What is catheter ablation of the heart?
Author Ольга Кияница
2017-10-31
Catheter ablation (CT) marked the emergence of practical surgery in the early 80's of the last century. For today, this procedure is a method of choice and a range of rescue for patients with atrial fibrillation and WPW syndrome. With the help of CT, many open heart operations are now performed in a less traumatic way, which significantly simplifies the rehabilitation and further life of patients after surgery.
Practicing cardiologists consider catheter ablation as non-surgical technique, since there are no cuts, only a few punctures remain in the places where catheters are introduced.
An important point at the preparatory stage before CT is the precise determination of the exact location of the pathological focus. For this purpose, the method of EPI is used - an electrophysiological study based on intracardiac administration of diagnostic catheters.
Video Catheter ablation at arrhythmias
Varieties of catheter ablation
Ablation, or destruction, of the ectopic focus can be carried out in several ways. Different methods of physical exposure are used for this purpose. Each has its own negative and positive sides, but it is also often used, since it allows us to solve the issue with additional paths as high as possible and reliably.
Types of catheter ablation
- Destruction using electric current.
- Destruction of additional paths with low temperatures
- Laser ablation.
- Ultrasound destruction.
- Ablation by radio frequency radiation.
The latter method is most used today and its common name is radio frequency catheter destruction. Its exceptional advantage from the rest of the techniques is the maximum preservation of surrounding tissues, which are considered normal, but due to the close location to the pathological focus, when performing other ablation methods, they are often damaged.
Catheter destruction for today is the most effective method. More than 90% of patients with various forms of arrhythmia after the destruction of pathological foci do not feel the attacks of rhythm disturbance. Only in some cases, patients after the destruction have to take medications, and then at a lower dosage than it was before the procedure.
The low effectiveness of catheter ablation is observed in the following cases:
- the location of the ectopic focal point is not exactly defined;
- the patient has multiple formation of arrhythmogenic foci;
- pathological formation is determined in large sizes, which is often observed after myocardial infarction;
- the impact energy was insufficient, which did not allow the hearth to be properly destroyed.
Why is it necessary to do catheter ablation? Despite the small percentage of failed operations, nevertheless, in comparison with other methods of treatment, CT is the most justifiable. Especially since the successful completion of the procedure can be fully cured of rhythm disturbance.
Preparation for catheter ablation
As a rule, the clinic should be delivered the night before or in the morning on the day of CT. In total there will be in the hospital in the absence of complications a day or two. Before the procedure is carried out, a series of surveys is needed that help to make the destruction more successful. From routine research:
- electrocardiography;
- blood test
A conversation with a doctor is one of the important stages in the preparation for catheter ablation. During the conversation, you can ask all the questions of interest, as well as get the information provided by all patients who are preparing for CT. In particular, it tells about the course of the procedure, the expected result and possible complications. Upon termination of communication with the doctor, all necessary documents are signed in which the patient gives his consent for surgical intervention.
Before the intervention, preparation for the site of the catheter is obligatory. Most often it is the inguinal area, but a large vessel that is on the neck, arm, or shoulder can be used. To prevent infection infected the area is shaving and clearing. After this, put on the catheter hand, which is necessary to facilitate the introduction of the required medications.
What do you need to do before the procedure?
- A few days before the scheduled date, a meeting with the doctor is held, the time of the CT and other nuances are discussed.
- When taking antiarrhythmic drugs, you need to stop it a few days before surgery. This allows for a more accurate diagnosis of ectopic foci.
- If you have an allergy to medicines or poor blood coagulability, you should tell your doctor.
- For normal stay in a hospital, it is necessary to collect things in advance: a robe, pajamas, slippers, personal belongings, and hygiene products.
- Be sure to write down all the medicines that are taken with the dosage marking.
- Approximately 6-8 hours before the start of the CT do not eat or drink. If you need to take a pill, then you can drink it with a few drops of water.
- Prolonged operation involves the formation of a urinary catheter, which allows you not to worry about emptying the bladder.
The presented general points are usually performed in all clinics specializing in CT. However, some changes to the standard preparation for the procedure are allowed, if there are good reasons for this.
Video Operation of radio frequency ablation
There are several stages of KT, which should be performed as thoroughly and in full.
1. A patient is transferred to an electrophysiological ward on a movable bed or in a wheelchair, where he is transferred to an X-ray table. For examination, there is an X-ray unit and a monitor for monitoring the vessel's catheter's progress. Additionally, a cardimonitor and other devices that will be needed during the operation will be installed.
The operating team consists of the following medical staff: an electrophysiologist, his assistant, a nurse, an engineer-technologist.
2. The patient is placed on the table, connected to monitors and other equipment, after which they are covered with sterile sheets. Medical staff is also dressed accordingly, with the obligatory use of sterile gloves, masks, and bathrobes.
3. Immediately, the procedure begins after the catheter is inserted through the femoral vein or vessel located on the neck, arm, or shoulder. Anesthetic is used to prevent the appearance of painful sensations at the site of the catheter insertion.
4. A small incision is performed to introduce the catheter, after which a puncture of a vein or other blood vessel is made. Through the received access, a catheter, one or more, is introduced that performs pulses both from the heart and toward the organ.
The progression of the catheters is controlled by an X-ray unit. When cardiac catheterization is performed, cardiomonitor is used.
5. For the ablation, a special destructive catheter electrode is used, which is inserted into the required cavity of the heart and brought to an atopic focal point. >At the end of the catheter there is a small electrode, which, as a result of the radio frequency pulse, destroys a small portion of the myocardium. Before that, of course, the exact localization of the pathological focus should be established.
A standard technique for catheter ablation can be used in some modifications, which depends on the shape of the arrhythmia and the clinical course of the rhythm disturbance.
- Atrioventricular reentry tachycardia is treated by CT in accordance with the following scheme: a pathological site is determined, an ablation catheter electrode is introduced to it, after which the required area of the loop of the reentry is destroyed.
- Wolf-Parkinson-White syndrome is eliminated by means of preliminary mapping, which determines the location of additional paths. After this, the pathological site is destroyed by a destructive catheter electrode.
- Atrial fibrillation is eliminated through the destruction of the AV node. This helps eliminate the pathological pulses that, in abundance, go to the ventricles. In the future, the frequency of heart rate is often reduced, which is an indication for implantation of the pacemaker.
- Ventricular tachycardia undergoes therapy through mapping, and after this catheter ablation of the ectopic focal point. As a result, pathological impulses do not pass in the usual way and the rapid heartbeat ceases.
In spite of the standard abatement of catheter, the individual approach is applied to each patient, resulting in a positive effect.
Forecast for operation
Not all patients, who are aimed at catheter ablation, know what to expect from surgery. Even if the procedure is considered to be less traumatic, yet there are nuances that do not allow you to relax even during such a safe operation.
It is important to know that during the intervention, the patient is in complete consciousness, except that under the action of an electromotive pulse study, a strong tachycardia will be created, contributing to fainting. This can happen, but very rarely.
During the introduction and advancement of the catheter vessels, pressure can be felt. But with the appearance of pain, difficulty in breathing, palpitations, you should immediately contact the doctor and report the signs of deteriorating state of health. Also, when long standing in the lying position, general discomfort and fatigue may occur, but after the procedure, the general condition in most cases quickly becomes normal.
Electro pulse stimulation is often not felt. Only in some cases appear the above signs of rhythm disturbance and deterioration of well-being. The occurrence of arrhythmias is not more likely to cause anxiety, but if it persists for a long time, it does not stop at one's own or there is a loss of consciousness, then a cardioversion occurs.
Security of the procedure
Among all existing types of heart surgery, catheter ablation is considered to be the safest. When it is carried out, the risks of infection are minimized, as there is no dissection of the body tissues and all manipulations are carried out under sterile conditions. Due to the use of an X-ray machine, the process of promoting the catheter with the electrode on the vessels is monitored.
Nevertheless, despite the thoughtfulness and availability of the procedure, catheter ablation remains an invasive way of treatment, so there are certain risks of complications:
- An easy degree is the formation of hematomas due to improper propagation of the catheter through the vessel.
- Severe damage is the damage to the heart wall, large vessel, the appearance of a thrombus or the development of infection.
In some cases, catheter ablation affects not only the pathological site, but also the conducting system of the heart. Therefore, according to the results of surgery, implantation of the pacemaker may be required.
Life after catheter ablation
The post-ablation period can be divided into two main periods of time: after the procedure and after returning home.
After the procedure, the puncture site is pressed and in this state it is up to 20 minutes. In some cases, the cutoff section is sewn by imperceptible seams. Then a few days will have to be in the postoperative department, where the bandages will be periodically performed. The permission to eat and drink is sometimes given immediately, in other cases, it is necessary to wait for some time.
The first hours after surgery should lie on your back and do not bend your legs, which will allow you to avoid bleeding. If this is still revealed, then you should immediately report what happened to the nurse. The obligatory medical staff supervises pulse and arterial pressure.To control cardiac activity, a special device is installed. On the same day or next, a medical examination will be conducted.
Most patients after a catheter ablation leave home on the first or second day.In rare cases, longer follow-up and additional activities are required. The last visit to a doctor before discharge often involves recommendations for a general way of life, physical exercises. Drugs that may be needed in the next few weeks are also advised.
It is important to remember that even at a patient's well-being after catheter ablation, it is necessary to pass the examinations at the doctor-cardiologist in a timely manner.
After returning home, you should limit your physical load, you can not lift the gravity, you also need to move moderately. In some cases, after the procedure, there is a swelling or hematoma, which, after proper care for the site of the injury, takes place in two to three weeks.
It is important to find out from the doctor who treats what things can not be done and when it is possible to return to the usual way of life.
The first time patients after catheter ablation often bother heartbeat and cardiac abnormalities. This should not be frightened, since in most cases such symptoms go away for some time. With medications you need to be careful, since some of the previously taken should be discarded, while the required ones remain in the appointment. Such questions are explained by the cardiologist and it is extremely important that the patient adhere to other doctor's recommendations.
Video Get rid of arrhythmia without cuts and anesthesia?
There are several stages of KT, which should be performed as thoroughly and in full.
1. A patient is transferred to an electrophysiological ward on a movable bed or in a wheelchair, where he is transferred to an X-ray table. For examination, there is an X-ray unit and a monitor for monitoring the vessel's catheter's progress. Additionally, a cardimonitor and other devices that will be needed during the operation will be installed.
The operating team consists of the following medical staff: an electrophysiologist, his assistant, a nurse, an engineer-technologist.
2. The patient is placed on the table, connected to monitors and other equipment, after which they are covered with sterile sheets. Medical staff is also dressed accordingly, with the obligatory use of sterile gloves, masks, and bathrobes.
3. Immediately, the procedure begins after the catheter is inserted through the femoral vein or vessel located on the neck, arm, or shoulder. Anesthetic is used to prevent the appearance of painful sensations at the site of the catheter insertion.
4. A small incision is performed to introduce the catheter, after which a puncture of a vein or other blood vessel is made. Through the received access, a catheter, one or more, is introduced that performs pulses both from the heart and toward the organ.
The progression of the catheters is controlled by an X-ray unit. When cardiac catheterization is performed, cardiomonitor is used.
5. For the ablation, a special destructive catheter electrode is used, which is inserted into the required cavity of the heart and brought to an atopic focal point. >At the end of the catheter there is a small electrode, which, as a result of the radio frequency pulse, destroys a small portion of the myocardium. Before that, of course, the exact localization of the pathological focus should be established.
A standard technique for catheter ablation can be used in some modifications, which depends on the shape of the arrhythmia and the clinical course of the rhythm disturbance.
- Atrioventricular reentry tachycardia is treated by CT in accordance with the following scheme: a pathological site is determined, an ablation catheter electrode is introduced to it, after which the required area of the loop of the reentry is destroyed.
- Wolf-Parkinson-White syndrome is eliminated by means of preliminary mapping, which determines the location of additional paths. After this, the pathological site is destroyed by a destructive catheter electrode.
- Atrial fibrillation is eliminated through the destruction of the AV node. This helps eliminate the pathological pulses that, in abundance, go to the ventricles. In the future, the frequency of heart rate is often reduced, which is an indication for implantation of the pacemaker.
- Ventricular tachycardia undergoes therapy through mapping, and after this catheter ablation of the ectopic focal point. As a result, pathological impulses do not pass in the usual way and the rapid heartbeat ceases.
In spite of the standard abatement of catheter, the individual approach is applied to each patient, resulting in a positive effect.
Forecast for operation
Not all patients, who are aimed at catheter ablation, know what to expect from surgery. Even if the procedure is considered to be less traumatic, yet there are nuances that do not allow you to relax even during such a safe operation.
It is important to know that during the intervention, the patient is in complete consciousness, except that under the action of an electromotive pulse study, a strong tachycardia will be created, contributing to fainting. This can happen, but very rarely.
During the introduction and advancement of the catheter vessels, pressure can be felt. But with the appearance of pain, difficulty in breathing, palpitations, you should immediately contact the doctor and report the signs of deteriorating state of health. Also, when long standing in the lying position, general discomfort and fatigue may occur, but after the procedure, the general condition in most cases quickly becomes normal.
Electro pulse stimulation is often not felt. Only in some cases appear the above signs of rhythm disturbance and deterioration of well-being. The occurrence of arrhythmias is not more likely to cause anxiety, but if it persists for a long time, it does not stop at one's own or there is a loss of consciousness, then a cardioversion occurs.
Security of the procedure
Among all existing types of heart surgery, catheter ablation is considered to be the safest. When it is carried out, the risks of infection are minimized, as there is no dissection of the body tissues and all manipulations are carried out under sterile conditions. Due to the use of an X-ray machine, the process of promoting the catheter with the electrode on the vessels is monitored.
Nevertheless, despite the thoughtfulness and availability of the procedure, catheter ablation remains an invasive way of treatment, so there are certain risks of complications:
- An easy degree is the formation of hematomas due to improper propagation of the catheter through the vessel.
- Severe damage is the damage to the heart wall, large vessel, the appearance of a thrombus or the development of infection.
In some cases, catheter ablation affects not only the pathological site, but also the conducting system of the heart. Therefore, according to the results of surgery, implantation of the pacemaker may be required.
Life after catheter ablation
The post-ablation period can be divided into two main periods of time: after the procedure and after returning home.
After the procedure, the puncture site is pressed and in this state it is up to 20 minutes. In some cases, the cutoff section is sewn by imperceptible seams. Then a few days will have to be in the postoperative department, where the bandages will be periodically performed. The permission to eat and drink is sometimes given immediately, in other cases, it is necessary to wait for some time.
The first hours after surgery should lie on your back and do not bend your legs, which will allow you to avoid bleeding. If this is still revealed, then you should immediately report what happened to the nurse. The obligatory medical staff supervises pulse and arterial pressure.To control cardiac activity, a special device is installed. On the same day or next, a medical examination will be conducted.
Most patients after a catheter ablation leave home on the first or second day.In rare cases, longer follow-up and additional activities are required. The last visit to a doctor before discharge often involves recommendations for a general way of life, physical exercises. Drugs that may be needed in the next few weeks are also advised.
It is important to remember that even at a patient's well-being after catheter ablation, it is necessary to pass the examinations at the doctor-cardiologist in a timely manner.
After returning home, you should limit your physical load, you can not lift the gravity, you also need to move moderately. In some cases, after the procedure, there is a swelling or hematoma, which, after proper care for the site of the injury, takes place in two to three weeks.
It is important to find out from the doctor who treats what things can not be done and when it is possible to return to the usual way of life.
The first time patients after catheter ablation often bother heartbeat and cardiac abnormalities. This should not be frightened, since in most cases such symptoms go away for some time. With medications you need to be careful, since some of the previously taken should be discarded, while the required ones remain in the appointment. Such questions are explained by the cardiologist and it is extremely important that the patient adhere to other doctor's recommendations.
Video Get rid of arrhythmia without cuts and anesthesia?
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