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Ablation for Cardiac Arrhythmia

By

L. Brent Mitchell

, MD, Libin Cardiovascular Institute of Alberta, University of Calgary

Last full review/revision Jan 2021| Content last modified Jan 2021
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The need for treatment of arrhythmias Overview of Arrhythmias The normal heart beats in a regular, coordinated way because electrical impulses generated and spread by myocytes with unique electrical properties trigger a sequence of organized myocardial... read more Overview of Arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic drugs Drugs for Arrhythmias The need for treatment of arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic... read more , cardioversion-defibrillation Direct-Current (DC) Cardioversion-Defibrillation The need for treatment of arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic... read more , implantable cardioverter-defibrillators Implantable Cardioverter-Defibrillators (ICD) The need for treatment of arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic... read more Implantable Cardioverter-Defibrillators (ICD) (ICDs), pacemakers Cardiac Pacemakers The need for treatment of arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic... read more Cardiac Pacemakers (and a special form of pacing, cardiac resynchronization therapy Cardiac Resynchronization Therapy (CRT) The need for treatment of arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic... read more ), catheter ablation, surgery Surgery for cardiac arrhythmias The normal heart beats in a regular, coordinated way because electrical impulses generated and spread by myocytes with unique electrical properties trigger a sequence of organized myocardial... read more Surgery for cardiac arrhythmias , or a combination, is used.

If a tachyarrhythmia depends on a specific pathway or ectopic site of automaticity, the site can be purposefully destroyed (ablated) to effect cure. Methods of ablation include

  • Radiofrequency ablation

  • Cryoablation

Ablation is usually accomplished using transvenous catheter supplied low-voltage, high-frequency (300 to 750 MHz) electrical radiofrequency (RF) energy. This energy heats and necroses an area < 1 cm in diameter and up to 1 cm deep.

Cryoablation uses tissue freezing (to -70° C) to effect tissue destruction. Other delivery systems have been developed for intraoperative use.

Success rate is > 90% for reentrant supraventricular tachycardias Reentrant Supraventricular Tachycardias (SVT) including Wolff-Parkinson-White Syndrome Reentrant supraventricular tachycardias (SVT) involve reentrant pathways with a component above the bifurcation of the His bundle. Patients have sudden episodes of palpitations that begin and... read more (via the atrioventricular [AV] node or an accessory pathway), focal atrial tachycardia and atrial flutter Atrial Flutter Atrial flutter is a rapid regular atrial rhythm due to an atrial macroreentrant circuit. Symptoms include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope. Atrial... read more , and focal idiopathic ventricular tachycardia (VT—right ventricular outflow tract, left septal, or bundle branch reentrant VT). Because atrial fibrillation (AF) Atrial Fibrillation Atrial fibrillation is a rapid, irregularly irregular atrial rhythm. Symptoms include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope. Atrial thrombi may form... read more often originates in or is maintained by an arrhythmogenic site in the pulmonary veins, this source can be electrically isolated by ablations at the pulmonary vein–left atrial junction or in the left atrium. Alternatively, in patients with refractory AF and rapid ventricular rates, the AV node may be ablated after permanent pacemaker implantation. Ablation is sometimes successful in patients with VT refractory to drugs particularly when ischemic heart disease is present.

Transcatheter ablation is safe; mortality risk is higher in complex procedures. Mortality is < 1/2000 for noncomplex ablation procedures but may be as high as 1/500 for pulmonary vein isolation procedures for atrial fibrillation or ventricular tachycardia substrate ablation procedures.

Complications include valvular damage, pulmonary vein stenosis or occlusion (if used to treat atrial fibrillation), stroke or other embolism, cardiac perforation, tamponade (1%), and unintended AV node ablation.

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