Radiofrequency catheter ablation of the heart (RFA) is a surgical intervention using special catheters that are punctured through the vessels into the cavity of the heart. Additionally, radio-frequency energy is used to eliminate rhythm disturbances (arrhythmias).
What it is?
Catheter ablation is one of the most modern methods of treating certain heart rhythm disorders. This type of treatment is referred to as minimally invasive intervention options, since its implementation does not require any incisions and access to the heart, but sometimes RFA is performed as part of open heart surgery.
Radiofrequency catheter ablation is performed using a flexible thin guide catheter inserted through a blood vessel. Then it is brought to the sources of pathological rhythm that cause the patient to have arrhythmia. Then, radio frequency pulses are fed through it, which destroy the areas of tissue responsible for improper operation.
For the first time, high-frequency energy to eliminate additional conduction channels, which is still used today, was produced in 1986. From that time, the active development of arrhythmology in the treatment of cardiac arrhythmias began.
Indications for
Indications for catheter ablation are determined by an arrhythmologist after consulting the patient and examining the result of the examination. The expediency of the method under consideration is observed in the following cases:
- The development of AV-nodal reciprocal tachycardia.
- The onset of WPW syndrome.
- The presence of atrial fibrillation (flutter).
- The appearance of ventricular tachycardia.
Relative contraindications
Patients are not recommended to perform radiofrequency catheter ablation in the following situations:
- The development of chronic renal failure.
- The appearance of allergic reactions to the contrast component and iodine intolerance.
- The presence of severe coagulopathy and severe anemia.
- The development of uncontrolled arterial hypertension.
- The appearance of fever and acute infectious diseases.
- The presence of endocarditis.
- The presence of a severe underlying non-cardiological disease.
- The development of decompensation of heart failure with pulmonary edema.
- The appearance of intoxication with glycosides and severe hypokalemia.
Why spend?
Most likely, the doctor will advise the patient to undergo such a procedure (sometimes it is also called radiofrequency catheter ablation) if other methods of therapy for arrhythmia do not give the desired and expected effect.
During this manipulation, an electrode is supplied to the heart tissues with a low voltage and a high frequency, which can modify the area of the organ that is responsible for the appearance of arrhythmia. In most patients who underwent catheter ablation of the heart, the following occurs:
- Long-term reduction in the incidence of arrhythmias and the severity of symptoms.
- The return of a healthy heart rate.
This means that after the successful completion of the intervention, you may not need to take medications that are used in the treatment of this disease, or the dosage of the drug can be reduced. True, any change in drug treatment is possible only after consulting a doctor.
What to expect from this procedure?
Cardiac catheter ablation is considered a safe intervention, so the likelihood of complications is extremely low. The doctor will discuss with the patient all the possible risks. Catheter surgery always begins with an electrophysiological study.
Possible consequences
Complications of this procedure can be divided into four groups:
- The appearance of problems due to radiation exposure (approximately 1 millisievert).
- The consequences that are associated with catheterization and vascular puncture (we are talking about damage to arteries, thrombophlebitis, arteriovenous fistula, pneumothorax).
- Complications during catheter manipulation (damage to the heart valves, development of embolism, perforation of the coronary sinuses or myocardial walls, as well as tamponade and infection at the puncture site).
- Complications after surgery are cardiac ablation, which are caused by radiofrequency (arterioventricular block).
This operation is classified as minimally invasive intervention. The advantages of the surgical intervention in question are quite obvious. First of all, this is minimal trauma along with the lack of the need to prescribe general anesthesia to the patient. Another plus is the short duration of the procedure in combination with a short postoperative bed day.
How does a patient prepare for RFA?
Radiofrequency catheter ablation is performed as planned. It is carried out in an x-ray room. General principles of preparation include:
- The last meal should occur on the evening before the procedure (you must endure twelve hours of hunger).
- In the area of catheter placement, the subclavian and inguinal region must be shaved.
- On the night before the study, bowel cleansing is performed.
- You must ask your doctor if you need to take standard medicines in the morning.
- Any antiarrhythmic drugs are canceled three days before the study.
- In the event that a person has diabetes, then you need to ask your doctor if you should take insulin or other sugar-lowering oral medications before the test.
Equipment for surgery
Such an operation as radiofrequency ablation of the heart is carried out in a special equipped operating room, which is equipped with:
- X-ray television system for radiography and fluoroscopy.
- Equipment will be needed to track the vital functions of the body and implement resuscitation measures (usually a defibrillator is used along with a breathing apparatus and monitors).
- Specialized EFI equipment for recording electrocardiograms.
- The presence of pacemakers and tool kits for catheterization.
- Protective equipment for the patient and staff (we are talking about suits, aprons, glasses, movable walls and so on).
Methodology
To perform the operation, the patient is sent to the operating room on an empty stomach, in a slightly sedated state. The areas of intended punctures are carefully treated and covered with sterile linen. Catheters are always inserted using transdermal techniques. As a rule, femoral veins, as well as arteries of the subclavian and jugular areas, are used for puncture.
Doctors puncture a vein with a needle. Next, the introducer sheath is inserted through the conductor, and then the catheter is inserted into the corresponding cardiac chamber. After that, it is connected to a junction box that transfers the electrical signal from the electrodes to the recording device, which stimulates the pulse from the ECS and makes it possible to reach the surface of different organ chambers. Then an EFI of the heart is performed .
Electrical signals that are received from the endocardial surface are filtered, and at the same time amplified and displayed on a computer monitor. Programmable ECS is endowed with the ability to programmable and continuous stimulation, adjust the amplitude and duration of the pulse.
When conducting radiofrequency catheter ablation of the heart, the patient may feel discomfort in the chest area, palpitations and slight soreness are not excluded. Sensations that appear against the background of an EFI, in the form of cardiac interruptions, a second stop, slowdown or acceleration of the rhythm, are the result of the doctor’s work, that is, with the help of an electrical impulse delivered directly to the organ, the doctor completely controls the heartbeat and triggers such attacks.
As part of the detection of arrhythmogenic regions (additional ventricular compounds), they are affected by radio frequency energy using a therapeutic electrode. After this, it is mandatory that approximately twenty minutes later, another EFI is performed to evaluate the effectiveness of the exposure. In the event that the electrophysiological indicator satisfies the doctor, the operation ends. Catheters are removed. A pressure bandage is applied to the puncture site.
The patient is transferred to the ward, and he is assigned to bed rest in the supine position for several hours (in some cases, it takes only knocks) to prevent bleeding from the puncture area. Observation within the hospital occurs from one day.
Radiofrequency catheter ablation for atrial fibrillation
Atrial fibrillation is one of the most frequent arrhythmias in people of middle and old age. At the same time, the upper chambers of the organ contract uncoordinated and chaotically with a frequency of approximately four hundred times per minute. Such a rhythm can have an adverse effect on the ventricles and as a result leads to the formation of insufficiency. In most examples, patients may complain of a strong heartbeat along with dizziness, shortness of breath, or fatigue. In some people, atrial fibrillation is completely asymptomatic. Rhythm restoration can be achieved with the help of tablets or by intravenous administration of the drug or electric shock (we are talking about electro-pulse therapy).
There are two ways to prevent atrial fibrillation: eliminating trigger lesions; transformation of the wall of the atrium so that multiple reciprocal cycles do not occur.
Trigger center of a single type. For example, there is atrial tachycardia of a focal type with an epicenter in the pulmonary vein. In this case, selective ablation is carried out similarly to the method described above. Atrial fibrillation is thus rarely eliminated due to the presence of numerous triggers.
Elimination of all potential trigger epicenters. In this case, the estuary of the four pulmonary veins is differentiated. Perform this in several ways:
- The selective ablation method of all electrical connections that arise between the atrium on the left and each pulmonary vein (this is also called electrical insulation). During the procedure, in 3% of cases, narrowing of the pulmonary vein may occur. And this leads to increasing dyspnea. Moreover, it is difficult to cure.
- The formation of a line of conduction isolation outside the venous mouth (the so-called anatomical isolation). In this case, a blockade is carried out both of the veins and of the atrial tissue on the left in contact with them. In this case, there is almost no risk of pulmonary vein narrowing.
What happens after surgery?
Immediately after catheter ablation is performed, atrial fibrillation removes catheters. In this case, the doctor presses on the injection site in order to prevent bleeding. A bandage may also be applied to the site of application of the catheter. At this time, it is extremely important to maintain stillness. After the procedure, it is mandatory to observe bed rest. On the next day after surgery, the patient can already be discharged from the clinic.
According to reviews, the ablation operation is very effective.
Rehabilitation period
At home, it is necessary to limit activity over the next few days and avoid physical stress. Most people tend to return to their standard lifestyle within three days.
A small hematoma along with a walnut-sized swelling in the area of catheter insertion is considered common. In the event that a person feels that this area has become hot to the touch, and at the same time swollen and painful, or if the patient has a fever with malaise or any other suspicious symptom, you should immediately contact a doctor. It is required to strictly follow the doctor's recommendations regarding therapy and appointing a date for a second visit.
How can this procedure cure common arrhythmias?
The target of ablation are those areas of the heart tissue that generate electrical pathological impulses that cause the development of atrial fibrillation. Through neutralization and blocking of these areas, the activity of the organ is controlled, and it returns to its normal rhythm.
Is the procedure effective?
As a rule, after a certain time, patients who underwent this operation have a significantly lower number of recurrences of atrial fibrillation compared to those who received medications (drug therapy).
According to the results of the study, catheter ablation is significantly more effective treatment in the presence of a paroxysmal form of atrial fibrillation. In sixty-six percent of patients who underwent this manipulation, a year after the procedure, the disease was not fixed, that is, they completely returned to the normal rhythm of the organ.
In the case of drug treatment, this figure is only sixteen percent. What is the likelihood of complications and side effects? With catheter ablation, this is almost five percent, and with drug treatment nine.
Reviews
Doctors in reviews of catheter ablation write that it is a fairly safe procedure to help reduce the manifestations of arrhythmia. As noted, in many patients after it, either a long-term decrease in the number of episodes of arrhythmia with a decrease in their severity, or the restoration of a healthy organ rhythm is observed.
Patients, in turn, share the opinion that, due to successful ablation, they were lucky to reduce the dosage of drugs, and some completely stopped taking drugs that they were forced to use to control their rhythm (we are talking about antiarrhythmics). People write that because of the use of such drugs, they often recorded undesirable manifestations in the form of weakness, shortness of breath, dizziness, as well as intoxication and more serious complications.
True, in their reviews of catheter ablation of the heart, doctors focus on the fact that with this manipulation there is a certain risk. Thus, there is a risk of bleeding, swelling and hematomas in the area of catheter insertion, as well as problems with infection of this place. More serious complications, as doctors note, occur quite rarely. Nevertheless, nevertheless, damage to blood vessels and the heart can be observed along with the formation of blood clots (this can lead to the development of a stroke), myocardial infarction or even death is not excluded.
But, as experts soothe, the risks of adverse events during catheter ablation, according to a retrospective large clinical study, are quite low and make up only one and a half percent.
Conclusion
Thus, cardiac ablation is a procedure that is performed using a flexible thin wiring called a therapeutic catheter. It is injected through a vein into the area of the organ, so that you can study and correct the electrical impulse. In the event that the doctor detects a heart rhythm malfunction in a patient, a special device can be used that transmits an RF wave and generates sufficient heat to form a small scar in a specific tissue area. These small areas of the connective structures block the abnormal electrical signals that cause rhythm disturbances such as atrial fibrillation.
We examined radiofrequency catheter ablation of the heart and reviews on this operation.