Catheter Ablation

What Is Catheter Ablation?

Catheter ablation describes a minimally invasive treatment of the heart. The catheter is a wire that is forwarded from the arm's crook or the groin through a blood vessel to the heart. Heat or cold, which can specifically damage heart muscles and leave scars, can be generated at the end of the catheter. This method is used to damage the part of the heart muscle that misdirects electrical excitation.

When is Catheter Ablation Used?

Catheter ablation is used as an alternative to drug therapy for cardiac excitation disorders. This method is used more frequently, especially in young patients with seizure-like and symptomatic atrial fibrillation.

Catheter Ablation Can Be Carried Out for the Following Diseases:

• Atrial flutter and atrial fibrillation
• Atrial tachycardia
• Wolff-Parkinson-White syndrome

In atrial flutter and atrial fibrillation, the atrium is irregularly excited by circular or disordered electrical impulses. Some of the impulses are transmitted to the ventricles, which do not regularly contract uniformly. As a result, affecting blood filling and ejection and reducing the heart's performance. For example, it can reach pooled blood in the ventricle, where the risk of a blood clot is significantly increased. This blood clot can be washed out of the heart and enter the cerebral vessels, causing a stroke. The patient may experience the heart's irregular contraction as palpitations (tachycardia), dizziness, shortness of breath, or chest pain. The difference between atrial flutter and atrial fibrillation is that the atrium contracts at frequencies of more than 250 to 350 beats per minute in atrial flutter. In contrast, atrial fibrillation can be 350 to 600 beats.

In atrial tachycardia, the electrical impulses do not come from the sinus node, the natural pacemaker of the heart in the right atrium, but other locations in the right atrium wall. However, the effect is the same as in atrial flutter and atrial fibrillation.

There is no circular excitation in the atrium in Wolff-Parkinson-White syndrome, but an additional conduction path between the right atrium and the ventricles. The atrium's excitation may reach the ventricles through this pathway just before or after the common path. In many cases, this syndrome is entirely asymptomatic. Still, it can also lead to so-called syncope, which results in a rapid sequence of heartbeats that do not allow the heart to fill up with blood appropriately so that hardly any blood can be transported.

Catheter Ablation Procedure

The standard procedure is high-frequency ablation. In this procedure, heat is generated at the catheter tip, which can then be selectively applied to the desired tissue.

Alternatively, cryoablation can be used, where the area responsible for transmitting stimuli is treated with cold. The advantage is that this method is almost painless.

Duration and Procedure of Catheter Ablation?

Catheter ablation is carried out similar to a heart catheter under local anesthesia. The patient is conscious but receives a mild sedative. Usually, the patient is admitted inpatient one day before the procedure, so that there is enough time for clarification and preliminary examination.

The first step in the electrophysiological examination (EPU) is to examine the cardiac arrhythmia and its point of origin. The treating physician knows where to add a small scar to the heart tissue. Heat or cold is generated at the tip of the catheter and applied to the target area. After sclerotherapy, a further electrophysiological examination is carried out to test whether the excitation is completely separated. The duration of the procedure is highly variable and can last between two to six hours.

Risks and Aftercare

There are risks associated with every surgical procedure. The general ones are infection and wound healing disorders at the catheter insertion point. Specific risks for treatment by catheter ablation are

• Pericardial effusion
• Destruction of the excitation line system
• Blood clot formation
• Narrowing/closure of the pulmonary veins
• Injury to surrounding structures and organs by the catheter

These risks are known and depend on the individual physical condition and previous illnesses of each patient.

A pressure bandage is applied to the puncture site to prevent secondary bleeding, which should remain there for 6 to 12 hours. After the therapy, the patient undergoes inpatient monitoring for at least one day. Continuous follow-up care during the initial three months is essential, as this period has proven to be a healing and stabilization phase. The patient must pay increased attention to the symptoms during this period.

Which Doctors and Clinics Are Specialized in Catheter Ablation?

Specialists can carry out catheter ablation in cardiology, cardio-surgery, and vascular surgery. The therapy is carried out in specialized clinics. Inpatient monitoring after the procedure is recommended.

We help you to find an expert for your disease. All listed physicians and clinics have been reviewed by us for their outstanding specialization in catheter ablation, and await your inquiry or treatment request.

Sources:

Scherr: Katheterablation bei persistierendem Vorhofflimmern. In: Herz. Band 40, Nummer 1, 2015, doi: 10.1007/s00059-015-4204-8, S. 31–36.

Sultan et al.: Interventionelle Therapie von paroxysmalem Vorhofflimmern. In: Herz. Band 40, Nummer 1, 2015, doi: 10.1007/s00059-014-4195-x, S. 25–30.

Thomas et al.: Typisches Vorhofflattern. In: Herzschrittmachertherapie + Elektrophysiologie. Band 27, Nummer 1, 2016, doi: 10.1007/s00399-016-0413-y, S. 46–56.

Deakin et al.: Elektrotherapie: automatisierte externe Defibrillatoren, Defibrillation, Kardioversion und Schrittmachertherapie. In: Notfall + Rettungsmedizin. Band 13, Nummer 7, 2010, doi: 10.1007/s10049-010-1369-9, S. 543–558.