Catheter ablation

Catheter ablation
Intervention

ICD-9-CM	37.34
MeSH	D017115

Catheter ablation is an invasive procedure used to remove or terminate a faulty electrical pathway from sections of the hearts of those who are prone to developing cardiac arrhythmias such as atrial fibrillation, atrial flutter, supraventricular tachycardias (SVT) and Wolff-Parkinson-White syndrome. In its radiofrequency ablation form, it is called radiofrequency catheter ablation. Cryoablation types also exist.

Medical uses

Catheter ablation may be recommended for an arrhythmia that cannot be controlled medically. The patient has faulty electrical activity in the heart that increases their risk of ventricular fibrillation and sudden cardiac arrest. Ventricular fibrillation is a life-threatening arrhythmia. Sudden cardiac arrest is a condition in which the heart suddenly stops beating.

Effectiveness

Catheter ablation of most arrhythmias has an extremely high success rate. Success rates for WPW syndrome have been as high as 95% ^[1] For SVT and atrial flutter, the success rates are 95-98%. For automatic atrial tachycardias, the success rates are 70-90%. The potential complications include bleeding, blood clots, pericardial tamponade, and heart block, but these risks are very low, ranging from 0.5-3%.

For atrial fibrillation, several experienced teams of electrophysiologists in US heart centers claim they can achieve up to a 75% success rate. However one recent study claims that the success rates are in fact much lower. Single procedure success rates have been published in this study at 28%. Often, several procedures are needed to raise the success rate to the 70-80% range.^[2] One reason for this may be that once the heart has undergone atrial remodeling as in the case of chronic atrial fibrillation sufferers, largely 50 and older, it is much more difficult to correct the 'bad' electrical pathways. Young people with AF with paroxysmal, or intermittent, AF therefore have an increased chance of success with an ablation since their heart has not undergone atrial remodeling yet.

Risks

Risks of catheter ablation for atrial fibrillation include, but are not limited to: stroke, esophageal injury and death.

Technique

Catheter ablation involves advancing several flexible catheters into the patient's blood vessels, usually either in the femoral vein, internal jugular vein, or subclavian vein. The catheters are then advanced towards the heart. Electrical impulses are then used to induce the arrhythmia and local heating or freezing is used to ablate (destroy) the abnormal tissue that is causing it. Originally, it was suggested that a DC impulse be used to create lesions in the intra-cardiac conduction system.^[3] Newer procedures allow for the terminating of diseased or dying tissue to alleviate the chance of arrhythmia.

Catheter ablation is usually performed by an electrophysiologist (a specially trained cardiologist) in a cath lab or a specialized EP lab.

Recovery or rehabilitation

After catheter ablation the person is moved to a cardiac recovery unit or cardiovascular intensive care unit where they are not allowed to move for 4–6 hours. Minimizing moving helps prevent bleeding from the place the catheter was inserted into the body. Some people have to stay overnight for observation, some need to stay much longer and others are able to go home on the same day. This all depends on the problem, the length of operation and whether or not general anaesthetic was used.

References

↑ Thakur, R. K., Klein, G. J., & Yee, R. (1994). Radiofrequency catheter ablation in patients with Wolff-Parkinson-White syndrome. CMAJ, 151(6), 771-776.
↑ Cheema, et al. Long-term single procedure efficacy of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol (2006) 15:145-155.
↑ Experimental production of complete heart block by electrocoagulation in the closed chest dog. Beazell, et al, Amer. Heart Journal, Dec, 1982, pp 1328-13334

External links

Surgery and other procedures involving the heart (ICD-9-CM V3 35–37+89.4+99.6, ICD-10-PCS 02)

Surgery and IC

Heart valves and septa	Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock–Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of great vessels Jatene procedure Mustard procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock–Taussig shunt SVC to the right PA Glenn procedure

Cardiac vessels	CHD Angioplasty Bypass/Coronary artery bypass MIDCAB Off-pump CAB TECAB Coronary stent Bare-metal stent Drug-eluting stent Bentall procedure Valve-sparing aortic root replacement

Other	Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure Cox maze and minimaze Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation

Diagnostic
tests and
procedures

Electrophysiology

Electrocardiography

Vectorcardiography

Holter monitor

Implantable loop recorder

Cardiac stress test

Bruce protocol

Electrophysiology study

Cardiac imaging

Angiocardiography

Echocardiography

TTE

TEE

Myocardial perfusion imaging

Cardiovascular MRI

Ventriculography

Radionuclide ventriculography

Cardiac catheterization/Coronary catheterization

Cardiac CT

Cardiac PET

sound: Phonocardiogram

Function tests

Pacing

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