Ablation is used as a minimally invasive treatment method to destroy abnormal tissues. In this medically indicated procedure, energy sources (such as radiofrequency, cryotherapy, or high-intensity focused ultrasound) are applied to the target tissue. In cardiology, especially for atrial fibrillation treatment, ablation aims to regulate heart rhythm by disabling faulty electrical pathways. In oncology, high-intensity focused ultrasound is used to destroy cancer cells. Additionally, a new technique called pulsed field ablation provides targeted ablation without damaging healthy cardiac tissue.
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
What Is Ablation?
Ablation therapy is a minimally invasive treatment method used to destroy abnormal or diseased tissues in the body. Depending on the patient’s condition and treatment needs, various techniques are employed. Energy sources such as radiofrequency, microwave, and cryoablation are used to target and selectively destroy unwanted cells.
How Does Ablation Work?
Ablation comprises a range of minimally invasive techniques used to destroy abnormal tissues. Each method uses its own form of energy to create thermal, mechanical, or electrical damage in the tissue, leading to cell death. The mechanisms and applications differ by technique. The main ablation methods are:
- Radiofrequency Ablation (RFA): Generates heat via electrical current
- Microwave Ablation (MWA): Heats water molecules with electromagnetic waves
- Laser Ablation: Uses concentrated light energy to damage tissue
- Cryoablation: Forms intracellular ice crystals via extreme cold
- Irreversible Electroporation (IRE): Creates permanent pores in cell membranes with electrical pulses
- Pulsed Radiofrequency Ablation (PRF): Modulates pain signal transmission without high heat
Ablation techniques are chosen based on the characteristics of the target tissue, tumor size, and its relationship to surrounding structures. For example, radiofrequency ablation is preferred for small areas, while microwave ablation treats larger regions and bigger tumors. Cryoablation is effective for tumors sensitive to cold and is commonly used in delicate locations. Irreversible electroporation offers advantages by disrupting cells without thermal effects. Pulsed radiofrequency ablation is primarily used for pain management. Each technique is carefully selected and applied to achieve optimal results for specific conditions and tissues.
When Is Ablation Used?
Ablation is a minimally invasive method used to destroy various abnormal tissues when drug therapy or surgery is insufficient or inappropriate. Its main applications include:
- Oncology
- Hepatocellular carcinoma
- Renal cell carcinoma
- Lung tumors
- Liver metastases
- Hepatic hemangiomas
- Bone metastases
- Benign thyroid nodules
- Gastroenterology
- Barrett’s esophagus
- Pulmonology
- Chronic obstructive pulmonary disease (COPD)
- Cardiology
- Atrial fibrillation
- Atrioventricular nodal reentrant tachycardia
- Wolff–Parkinson–White syndrome
- Ventricular tachycardia
In cardiology, catheter ablation corrects arrhythmias by disabling faulty pathways. In oncology, radiofrequency or ultrasound targets and destroys cancer cells. In pulmonology, bronchoscopic techniques apply ablation to specific lung areas to improve respiratory function. These procedures speed recovery and minimize pain and complication risks due to their minimally invasive nature.
Who Is Not a Candidate for Ablation?
Ablation is contraindicated in certain medical conditions. Before treatment, the patient’s overall health, the target area, and the chosen ablation method must be carefully assessed. Ablation may increase complication risks in these scenarios:
- Active systemic infection
- Uncontrolled bleeding disorders
- Presence of cardiac thrombus
- Severe pulmonary hypertension
- Specific contraindications for cardiac ablation:
- Left atrial thrombus
- Severe left ventricular dysfunction
- Recent myocardial infarction
- Specific contraindications for endometrial ablation:
- Pregnancy
- Desire for future fertility
- Known or suspected endometrial cancer
- Specific contraindications for microwave ablation:
- Tumors adjacent to vital structures
- Large tumor size
- Severe comorbidities (e.g., uncontrolled diabetes, COPD)
- Inability to maintain required position during the procedure
Ablation planning must balance risks and benefits by evaluating all contraindications. Detailed pre-procedure assessment is especially important for elderly patients or those with multiple chronic conditions.
How Is Ablation Performed?
Ablation is performed using minimally invasive methods to target abnormal tissues with high-frequency current, microwaves, cryogenic cooling, ultrasound, or chemicals. The chosen technique depends on the tissue type, location, and patient health. Each ablation type has specific advantages and indications:
Radiofrequency Ablation
- A thin needle delivers radiofrequency energy to heat the target tissue.
- Indications: Liver lesions, cardiac arrhythmias, bone lesions
Microwave Ablation
- Electromagnetic waves via an antenna create thermal coagulation.
- Indications: Liver, lung, and kidney tumors
Cryoablation
- Extreme cold induces intracellular ice formation and cell death.
- Indications: Prostate, kidney, and breast tumors
Irreversible Electroporation (IRE)
- Electrical pulses create permanent pores in cell membranes.
- Indications: Tumors near vital structures
High‑Intensity Focused Ultrasound (HIFU)
- External ultrasound waves are focused to generate high heat in tissue.
- Indications: Uterine fibroids, prostate cancer, bone metastases
Laser Ablation
- Concentrated light energy causes tissue coagulation.
- Indications: Skin lesions, brain tumors, ophthalmic diseases
Chemical Ablation
- Chemical agents are injected to induce cell death.
- Indications: Liver tumors, thyroid nodules
Imaging guidance—ultrasound, CT, or MRI—is essential for precise targeting during ablation. Local or general anesthesia may be used depending on the procedure and patient needs. Afterward, patients are monitored for bleeding, infection, or injury to adjacent tissues.
What Are the Side Effects of Ablation?
Although ablation effectively treats conditions such as cardiac arrhythmias, it may cause side effects and complications. During catheter ablation, common issues include bleeding, vascular injury, and arrhythmia exacerbation, while rare complications can also occur. Common complications include:
- Bleeding or hematoma
- Vascular injury
- New or worsened arrhythmias
- Infection at the access site
Most side effects are rare and transient. Patients should maintain regular communication with their medical team throughout treatment.
How Should One Prepare for Ablation?
Preparation for ablation involves a structured process to ensure patient safety and maximize procedure success. The preparation varies by ablation type and involves a multidisciplinary approach. Pre-procedure steps include:
- Comprehensive health assessment and necessary diagnostic tests
- Medication management—anticoagulants or antiarrhythmics may be paused to reduce bleeding risk
- Fasting and hydration instructions
- Anesthesia evaluation and planning
- Informed consent covering risks, benefits, and alternatives
- Hygiene and personal belongings instructions
Strict adherence to pre-procedure instructions improves outcomes and minimizes risks. Patients should ask any questions and follow all recommendations from their care team.
How Should Post‑Ablation Care Be Managed?
Post‑ablation care is critical for effective healing and minimizing complications. Although each ablation type has specific requirements, core principles include:
- Initial Monitoring: Observe for bleeding, hematoma, or acute complications
- Activity Restrictions: Avoid heavy lifting, strenuous activity, water exposure, and rubbing the treated area
- Infection Surveillance: Monitor for redness, swelling, warmth, or discharge
- Medication Adherence: Continue anticoagulants or antiarrhythmics as prescribed
- Gradual Physical Activity: Resume light exercise and maintain balanced diet and hydration
- Scheduled Follow‑Ups: Attend all post‑procedure appointments and imaging checks
Lifestyle modifications such as stress management, avoiding smoking and alcohol, and healthy eating support cardiac health and recovery. Regular follow‑up is essential to detect and manage any complications early.
How Does Resistance to Ablation Develop?
Although ablation aims to eradicate cancerous tissue, some tumors develop resistance, reducing treatment efficacy and leading to recurrence. Resistance mechanisms include:
- Incomplete ablation and tumor recurrence
- Activation of angiogenesis
- Cancer stem cell survival
- Upregulation of heat shock proteins (HSPs)
- Increased expression of survivin
- Enhanced DNA repair capabilities
- Supportive tumor microenvironment
Post‑ablation hypoxia can stimulate new blood vessel formation, supplying nutrients and oxygen to surviving cells and facilitating regrowth. Cancer stem cells may enter a quiescent state to evade treatment and later repopulate the tumor. Heat shock proteins produced in response to cellular stress improve cell survival, while anti‑apoptotic proteins like survivin protect cells from death. Understanding these mechanisms is crucial for developing strategies to overcome resistance and improve long‑term outcomes.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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