Catheter ablation is a procedure to correct abnormal heart rhythm, a condition known as arrhythmia. There are different types of arrhythmias, in which the heart may beat too fast (tachycardia), too slow (bradycardia), or with an irregular pattern.
Catheter ablation, also known as cardiac ablation, uses heat or cold energy to create tiny scars in small areas of the heart tissues that are responsible for rhythm problems. As the name suggests, catheter ablation is done by inserting a thin, flexible tube called a catheter through a tiny incision in your groin area into your heart. Your doctor may recommend this treatment when oral medication and lifestyle changes prove to be ineffective in controlling your condition. Catheter ablation is presently the first line of treatment for most heart rhythm problems as medications are not very effective.
Before discussing more on catheter ablation, let’s first talk about electrophysiology (EP) studies.
An EP study is used to study the electrical conduction system of the heart, and to detect abnormal conduction that may be responsible for heart rhythm disturbances. On top of diagnosing arrhythmia, it is also used to identify the source of this problem and to help determine the best treatment.
Once identified, your cardiologist may then proceed with treatment, including catheter ablation, to control the condition. Other reasons why your doctor may recommend an EP study is to:
The procedure involves inserting thin wire electrodes into a vein through an area in the groin or neck. This wire will then be threaded through the vein into the heart, using X-ray images as a guide. It is generally painless and usually takes 1 - 4 hours.
Once the electrode is in your heart, there are several things your doctors can do:
If your EP study results and other tests suggest that catheter ablation is necessary, the procedure can be done directly following the EP study. An EP study helps your doctor better diagnose your condition and discern whether you are suitable for catheter ablation, or to prescribe other forms of treatment.
Another name for catheter ablation, RF ablation is a procedure to scar up certain areas of the heart tissue that cause abnormal heart rhythms. This is done to prevent abnormal heartbeats and thus restore the heart to its normal rhythm.
Common conditions treated with catheter ablation are:
Upper chambers of the heart
Lower chambers of the heart
Atrial fibrillation (AF) refers to irregular and often very rapid heart rhythm, which happens when the atria (heart’s upper chamber) beats out of sync with the ventricles (lower chambers). If left untreated, the condition may cause blood clots and is thus a risk factor for stroke, heart failure, and various other heart conditions. About 15-20% of stroke patients have this condition and A-fib is also associated with a 5-fold increased risk of stroke.
Apart from causing an increased risk of stroke, AF can cause symptoms like palpitations, feeling of irregular heart beat, chest discomfort, shortness of breath and loss of consciousness. Long-standing AF can lead to heart failure in certain cases. In some patients, AF can be asymptomatic and detected on routine screening or examination.
The mainstay of AF treatment is to prevent stroke associated with it and to alleviate symptoms. Catheter ablation is one of the first-line treatment options in patients with symptomatic atrial fibrillation. Trial of medication to alleviate symptoms is also an option. Treatment of AF is individualised for each patient and your doctor will discuss, in detail, the different options available.
The general procedure of a cardiac ablation to treat atrial fibrillation is similar to the one mentioned in the previous section. It may involve using heat (RF) or extreme cold (cryoablation) to create scars in your heart tissues. For the different arrhythmias, the difference mainly lies in the target area. In the case of atrial fibrillation, the type of procedure may be:
Note: this reduces occurrences of A-fib episodes but oftentimes does not cure the condition. Currently, other options are preferred over this method.
Following cardiac ablation, patients may still be put on lifelong blood thinners to prevent strokes. In other cases, your doctor may also recommend another procedure called the left atrial appendage closure. This procedure reduces your risk of stroke and eliminates the need for blood-thinning medication.
Catheter ablation is a minimally invasive day procedure with a moderately high success rate in treating various types of arrhythmia. That said, not all cases of arrhythmia call for this procedure. Each condition really differs between patients so it is always best to discuss with your doctor to find the most effective strategy to manage the condition. With individualised treatments and lifestyle changes, arrhythmia is definitely manageable.
“Atrial Fibrillation (Afib); Causes, Symptoms & Treatment.” Cleveland Clinic, 18 July 2019, https://my.clevelandclinic.org/health/diseases/16765-atrial-fibrillation-afib#management-and-treatment. Accessed 13 December 2021.
“Cardiac ablation.” Mayo Clinic, 5 March 2021, https://www.mayoclinic.org/tests-procedures/cardiac-ablation/about/pac-20384993. Accessed 13 December 2021.
“Electrophysiology (EP) Study.” Mount Elizabeth Hospitals, https://www.mountelizabeth.com.sg/specialties/medical-specialties/heart-vascular/electrophysiology-study. Accessed 13 December 2021.
“Facts About Catheter Ablation.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/catheter-ablation. Accessed 13 December 2021.
“Heart arrhythmia - Symptoms and causes.” Mayo Clinic, 1 October 2021, https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668. Accessed 13 December 2021.
“EP study.” Mayo Clinic, 26 March 2021, https://www.mayoclinic.org/tests-procedures/ep-study/about/pac-20384999. Accessed 13 December 2021.
“What is Atrial Fibrillation (AFib or AF)?” American Heart Association, 31 July 2016, https://www.heart.org/en/health-topics/atrial-fibrillation/what-is-atrial-fibrillation-afib-or-af. Accessed 13 December 2021.
Dr Devinder Singh is the Medical Director of Cadence Heart Centre. He is an experienced Senior Consultant Cardiologist & Cardiac Electrophysiologist with over 20 years of clinical experience.
His expertise lies in clinical cardiology, cardiac rhythm disorders (arrhythmia), cardiac pacing (including cardiac resynchronisation therapy) and cardiac magnetic resonance imaging. He performs electrophysiology studies and radiofrequency ablation of cardiac arrhythmias, and is well versed in pacemaker and deﬁbrillator insertions.
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