Radiofrequency catheter ablation of the heart (RFA) is a surgical intervention using special catheters that are punctured through the vessels into the heart cavity. In addition, radiofrequency energy is used to eliminate rhythm disturbances (arrhythmias).
What is this?
Catheter ablation is one of the most advanced treatments for certain cardiac arrhythmias. This type of treatment is classified as a minimally invasive intervention option, since it 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. Further, it is brought to the sources of the pathological rhythm, which cause arrhythmia in the patient. Then, radio frequency pulses are fed through it, which destroy areas of tissue,responsible for wrong work.
The first high-frequency energy to eliminate additional conduction channels, which is still used today, was produced in 1986. Since that time, the active development of arrhythmology in the treatment of cardiac arrhythmias began.
Indications for conduction
Indications for catheter ablation are determined by an arrhythmologist after consulting the patient and studying the result of the examination. The expediency of the considered method is observed in the following cases:
- Development of AV nodal reciprocal tachycardia.
- The appearance of the WPW syndrome.
- Presence of atrial fibrillation (flutter).
- The appearance of ventricular tachycardia.
Relative contraindications
RFCA is not recommended for patients in some of the following situations:
- Development of chronic renal failure.
- The appearance of allergic reactions to the contrast agent and iodine intolerance.
- Presence of severe coagulopathy and severe anemia.
- Development of uncontrolled arterial hypertension.
- Appearance of fever and acute infectious diseases.
- Presence of endocarditis.
- Presence of severe underlying non-cardiac disease.
- Development of decompensated heart failure with pulmonary edema.
- The appearance of intoxication with glycosides and severe hypokalemia.
Why is it worth holding?
Most likely, the doctor will advise the patient to undergosuch a procedure (sometimes also called radiofrequency catheter ablation) in the event that other methods of treating arrhythmia do not give the desired and expected effect.
During this manipulation, a current is supplied to the heart tissues through the electrode, which is characterized by low voltage and high frequency, which can modify the area of the organ that is responsible for the appearance of arrhythmia. Most patients who undergo catheter ablation of the heart experience the following:
- Long-term reduction in arrhythmia episodes and symptom severity.
- Return to a he althy heart rate.
This means that after the successful completion of the intervention, it may not be necessary to take the drugs that are used in the treatment of this disease, or the dosage of the drug can be lowered. True, any change in drug treatment is possible only after consulting a doctor.
What to expect from this procedure?
Catheter ablation of the heart is considered a safe intervention, so the likelihood of complications is extremely small. The doctor will discuss all possible risks with the patient. Catheter surgery always begins with an electrophysiological study.
Possible consequences
Complications of this procedure can be divided into the following four groups:
- Appearance of problems due to radiation exposure (approximately 1 millisievert).
- Consequences associated with catheterization and vascular puncture(we are talking about damage to the arteries, thrombophlebitis, arteriovenous fistula, pneumothorax).
- The appearance of complications during catheter manipulation (damage to the heart valves, the development of embolism, perforation of the coronary sinuses or myocardial walls, as well as tamponade and infection at the puncture site).
- Complications after cardiac ablation due to radiofrequency action (arterioventricular block).
This operation is classified as a minimally invasive intervention. The advantages of the considered surgical intervention are quite obvious. First of all, this is minimal trauma along with the absence of the need to prescribe general anesthesia to the patient. Another plus is the short duration of the procedure, combined with a short postoperative bed day.
How does a patient prepare for RFA?
Radiofrequency catheter ablation is done routinely. It is carried out in the X-ray operating room. General preparation guidelines include:
- The last meal should be on the evening before the procedure (twelve hours of fasting required).
- In the area where the catheter is inserted, the subclavian and groin area must be shaved.
- The night before the study, a bowel cleansing is performed.
- Need to ask your doctor if you need to take your 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 the doctorshould he take insulin or other oral antidiabetic drugs before the test.
Equipment for surgery
An operation such as radiofrequency ablation of the heart is performed in a special equipped operating room, which is equipped with:
- X-ray television system for radiography and fluoroscopy.
- You will need equipment to monitor vital signs and perform resuscitation (usually using a defibrillator along with breathing apparatus and monitors).
- Specialized EFI equipment for recording electrocardiograms.
- Availability of pacemakers and cath kits.
- Protective equipment for the patient and staff (we are talking about suits, aprons, goggles, movable walls, and so on).
Methodology
The patient is sent to the operating room on an empty stomach, in a slightly sedated state, for the operation. The areas of the proposed punctures are carefully treated and covered with sterile linen. Catheter insertion is always done using percutaneous techniques. For puncture, as a rule, the femoral veins are used, as well as the arteries of the subclavian and jugular regions.
Doctors puncture a vein with a needle. Further, the introducer is introduced along the conductor, and then the catheter is introduced into the corresponding cardiac chamber. After that, it is connected to a junction box carrying electricala signal from the electrodes to the recording device, which makes it possible for the stimulating pulse from the EKS to reach the surface of different chambers of the organ. Then EPS 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. The programmable pacemaker is endowed with the ability for programmable and continuous stimulation, amplitude and pulse duration adjustment.
When performing radiofrequency catheter ablation of the heart, the patient may feel discomfort in the chest area, palpitations and slight soreness are not excluded. The sensations that appear on the background of the EPS, in the form of heart failures, a second stop, slowing down or accelerating the rhythm, are the result of the doctor’s work, that is, with the help of an electrical impulse applied directly to the organ, the doctor completely controls the heartbeat and provokes attacks of it.
As part of the detection of arrhythmogenic regions (additional ventricular connections), they are affected by radio frequency energy using a therapeutic electrode. After that, after about twenty minutes, EFI is carried out again to evaluate the effectiveness of the impact. In the event that the electrophysiological indicator satisfies the doctor, the operation ends. The catheters are removed. A pressure bandage is applied to the puncture site.
The patient is transferred to the department, and he is assigned to bed rest inlying on the back for several hours (in some cases it takes one knock) in order to prevent bleeding from the puncture area. Observation within the hospital takes from one day.
RF Catheter Ablation for Atrial Fibrillation
Atrial fibrillation is one of the most common arrhythmias in middle-aged and elderly people. At the same time, the upper chambers of the organ contract uncoordinated and chaotically at a frequency approximately equal to 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 palpitations along with dizziness, shortness of breath, or fatigue. In some people, atrial fibrillation is completely asymptomatic. Restoration of the rhythm can be achieved with the help of pills or through intravenous administration of the drug or electric shocks (we are talking about electrical impulse therapy).
There are two ways to prevent atrial fibrillation: elimination of trigger foci; transformation of the atrial wall so that multiple reciprocal cycles do not occur.
Trigger focus of a single type. For example, there is a focal atrial tachycardia with an epicenter in the pulmonary vein. In this case, selective ablation is carried out in the same way as described above. Atrial fibrillation is rarely treated this way due to the presence of multiple triggers.
Elimination of all potential trigger epicenters. ATIn this case, the mouth of the four pulmonary veins is delimited. Do this in several ways:
- By selective ablation of all electrical connections between the left atrium and each pulmonary vein (otherwise known as electrical isolation). During the procedure, in 3% of cases, narrowing of the pulmonary vein may occur. And this leads to increasing dyspnea. Plus, it's hard to cure.
- Formation of a line of conduction isolation outside the venous orifice (the so-called anatomical isolation). In this case, a blockade of both the vein and the atrial tissue on the left, which is in contact with them, is carried out. In this case, there is almost no risk of narrowing of the pulmonary vein.
What happens after the operation?
Immediately after catheter ablation for atrial fibrillation, the doctor removes the catheters. In this case, the doctor presses a little on the insertion site of the device in order to prevent bleeding. A bandage may also be applied to the site of the catheter. During this time, it is extremely important to remain still. After the procedure, it is mandatory to observe bed rest. The next day after the operation, 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 for the next few days and avoid physical overexertion. Most people tend to return to their normal lifestyle within three days.
A small hematoma is common, along with a walnut-sized swelling at the insertion site. 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, a doctor should be contacted immediately. It is required to strictly follow the doctor's recommendations regarding therapy and setting a date for a return 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 the neutralization and blockage of these areas, the activity of the organ is controlled and it returns to its normal rhythm.
Is the procedure effective?
Typically, after some time, patients who have undergone this operation have a significantly lower number of recurrences of atrial fibrillation compared to those who received medication (drug therapy).
According to the results of the study, catheter ablation is a significantly more effective treatment for paroxysmal 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 normal.organ rhythm.
In the case of medical 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 that helps reduce the manifestations of arrhythmia. As noted, in many patients after it, either a long-term decrease in the number of arrhythmia episodes with a decrease in their severity, or a restoration of a he althy organ rhythm is observed.
Patients, in turn, share the opinion that, thanks to successful ablation, they were lucky to reduce the dosage of drugs, and some even stopped taking the drugs that they were forced to use to control the rhythm (we are talking about antiarrhythmics). People write that due to the use of such drugs, they often had 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 there is a certain risk with this manipulation. Thus, there is a risk of bleeding, swelling and bruising in the area of the catheter insertion, as well as problems with infection of this place. More serious complications, according to doctors, occur quite rarely. Nevertheless, damage to blood vessels and the heart can still be observed along with the formation ofblood clots (this can lead to the development of a stroke), myocardial infarction or even death is possible.
But, experts say, the risks of adverse events during catheter ablation, according to a retrospective large clinical study, are quite low and amount to only one and a half percent.
Conclusion
Thus, ablation of the heart is a procedure that is performed using a flexible thin wire called a therapeutic catheter. It is injected through a vein into the area of the organ, thanks to which it is possible to study and correct the electrical impulse. In the event that a doctor detects a heart rhythm failure in a patient, a special device can be used that transmits a radio frequency wave and generates enough heat to form a small scar in a certain area of \u200b\u200btissues. These small areas of connective structures block abnormal electrical signals that cause rhythm disturbances such as atrial fibrillation.
We reviewed radiofrequency catheter ablation of the heart and reviews of this operation.
