Catheter ablation of an irregular heartbeat involves having a tube (a catheter) inserted into the heart through
which electrical energy is sent to either reset the heartbeat or stop the heart from beating so a mechanical pacemaker can be put in place.
Purpose
Irregular heartbeats can occur in healthy people without causing any dangerous symptoms or requiring medical attention. Slight changes in the normal patterns of heartbeats often reset themselves without notice.
But when the heartbeat is greatly disrupted—either because of traumatic injury, disease, hypertension, surgery, or reduced blood flow to the heart caused by blockages in the blood vessels that nourish the heart—the condition must be recognized and treated immediately. Otherwise, it can be fatal.
Various drugs can be used to control and help reset these abnormal heart rhythms (arrhythmias). The technique of catheter ablation (meaning tube-guided removal) is used to interrupt the abnormal contractions in the heart, allowing normal heart beating to resume. Atrial fibrillation and flutter and Wolff-Parkinson-White syndrome are two of the most common disorders treated with catheter ablation.
Precautions
The improper correction of abnormal heartbeats can cause additional arrhythmias and can be fatal. Abnormalities in different areas of the heart cause different types of irregular heartbeats; the type of arrhythmia must be clearly defined before this procedure can be properly done.
Description
Catheter ablation involves delivering highly focused heat (or radio frequency energy) to specific areas of the heart. Radio frequency energy is very rapidly alternating electrical current that is produced at the tip of the catheter that is placed inside the heart. At the same time as the catheter is inserted, a second electrode is placed on the patient's skin. When the catheter is energized, the body conducts the energy from the catheter's tip, through the heart and to the electrode on the skin's surface, completing the circuit.
Although very little electricity is given off by the catheter, the instrument does generate a large amount of heat. This heat is absorbed by the heart tissue, causing a small localized burn and destroying the tissue in contact with the catheter tip; in this way, small regions of heart tissue are burned in a controlled manner. This controlled destruction of small sections of heart muscle actually kills the nerve cells causing the irregular heartbeat, stopping the nerve signals that are passing through this section of the heart. This usually causes the irregular heartbeat to be reset into a normal heartbeat.
Preparation
People can undergo this procedure by having general anesthesia or by taking medicines to make them relaxed and sleepy (sedatives) along with painkillers. Once the type of irregular heartbeat is identified and these medicines are given, the catheter is inserted through a blood vessel and into the heart. Importantly, correct placement of the catheter is visualized by using a specialized type of x-ray machine called a fluoroscope.
Aftercare
Being sure the patient is comfortable during and after this procedure is very important. However, because each person may have a different arrhythmia and possibly other medical problems as well, each patient's needs must be evaluated individually.
Risks
Overall, fewer than 5% of people having this procedure experience complications. The most common complications are usually related to blood vessel injury when the catheter is inserted and to different heart-related problems due to the moving of the catheter within the heart. However, in general, this technique is safe and can control many different heart arrhythmias.
Normal results
Depending upon the type of irregular heartbeat being treated, either the normal heartbeat resumes after treatment or the ability of the heart to beat on its own is lost, requiring the insertion of a pacemaker to stimulate the heart to beat regularly.
Abnormal results
Additional irregular heartbeats can occur as a result of this procedure, as can damage to the blood vessels that feed the heart. Because this procedure requires the use of the x-ray machine called a fluoroscope, there is exposure to x-ray radiation, but it's doubtful that this is harmful in adult patients. The risk versus benefit is considered with pediatric patients.
BOOKS
Scheinman, Melvin M. "Treatment of Cardiac Arrhythmias with Catheter Ablative Techniques." In Hurst's The Heart, ed. Robert C. Schlant, et al. New York: McGraw Hill, 1994.
PERIODICALS
Lashus, Andrew G., Christopher L. Case, and Paul C. Gillette. "Catheter Ablation Treatment of Supraventricular Tachycardia-Induced Cardiomyopathy." Archives of Pediatrics and Adolescent Medicine 151 (Mar. 1997): 264.
Patlak, Margie. "When Heartbeats Go Haywire." FDA Consumer 31 (Apr. 1997): 12.
"Radiofrequency Catheter Ablation for Treatment of Cardiac Arrhythmias." Medical Letter on Drugs and Therapeutics 38 (26 Mar. 1996): 409.
Fluoroscope—A specialized x-ray machine used to visualize the placement of the catheter when attempting to correct irregular heartbeats.
Pacemaker—An electrical device that has electrodes attached to the heart to electrically stimulate the heart to beat normally. Pacemakers can be internal (placed under the skin) or external, with the electrodes placed on the skin or threaded through a tube placed into the heart.
