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A catheter ablation is part of an electrophysiological (EP) study and is minimally invasive. In this video, Ravi K. Sureddi, MD, a cardiac electrophysiologist at Riverside Community Hospital, describes how a catheter ablation is performed.
Catheter ablation targets and destroys small areas of cells in the heart thought to be the source of the electrical malfunction in atrial fibrillation (AFib). This procedure usually improves a person's heart function, exercise capacity and quality of life.
Not all people undergoing ablation have their arrhythmia completely eliminated by the procedure; however, many people still experience greatly improved heart rate control. The result of ablation may be that drug therapy that failed to control heart rate in the past may be effective once again.
Some patients with heart rhythm disturbances ("arrhythmias") do not respond adequately to treatment with medication, and for other arrhythmia patients, therapy with medications is not as safe or appropriate as more definitive treatment. Catheter ablation is a procedure used to selectively eliminate (damage or get rid of) the heart cells causing the arrhythmia.
While many energy sources are being investigated to perform catheter ablation procedures, radiofrequency (RF) electrical energy is most commonly used today. RF energy consists of high frequency radiowaves and has been used safely during surgical procedures for many years to cauterize (burn) tissue and prevent bleeding. When delivered by catheters that are positioned inside the heart, RF energy can selectively cauterize the heart cells responsible for an abnormal heart rhythm. Ablation is designed to permanently cure your arrhythmia, or if that is not possible, to make them less frequent, slower, and better tolerated.
An abnormal area of heart tissue can, in some cases, produce irregularities in the transmission of electrical impulses in the heart. This results in a cardiac arrhythmia -- an abnormal, often rapid or irregular heartbeat. As a result of a cardiac arrhythmia, the heart may not able to pump blood normally. Depending on the type of arrhythmia, this situation can lead to a variety of symptoms, including congestive heart failure, stroke, or even sudden cardiac death.
Physicians can often cure arrhythmias by interrupting the path of the electrical impulses that produce them using a technique called catheter ablation. Cardiologists can often treat both supraventricular arrhythmias (including atrial fibrillation) and ventricular arrhythmias as part of a non-surgical catheter procedure.
Catheter ablation causes less discomfort and results in faster recovery times than open-heart surgery. Catheter ablation procedures are highly effective, with success rates often greater than 90% for most arrhythmias. These procedures are low risk, and typically require less than a 24-hour hospital stay.
In catheter ablation, electrode catheters are inserted through veins and guided to various positions inside the heart. Using these catheters, radiofrequency energy or freezing temperature is applied to the abnormal electrical pathway in the heart tissue. This interrupts the path of the abnormal electrical impulses, and cures the arrhythmia.
To reduce symptoms of palpitations, fatigue and shortness of breath in people with atrial fibrillation (AF), various medications are available to slow the heart rate during AF episodes, or prevent episodes from occurring. In people for whom drugs are not effective, catheter ablation is a minimally invasive procedure that uses radiofrequency energy to destroy the tissue that triggers AF. It is more effective than medications and offers many people the chance to avoid lifelong drug therapy while remaining free of AF symptoms.
Radiofrequency catheter ablation, or RFCA, is a nonsurgical, minimally invasive way of curing various heart rhythm disturbances. Arrhythmias are disturbances usually caused by shortcuts in the electrical system of the heart. RFCA is used to correct these problems by using a catheter (thin electrical wire) to cauterize a tiny portion of the heart muscle. Heart rhythm disturbances treated with this procedure include SVT (supraventricular tachycardia), VT (ventricular tachycardia) and AF (atrial fibrillation).
The procedure may take two to four hours on average. Most patients don’t need general anesthesia; twilight sleep and local anesthesia are usually needed. There is an overnight stay for observation. Patients may return to work in a couple of days.
Success rates vary depending on the heart rhythm treated. SVT can be cured 95 percent of the time, but the success rate for AF and VT is lower, about 70 percent, with the first procedure. The risk is usually very low, less than 1 percent for a serious complication, and the procedure is essentially painless.
After numbing the skin, tiny plastic tubes are inserted in the veins, usually in the leg or arm. Through these tubes, very thin wires are steered into the veins and positioned in different heart chambers. X-rays are used to guide these wires, or catheters. The source of the rhythm disturbance is determined by electrical mapping, usually with the help of a powerful computer. The radiofrequency catheter is positioned at the location causing the rhythm problem. Microwave energy is used to heat and destroy (or ablate) the tiny portion of the heart muscle that contains the trouble spot. The catheters are then removed, and after resting a few hours, the patient may resume normal activities.
Catheter ablation is a bit like angioplasty because it is performed without major surgery, using instruments guided into the heart via tiny wires (catheters) that are inserted into a blood vessel in the groin. The similarity ends there, though. Angioplasty opens a closed or blocked coronary artery. Catheter ablation injures small patches of tissue on the heart's inner surface. This destroys the sources of stray electrical signals that trigger and sustain atrial fibrillation, or acts like a roadblock against them.
Briefly heating the inner wall of the left atrium around the openings to the pulmonary veins (dotted lines) creates scar tissue that can block the signals that trigger atrial fibrillation.
The pulmonary veins are a common source of these extra signals. Making a ring of scar tissue around the openings to these veins creates a barrier that keeps the electrical signals they generate from affecting the rest of the heart. This is called pulmonary vein isolation. The earliest devices used heat to create scar tissue. Newer ones being tested use freezing cold, laser energy, or ultrasound. Catheter ablation is used to destroy small knots of nerves (ganglia) that are overly sensitive to inputs from the autonomic nervous system, which controls involuntary actions of the smooth muscles, heart, and glands. It is also used to inactivate patches of tissue that inappropriately amplify or recycle electrical signals.
Although catheter ablation is a very promising approach, it is new enough, and the techniques are evolving so fast, that we don't yet know enough about its long-term effects. For that reason it isn't recommended as a first-line treatment for atrial fibrillation, but is an option for individuals who don't respond to anti-arrhythmia medications or who can't take them.
This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.