Definition and Overview

Cardiac catheter ablation is a non-surgical procedure that corrects the heart's abnormal electrical activity or rhythm by delivering energy like radiofrequency (RF) through catheters.

This procedure is used to treat certain kinds of arrhythmia, a general term that refers to abnormal or irregular electrical activity of the heart. It could mean that the beating is fast, slow, inconsistent, or follows a different pattern.

The effects of arrhythmia can depend on many factors including the severity of the condition. In mild cases, patients do not feel any symptoms. In fact, others may not even be aware that they have the condition. Others, on the other hand, suffer from fainting spell or dizziness due to the inefficient supply of blood. In more severe cases, the condition leads to blood clot formation, congestive heart failure, and even death.

Who should undergo and expected results

Cardiac catheter ablation is performed to treat certain types of arrhythmia such as atrial fibrillation (AF), which is characterized by disorganized electrical impulses in the atria. As a result, the blood accumulates in one area and does not properly flow to the ventricles.

Atrial fibrillation and other types of arrhythmia can be corrected using medications. However, if the patient, for some reason, doesn't respond well to such treatment, cardiac catheter ablation will be considered. In some cases, this becomes the first course of treatment if the condition has already progressed.

How the procedure works

The cardiologist will request different tests including electrocardiography and Holter monitor to keep track of the heart's rhythms. By combining the results of these tests with medical interviews and review of the patient's family and personal medical history, the cardiologist will determine whether the patient is qualified for cardiac catheter ablation.

There are no special preparations needed a night before the procedure other than fasting after midnight, including drinking only small amounts of water throughout the day.

On the day of the procedure, the patient is ushered into a lab or cardiac room where he lies flat on a table. The site in which the catheter is inserted will be cleansed with an antiseptic. The area will also be numbed. There are three common sites for catheter insertion: the wrist, neck, and groin. The patient is also attached to an IV line, which delivers the medications to keep the patient comfortable and sedated throughout the procedure. To monitor the patient's vitals, certain types of equipment such as a blood pressure monitor are used.

A small incision is then made at the catheter site to access a blood vessel, which may be an artery or a vein. A transducer is inserted into one of the catheters for an ultrasound to monitor the conditions of the heart throughout the procedure. Another device is utilized to provide real-time data on the electrical activity.

Once the site of the disruption is identified, the cardiologist will deliver energy waves like RF through the catheter using either a pacemaker device or a machine.

Depending on the condition of the patient during the procedure and complexity of the problem, a cardiac catheter ablation can take around four hours.

Possible risks and complications

Cardiac catheter ablation is generally a safe procedure with very minimal risks but the patient may feel uncomfortable at first as the medication is delivered through the IV line. As in other kinds of surgery, infection may develop at the incision site. There may also be bleeding.

References:

  • Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, et al. (HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2007:4(6):816-61.

  • Lustgarten DL. History of cardiac cryosurgery and cryoablation. In: Bredikis AJ, Wilber DJ, eds. Cryoablation of Cardiac Arrhythmias. Philadelphia, PA: Elsevier Saunders; 2011:chap 1.

  • Miller JM, Zipes DP. Therapy for cardiac arrhythmias. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 35.

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