Catheter Ablation

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Your rhythmic heartbeat is controlled by a smooth, constant flow of electricity through the heart. A short-circuit anywhere along this electrical pathway can disrupt the normal flow of signals, causing an arrhythmia (an irregular heartbeat). Cardiac ablation is a procedure used either to destroy these short-circuits and restore normal rhythm, or to block damaged electrical pathways from sending faulty signals to the rest of the heart.

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What to Expect During the Procedure

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Cardiac ablation is performed by a cardiac electrophysiologist — a physician who specializes in diagnosing and treating heart rhythm disorders. The procedure involves inserting catheters — narrow, flexible tubes — into a blood vessel, often through a site in your groin or neck, and threading them through the vein until they reach your heart. You will be given sedatives to make you relaxed and comfortable, and a topical anesthetic to numb your skin before the catheters are inserted.

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Using electrodes on the tip of the catheters, the doctor first conducts an electrophysiology (EP) study to pinpoint the location of the short-circuit. Once the precise location is confirmed, the “short-circuit” is either destroyed (to reopen the electrical pathway) or blocked (to prevent it from sending faulty signals to the rest of the heart). This is done by sending energy through the catheters to destroy a small amount of tissue at the site. The energy may be either hot (radiofrequency energy), which cauterizes the tissue, or extremely cold, which freezes or “cryoablates” it.

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Most people say they experience only brief moments of discomfort, rather than pain, during the procedure. As with an EP study, you will need to lie still for four to six hours afterward to make sure your catheter incision starts healing properly.

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Results

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Cardiac ablation is an effective treatment for many types of arrhythmias. It is successful in 90 to 98 percent of cases, eliminating the need for open-heart surgery or long-term drug therapy.

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Is Ablation Right for You?

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Cardiac ablation may be an option in any of these cases:

• If your arrhythmia can’t be controlled with lifestyle changes or medication.

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• If you can’t tolerate or don’t want to take the drugs used to treat your arrhythmia.

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• If you have a supraventricular tachycardia (SVT) — a rapid heartbeat that begins in the upper chambers of the heart.     

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• (Less commonly) if you have ventricular tachycardia (VT), an arrhythmia that begins in the lower chambers. For VT, ablation is sometimes coupled with an ICD (implantable cardioverter defibrillator).

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Atrial Fibrillation Ablation

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• Pulmonary vein isolation: Research has shown that most atrial fibrillation signals come from the four pulmonary veins. During this procedure, special catheters are inserted into the heart. Two catheters are inserted into the right atrium and two into the left atrium.

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A specialized viewing device called intracardiac echocardiography is used to visualize the left atrium during the procedure. One catheter in the left atrium is used to map or locate the abnormal impulses coming from the pulmonary veins. The other catheter is used to deliver the radiofrequency energy to create lesions outside the pulmonary veins. The procedure is repeated for all four pulmonary veins.

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The lesions heal and within 4 to 8 weeks, form a circular scar around the pulmonary veins. The scar blocks any impulses firing from within the pulmonary veins, thereby "disconnecting" the pathway of the abnormal rhythm and curing atrial fibrillation.

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• Ablation of the AV node: During this procedure, the doctor applies radiofrequency energy to injure the AV node. The end result is a permanent, very slow heart rate, since the electrical impulses from the top chamber of the heart cannot travel down to the lower chamber. Therefore, the patient needs a permanent pacemaker to maintain an adequate heart rate.

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Atrial Flutter Ablation

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This is an arrhythmia caused by one or more rapid circuits in the atrium. Atrial flutter ablation is done by applying energy to a structure in the right atrium called the isthmus to block conduction.

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