Catheter ablation

Content

Introduction

Catheter ablation or cardiac ablation is a minimally invasive procedure used to correct heart rhythm disturbances (arrhythmias). It is performed in an electrophysiology laboratory using probes that literally destroy the structures in the heart responsible for the arrhythmia.

For arrhythmia means a heartbeat that is too fast (tachycardia), too slow (bradycardia) or irregular (ectopic beats, atrial fibrillation) compared to the normal heart rate between 60-100 beats per minute.

The cardiac ablation procedure is usually performed when the arrhythmia is not controllable with drug therapy alone.

A long and flexible probe (connected to a suitable device) is introduced through a peripheral blood vessel (generally from the groin or arm) and is guided until it reaches specific points inside the heart. The probe emits energy in the form of extreme heat or cold and works by healing or destroying a small area of ​​the heart tissue to restore the heart's regular rhythm without damaging healthy heart tissue.

When it should be done

Catheter ablation is performed when drugs to treat the arrhythmia are not effective or are poorly tolerated and the disorders prevent the person from leading a normal life (disabling).

The ablation procedure is performed for the treatment of arrhythmias such as:

  • supraventricular tachycardia (SVT)
  • Ectopic atrial tachycardia
  • atrial fibrillation
  • atrial flutter

The ablation procedure is preceded by an electrophysiological study, usually performed in the same operating session.

Preparation

The examination does not require any special preparation. The cardiologist decides, a few days before the operation, if and when the taking of the drugs should be suspended. It is necessary to fast from the night before and not to drink liquids before the examination.

The surgeon should be informed of the presence of a pacemaker to assess whether additional precautions are necessary.

How it is done

Catheter ablation is performed in a hospital, electrophysiology ward or clinic and, most of the time, with the conscious person. Only in some cases is it performed under general anesthesia.

During the operation, the person is in continuous contact with the operator, must avoid changes in position and is constantly monitored by equipment that checks the activity of the heart. He may experience a burning sensation lasting a few seconds.

The procedure involves passing a thin tube (catheter) through an artery or vein in the neck, arm or groin until it reaches the main blood vessels and heart chambers. The use of the fluoroscope, an X-ray equipment also called image intensifier, allows to obtain real-time images of the parts of the body crossed. Some catheters have wire electrodes that record and locate the source of abnormal heartbeats. Through the catheter, in correspondence with the areas identified as responsible for the arrhythmia, the device sends a current that generates heat (radiofrequency, laser light), or a gas at extremely low temperatures (cryothermia) to create a real scar, called ablation line. The scar forms a barrier that prevents electrical impulses from passing through thus preventing abnormal electrical signals from causing arrhythmias.

After ablation, the doctor removes the catheter and closes the vessel used (arm, groin or neck) with an occlusive bandage. The procedure takes 2 to 4 hours.

At the end of the operation, the person is kept under observation for a couple of hours, during which vital parameters such as heart rate and blood pressure are checked.

After a short stay in the hospital, the person can be brought home by the carer (for example, a family member). The drugs used during the ablation procedure, in fact, could cause drowsiness and / or slow reflexes. , which limits movement to prevent bleeding in the area where the catheters have been inserted.

Complications

Complications associated with catheter ablation are quite rare (0.5-4%) and are related to:

  • arrhythmias
  • bleeding and infection of the blood vessels caused by the catheter
  • mobilization of blood clots in the peripheral circulation (venous thromboembolism, pulmonary embolism, cerebral embolism etc ...)
  • pericardial effusion (the pericardium is a membranous structure that lines the heart and the origin of the great vessels)
  • pneumothorax that is, an accumulation of air inside the pleural space (ie between the two membranes that cover, respectively, the lungs and the chest wall)
  • hemothorax (an effusion and accumulation of blood within the pleural cavity)
  • cardiac tamponade (a buildup of blood in the pericardial sac)

Prevention

To keep your heart healthy you need to:

  • not smoking
  • engage in regular physical activity
  • observe a healthy and balanced diet
  • check cholesterol levels
  • check blood pressure levels
  • do not gain weight
  • manage stress levels

Bibliography

Mayo Clinic. Cardiac ablation (English)

Mayo Clinic. Heart arrhythmia (English)

National Institutes of Health (NIH). National Heart, Lung, and Blood Institute. Catheter ablation (English)

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