Catheter ablation (also known as radiofrequency catheter ablation) is a non-surgical technique where a thin electrode catheter (a specially insulated electrical wire) is used to localise the abnormal site in the heart causing the arrhythmia (electrical disorder of the heart). Radiofrequency energy is then delivered via the catheter to ablate (or destroy) it. It is an extension of the electrophysiological study (EPS).
In experienced centres, and depending on the type of arrhythmic, the success rate is about 95-98% and the recurrence rate is <5%. The risk of the procedure for any serious complication is around 1% (bleeding, infection, injuries to the blood vessels and surrounding structures of the heart, heart block needing permanent pacemakers, death). Patients are usually discharged the next day after the ablation procedure.
Most patients can return to normal activities within a day or two. You may find a small bruise or lump under your skin where the catheter was inserted. This is common and should go away within a few days. Avoid strenuous physical exercise for about 2-4 weeks but after that, full physical and normal activities can be resumed.
Patients with cardiac arrhythmias may be at risk for sudden cardiac arrest, have recurrent attacks of arrhythmia or may need lifelong drug therapy and its potential side effects.. Radiofrequency catheter ablation is able to cure some of these patients by ablating the abnormal focus of arrhythmia.
Your doctor will determine your suitability for the procedure by reviewing your medical history, physical examination, electrocardiogram (ECG) recordings, echocardiogram recordings, Holter monitor recordings and other tests as needed.
After evaluation, your doctor will discuss the treatment options and determine if you are a candidate for this procedure.
Normal Conduction of the Heart
RFCA can be used to treat:
How the procedure is done
The radiofrequency catheter ablation is performed in the cardiac catheterisation lab. The staff will be wearing sterile gloves, gowns, caps and masks. A technician will place several ECG electrodes on your chest to monitor the heart rate and rhythm during the procedure, and a gel pad on your back. A blood pressure cuff will be put around your arm and oxygen saturation metre will be placed around your finger. Your groin and left chest area will be washed with antiseptic solution and sterile sheets will be placed over your body. Do not touch this sheet with your hands because it should remain germ-free. Before the insertion of the catheters (special insulated electrical wires), intravenous injections of sedatives will be given.
Following the injection of local anesthetic, the catheters will be inserted usually via the left subclavian vein (near the left shoulder) and either femoral veins (at the both groins). The catheters are positioned in the heart by the operators using X ray imaging guidance. During the study, the patient may feel a rapid heart rate due to the pacing or the induction of the tachycardia. The EPS gives an electrical map of the heart and determines the cause of the arrhythmia (electrical malfunction). The exact site is then localized by the electrical signals obtained from the tip of the catheter. Once the abnormal site is precisely localized, radiofrequency energy is then delivered via the tip of the catheter to destroy or “burn” (temperature of 60 to 70°C only) the abnormal tissue. The size of the "burn" is very small and is usually about 5 mm in diameter only and hence very precise localization is necessary for it to succeed. Radiofrequency energy is delivered for usually 30-60 seconds, to ablate the abnormal focus. The procedure usually takes about 1 2 hours. After the ablation, the patient waits for another 15-30 minutes in the lab to ensure that there is no immediate recurrence.
Some medications, which can affect the EPS, should be stopped about 3-5 days before admission. You need to fast for about 6 hours before the procedure. Sedation will be given before the procedure.
The nurse will instruct you to rest in bed for about 8 to 12 hours. You can have food and drinks, on returning back to the ward. The nurse will monitor the pulse rate hourly and blood pressure 4 hourly for 24 hours. A telemetry (ECG monitoring device) will be put on when necessary. An intravenous drip may be started and oral medication may be given on return to the ward. Call the nurse or doctor if there is bleeding from the groin.
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