Cardiac ablation is a procedure we use to treat various types of heart rhythm disturbances which consists in selectively eliminating that area of the heart which is causing the arrhythmia. This is supposed to prevent the abnormal electrical rhythms or signals from moving through the heart.
There are two methods for performing cardiac ablation:
- Radiofrequency ablation uses heat energy to eliminate the problem area.
- Cryoablation or use of cold.
What happens in radiofrequency ablation?
Usually the procedure is performed under conscious sedation (in order to reduce anxiety), with vital signs being monitored the whole time (heart rate, blood pressure). The femoral vein (in the groin) is punctured so that catheters can be introduced into the heart chambers.
The procedure takes several hours. The first part consists in performing an electrophysiology (arrhythmia) study, conducting programmed electrical stimulation of the atrium and ventricle to induce arrhythmia (to establish the mechanism that is producing it). Immediately afterward, ablation is carried out using mapping techniques (detection) to determine the optimum place for the operation. Once the ablation is over, a check is performed to ensure noninducibility (non-production) of the arrhythmia and the procedure is ended.
The patient must remain resting in bed for a minimum of 4 hours, after which time, if there have been no complications, he or she can be discharged from the hospital.
For what cases is it indicated?
Catheter ablation revolutionized the management of patients with tachyarrhythmia, an evolutionary development from arrhythmia surgery. Initially, this was done using a high-voltage direct current (DC); however, in the 1980s, radiofrequency replaced the DC method (due to the high rate of complications) as the energy source of choice, and catheter ablation became the preferred method for management of many tachycardias.
It is considered the first-line therapy for some arrhythmias (Wolf -Parkinson –White syndrome) and as an important technique for handling other arrhythmias refractory to medical treatment or ones where other treatment would be contraindicated (atrial tachycardia, atrial fibrillation or flutter, nodal reentrant supraventricular tachycardia, idiopathic ventricular tachycardia).