Invasive treatment of arrhythmias with catheters which are used to produce a small scar in the heart which acts as a road block to prevent abnormal electrical signal from spreading and generating the arrhythmia.
Catheter ablation, also called EP (electrophysiology) ablation, can be used to treat a wide range of tachycardias (abnormally fast heart rhythm) which can be dangerous or difficult to treat with medication. The arrhythmias commonly treated with EP ablation are, e.g. atrial flutter, AVNRT (atrioventricular node reentry tachycardia), AVRT (atrioventricular reentry tachycardia, Wolff Parkinson White - WPW syndrome), atrial fibrillation (pulmonary vein isolation alone or as a part of pace and ablate strategy with implantation of permanent pacemaker and ablation of AV node) and some types of ventricular tachycardias. Catheter ablation has a very high success rate in most arrhythmias, but in atrial fibrillation, further medication including anticoagulation (blood thinning medication) and repeat ablations are often necessary, and in ventricular arrhythmias, antiarrhythmic medication and sometimes implantations of ICD (implantable cardioverter-defibrillator) may be recommended.
Catheter ablations are carried out by electrophysiologists, cardiologists specialising in heart rhythm. During the catheter ablation, thin, flexible tubes (catheters) are passed from the vein at the top of the leg to the heart. Catheters are then used to measure electrical signals within the heart and locate the precise area for ablation. Energy is sent through the catheters to the selected area to destroy it. The energy can be in the form of heat (radiofrequency ablation) or cold (cryoablation). Catheter ablation is usually carried out under local anaesthesia and sedation as a day case procedure (without overnight admission to the hospital).
Catheter ablation is safe, but there are potential complications, including triggering short-lived arrhythmias, haematoma (bruising), infection and discomfort at the site of catheter insertion, failure to terminate the arrhythmia, tamponade (bleeding to the pericardial sac surrounding the heart) and need for redo procedure.