Cardiac Catheter Ablation

Cardiac catheter ablation was one of the most significant advances in the treatment of irregular heartbeats, known as arrhythmias, and particularly Afib, which is estimated to affect over 5 million Americans and increase the risk of stroke by up to five times. When Afib occurs, the upper chambers of the heart, known as the atria, beat and quiver in a disorganized and fast manner. The result creates an irregular heartbeat that can often start as mild and occasional (also known as paroxysmal), and can eventually develop into more severe and persistent. As a result, it is important to start treatment early.

Unfortunately, anti-arrhythmic medication, as well as anticoagulants, may have limited effectiveness, may cause significant side effects, and ultimately only work for as long as the patient is on medication. While this is typically the first course of action for newly diagnosed Afib, most patients decide to move on to a curative procedure such as catheter ablation. If you would like to learn about cardiac cryo-ablation, click here.

What is catheter ablation?

Catheter ablation is a procedure by which errant electrical signals of the heart are identified and subsequently destroyed using targeted heat generated by radio frequency RF. The RF waves generated by the device create heat in a very small area and allow your electrophysiologist to accurately destroy problematic heart tissue. Treated tissue then dies and is absorbed into the body over the course of 6-to-8 weeks.

As the name suggests, the entire procedure is performed using a catheter, which represents a minimally invasive alternative to what otherwise would have required open heart surgery. A small incision is made at the groin and a tiny catheter is threaded up a blood vessel and into the heart. This was traditionally performed using fluoroscopy or continuous x-ray, but with advances in imaging technology, Arizona Cardiac Electrophysiology is proud to say that the majority of our procedures are performed using little to no fluoroscopy. Instead, we use ultrasound technology to guide the catheter. Ultrasound does not expose the patient to radiation, which is particularly important for younger patients and those with cancer risk.

Once the catheter has reached the heart, an electromagnetic mapping device creates an accurate 3-D image of the heart structure and maps the source and pathways of the electrical signals. This first part of the procedure, if performed alone, is known as an electrophysiology (EP) study and is used as a diagnostic tool for certain arrhythmias, like paroxysmal Afib, when other methods have been unsuccessful in confirming the diagnosis.

The beauty of this procedure lies in the fact that the arrhythmia can be treated at the same time as the EP study. Indeed, we can even induce an arrhythmia using certain medications, which allows us to pinpoint exactly where the errant electrical heart signals originate and treat them on the spot.

Because of the real-time nature of the imaging, we can even see the results of the ablation immediately after treatment. This means that if any obvious, improper electrical signals remain, we can catch them before the end of the procedure.

With that being said, arrhythmias are often unpredictable and there is the possibility that certain problematic electrical signals do not show up during the initial ablation. Repeating the procedure, known as a touchup, is similarly safe and effective, and usually results in resolution of the arrhythmia.

Benefits of catheter ablation

• Of course, the most significant benefit of a catheter ablation is eliminating or drastically improving the arrhythmia, which not only reduces the anxiety and discomfort associated with arrhythmic episodes, but also reduces the risk of blood pooling in the Left Atrial Appendage, causing a significant increase in the risk of stroke. A left atrial appendage occlusion procedure such as the Lariat or use of the Watchman device may be performed alongside the catheter ablation to seal off the LAA and further reduce stroke risk.
• Catheter ablation is curative, meaning that many patients can reduce or eliminate their anti-arrhythmic and anticoagulant medication over the long-term. This reduces the risks and side effects of medication therapy.
• The minimally invasive nature of the catheter ablation means that a more invasive procedure, such as open-heart surgery, is typically not necessary for an arrhythmia. This is a huge leap forward in the treatment of many cardiovascular conditions and diseases.
• Because only a small incision is required in the groin, patients are usually up and about within a day or two and are able to continue their daily lifestyle with very little downtime.

Risks of a cardiac catheter ablation

Generally, the risks of a catheter ablation are very low in the hands of an experienced electrophysiologist. As with any procedure there are some risks which include:

• The risk of anesthesia. While this risk is very low and patients are monitored for any possible reactions, there’s always a small risk in any procedure using anesthesia.
• Risk of damage to the blood vessel walls is a rare, but possible, side effect of any catheter-based procedure. However, experience and advances in catheter technology have minimized this risk.
• There’s also a very small risk of damage to the heart structure itself, or the possibility of a cardiovascular event during the procedure. Again, this is very rare and electrophysiology labs are equipped to handle any possible adverse event.
• Lastly, there is a chance that the procedure fails to offer complete resolution of the arrhythmia. We estimate that a cardiac catheter ablation is effective in up to 90% of patients. That final 10% of patients may have to remain on medication, or may require an additional catheter ablation procedure or other intervention.

Bottom line

Cardiac catheter ablation is an exceptionally effective and very safe option for those living with arrhythmias. Of course, speaking to a qualified electrophysiologist such as Dr. Niazi or Dr. Bisla is the first step in checking whether you qualify for such a procedure and if the benefits outweigh the risks for your particular circumstance. We invite you to schedule a consultation with our office to learn more and take the first steps to be free from your condition.