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What is catheter ablation for cardiac arrhythmia?

Catheter ablation is a specialist catheter-based procedure that removes (ablates) abnormal heart muscle tissue, and can eliminate dangerous cardiac arrhythmias. The procedure is used particularly in patients whose cardiac arrhythmia cannot be controlled with medication. Following ablation, the patient's heart rhythm usually returns to normal. This challenging procedure may at times be performed using a robotic navigation system.

What conditions are treated with this procedure?

Catheter ablation is not suitable for all types of cardiac arrhythmias. The procedure is performed in order to treat different types of tachycardia that result in a fast (palpitations) and at times irregular heart rate. These include:

What is the purpose of this type of treatment, and what are the results?

The purpose of catheter ablation is to treat a fast and at times irregular heartbeat, and to restore the heart to its normal rhythm.

In a normal heart, the heart's contraction is controlled by what is referred to as the sinus node, a small area of electrically active cells situated in the right atrium. Here, regular electrical impulses are generated, which are then transmitted to the atria and ventricles, resulting in rhythmic contractions.

A number of different heart conditions can lead to changes in the electrical conductivity of the heart, including for example coronary heart disease leading to chronic oxygen deficiency, or scarring from a previous heart attack. Additional areas of the heart muscle may turn into "spark plugs" and begin to generate electrical impulses. The electrical impulses generated in this manner also often fail to propagate in the normal manner (they may enter a circular pattern). In many cases, this results in a condition referred to as tachyarrhythmia, which is characterized by the heart contracting in an extremely rapid and often irregular manner.

Tachyarrhythmias can be life-threatening, or they can lead to the exacerbation of other conditions. One of the most common arrhythmias, for instance, known as atrial fibrillation, can increase the patient's risk of stroke, as well as further reducing the efficiency of the heart in patients with heart failure.

Aside from drug-based treatment, catheter ablation has also gained increasing importance in the treatment of tachyarrhythmias. Catheter ablation is based on the principle that once additional areas generating electrical impulses have been identified, they can be destroyed (ablated) using a special catheter introduced via the blood vessels in the groin. Ablation usually involves the delivery of high-frequency electrical impulses. Less frequently, ablation may be performed using cold temperatures, ultrasound or lasers.

Ablation is a technically challenging procedure, usually taking a few hours to complete. As a result, interventional cardiologists may sometimes resort to robotic navigation systems, which allow precise navigation of the special catheters that are pushed into the heart. Using 3D imaging technology, the physician can monitor the movement of the robotic system, controlling navigation using a joystick.

Following ablation, the patient's heart often returns to a permanent normal rhythm. An ambulatory ECG can help establish whether treatment has been successful.

A step-by-step description of catheter ablation for arrhythmia

A typical ablation procedure, which also includes an examination of the heart's electrical activity, usually consists of the following steps: