Catheter ablation

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.


Indications

Catheter ablation is also called EP (electrophysiology) ablation. It can be used to treat a wide range of tachycardias (abnormal 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 medication and sometimes implantations of ICD (implantable cardioverter defibrillator) may be recommended.

Procedure

Catheter ablations are carried out by electrophysiologists, cardiologists specialising in this area. During the catheter ablation, thin flexible tubes (catheters) are passed from the vein in the groin 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 anesthesia and sedation as a day case procedure (without the need for overnight admission to hospital).

Complications

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.

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