Arrhythmia Associates LLP

Our Process - Treatment - Catheter Ablation

Catheter Ablation

An extension of the diagnostic EP Study is the catheter ablation. The catheter ablation procedure is generally performed immediately after the diagnostic EP study in appropriate patients. The majority of the ablation procedures utilize specialized catheters that deliver radiofrequency (RF) energy. In certain circumstances, we utilize a catheter that delivers freezing energy called Cryoablation and this technique also makes the cardiac tissue electrically inert.

Catheter ablation is a non-surgical technique that often offers a cure for patients with heart rhythm abnormalities. For some types of arrhythmia, catheter ablation is the first-line treatment. This procedure is also an option for those patients who are not controlled by medical therapy.

Why Select Cardiac Ablation Therapy for Cardiac Arrhythmias?
Cardiac ablation therapy offers several advantages over other forms of therapy for cardiac arrhythmias. Medications are almost always imperfect in their ability to control arrhythmias. Side effects may limit the dose and hence the effectiveness of medications and overall, the cost of treatment for a lifetime of medications is far greater than for out patient ablation.

Cardiac ablation is effective and low risk treatment for cardiac arrhythmias. Furthermore, cardiac ablation provides a permanent cure of the cardiac arrhythmia with virtually no side effects. The procedure is most often performed as an outpatient and patients return to full activities in a day or two.

Procedure
In a similar way to a diagnostic electrophysiology (EP) study, catheters are placed intravenously and advanced to several positions within the right heart. These catheters can be used, as with the EP Study, to record from and stimulate the heart. These catheters can be manipulated throughout the heart in an attempt to identify the precise location from which an arrhythmia originates. Since most arrhythmias require a specific and usually small area of the heart in order to begin or continue, localization of these key, but vulnerable sites, could lead to elimination of the arrhythmia.

If these sites are identified, a catheter is moved to this area of the heart. The tip of a specially designed catheter placed in this position can be used to deliver energy (usually radiofrequency energy). This energy will heat up the adjacent tissue to the point of coagulation. The amount of tissue heated, however, is quite small. But if it includes the critical area for arrhythmia formation, this tissue can be permanently made nonfunctional and thus incapable of causing an arrhythmia.

This procedure lasts somewhat longer than the typical EP Study but ablation is the critical element for potential cure of many clinically important arrhythmias. Most often, patients go home the day of the procedure but occasionally we require an overnight hospital stay. The anticipated results of the procedure depend somewhat on the nature of the arrhythmia targeted. For the most common arrhythmias, the procedural success rate by our experienced operators is in the range of 90-99%. The risks of the procedure are generally small and often only related to intravenous puncture. Serious cardiac complications are uncommon, but can occur.

Length of Procedure: 2 - 3 hours

Recovery
After the procedure, you gradually will awaken from sedation. The laboratory staff will withdraw the electrode catheters used to perform the procedure and will apply pressure over the groin and neck sites of catheter insertions for about five to 10 minutes. You will remain in bed for up to four hours after which you will be allowed to get up and walk. After you are able to walk without difficulty, you will be discharged from the hospital and go home.

Follow-up care
Of course, your doctors will speak with you about the details of the procedure before discharge from the hospital and you will receive instruction about medications to take, wound care, and follow-up appointments. Recovery at home is very rapid, and full normal activity should be no problem within 24 hours.

Cryoablation
Cryoablation is an alternative technique to perform ablation. Arrhythmia Associates were the first physicians in the Washington metropolitan area to utilize cryoablation therapy for the treatment of a variety of arrhythmias. While radiofrequency ablation utilizes radiowaves to heat the muscle cells responsible for clinical arrhythmia, cryoablation freezes these muscle cells and makes them permanently non-functioning. Arrhythmia Associates were the first electrophysiologists in the Washington DC area to utilize this novel technology. Specialized ablation catheters are used. The advantage to cryoablation over radiofrequency ablation is that when cryoablation is performed, the catheter becomes adherent ("cryoadherence") to the heart tissue and the catheter will not move from its location even though the heart is constantly moving. If the arrhythmia focus is very close to vital anatomic structures, this property of cryoadherence is advantageous. The disadvantage of cryoablation is that the lesion delivered is smaller and there is a greater chance of recurrence of the tachycardia.