t have any other medical conditions requiring dietary management, such as diabetes or kidney disease, following a heart-healthy diet is recommended.
A heart-healthy diet is lower in sodium, fat, and cholesterol than the typical American diet. It emphasizes 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
According to the American Heart Association, the recommended daily amount of sodium intake for people with heart conditions and high blood pressure is 1,500 mg.
Regarding the recommended amount of total cholesterol daily, many health organizations encourage limiting daily cholesterol intake to 300 mg daily. However, more and more research has uncovered that dietary cholesterol has minimal intake on your blood cholesterol levels.
Instead, limit your intake of saturated and trans fats and get adequate physical activity to reduce blood cholesterol levels. If you would like to learn about specific dietary patterns that reduce cholesterol, the following diets 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
These diets follow similar dietary patterns to the heart-healthy recommendations listed above.
The recommended amount of saturated fat per day could be confuse some people since the 2020-2025 Dietary Guidelines for Americans recommends limiting saturated fat to less than 10% of your total daily calories.
However, I highly recommend following the AHA guidelines which limit saturated fat intake to no more than 5-6% of total daily calories. This means that if you follow a 2,000-calorie meal plan, only 120 calories (~13 grams) should come from saturated fat.
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 (2,000 mg) of sodium daily and a fluid restriction of 2 liters daily. The goal of this restrictive diet is to prevent water build-up in your body and around your heart.
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However, it is more complicated. There is no one-size-fits-all diet to manage congestive heart failure.
Current U.S. guidelines 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 a balanced diet is not followed, 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, limiting fluid intake is only recommended if your sodium level is low or if you have advanced heart failure.
The bottom line is to stick with a lower sodium diet of under 2,300 mg daily 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. Limiting your intake of higher-sodium foods will also be beneficial.
For more on foods high in sodium, take a peek at the American Heart Association’s Salty Six handout.
You may also print off and follow the recommendations in this “Living With Heart Failure” guide.
For additional handouts on sodium, check out the following:
- Sodium: How Much is Too Much?
- Salt Substitutes: An Informational Guide
- Heart Healthy Grocery Guide (FREE)
Medications to Manage Weight Gain
In addition to dietary recommendations, you may also take 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:
- Diuretics
- Vasodilators, and
- Ionotropic medications
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.
Furosemide (brand name Lasix) is the most common diuretic used to treat heart failure and pulmonary edema. 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, improving blood flow and blood pressure.
Two common vasodilators are nitroglycerin and sodium nitroprusside.
Nitroglycerin is often used to treat chest pain from angina. However, you can also use it to treat CHF.
Sodium nitroprusside is often used to treat acute hypertension. However, acute decompensated heart failure can also be treated using this medication.
Both of these medications work very quickly to relax 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. It is given through an IV, especially if you have low blood pressure and lowered cardiac output.
Monitoring Symptoms at Home
Once you are discharged from the hospital, you will be responsible for monitoring your health. Your nurse should provide instructions on how to care for your surgical incisions, restrictions on physical activities, which vitals to monitor, and signs and symptoms to watch out for, including fluid retention after your cardiac ablation.
Continue to follow a heart-healthy diet and any other individualized dietary instructions you may have been given.
It’s important to take it easy for the first week to allow yourself to heal. Complete 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, and it should resolve once your daily activities are resumed.
Knowing the signs of fluid retention will help 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
Conclusion
Having a cardiac ablation is a big decision. It may be the best option for treating atrial fibrillation or other arrhythmias when medications aren’t working. Being informed about all risks and benefits can help you decide whether to proceed. Coming up with an appropriate plan after surgery is also crucial.
If you have any weight gain following your cardiac ablation, it may only be temporary and managed while you are still in the hospital.
The nursing staff will monitor your progression, including 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, which may include a stricter diet than you are used to.
Some dietary recommendations must be more 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 essential to continue a preventative, heart-healthy diet and monitor for any rapid weight gain or symptoms of fluid overload.
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