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Catheter Ablation

Catheter ablation is a relatively new medical procedure that was first developed in the 1980s. The procedure was originally used to treat supraventricular tachycardias (SVT) caused by an abnormal extra electrical pathway in the heart. Radiofrequency energy was delivered through a catheter to the area of the heart responsible for the SVT. This created a small area of scar tissue that interrupted the abnormal electrical pathway, effectively curing the SVT.
Since then, catheter ablation has been refined and expanded to treat a wide range of arrhythmias, including atrial fibrillation, ventricular tachycardia, ectopic beats and atrial flutter. The procedure has become more sophisticated and effective, thanks to advances in technology, including 3D mapping systems that allow doctors to visualize the heart in real-time and pinpoint the precise location of the abnormal electrical signals
fig 86 ablation catheter
During a catheter ablation procedure, a thin, flexible tube called a catheter is inserted through a vein in the groin, or neck and guided into the heart. Once the catheter is in place, the doctor normally uses radiofrequency energy or extreme cold (cryoablation) to destroy small areas of heart tissue that are causing the abnormal heart rhythm. This process is called ablation. By destroying the tissue causing the abnormal rhythm, the heart is able to beat normally again
Fig 56 catheter ablation Converted
During an AF ablation procedure, catheters are guided through a vein in the leg to the right atrium and then to the left atrium using a specialised needle and tube. The catheters are used then to deliver energy to the tissue around the pulmonary veins, either by heating the tissue (radiofrequency ablation), or freezing it (cryoablation), or by delivering a strong electrical current (pulsed field ablation). This creates a scar that blocks the abnormal electrical signals originating in the veins and were causing the AF. Extra lines of ablation are then added if needed inside the atrium.
Catheter ablation is usually done under local anesthesia and mild sedation, and the patient is typically able to go home the same day or the next day after the procedure. The success rate of catheter ablation varies depending on the specific type of arrhythmia being treated and other factors, but it can be an effective treatment option for many patients
There are two types of energy commonly used these days for catheter ablation:
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Radiofrequency (RF) energy

This involves heating the tip of the catheter to a high temperature (usually around 60°C) using an alternating current. The heat is applied to a specific area of the heart tissue to destroy the cells and creating a lesion or scar, which restores normal rhythm.

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Cryoenergy

his involves cooling the tip of the catheter to a very low temperature (usually around -80°C) using liquid nitrous oxide gas. The cold temperature freezes and destroys a specific area of the heart tissue, creating a lesion or scar to interrupt the abnormal electrical pathways.

Both types of energy are effective in creating the desired lesion or scar, and the choice of which energy to use will depend on several factors, including the location of the tissue to be ablated, the type of arrhythmia being treated, and the physician’s preference and experience. In some cases, a combination of both RF and cryoablation may be used to achieve the best results. There are other types of energy that have been used such as Laser and pulsed field ablation (PFA), but their use is less common currently
Fig 99 types of ablation
Some potential benefits of catheter ablation include:
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Improved Symptoms

Many people with arrhythmias experience symptoms such as palpitations, shortness of breath, dizziness, and fatigue. Catheter ablation can often eliminate or reduce these symptoms, improving a person's quality of life.

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Reduced Risk of Stroke

Some types of arrhythmias, such as atrial fibrillation, can increase the risk of stroke. By restoring normal heart rhythm, catheter ablation can help reduce this risk.

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Reduced Need for Medications

For some people, catheter ablation can eliminate the need for long-term medication use, which can have its own risks and side effects.

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Improved Survival

In some cases, catheter ablation may improve long-term survival for people with certain types of arrhythmias.

Catheter ablation has a high success rate and low risk of complications. However, like any medical procedure, it does carry some risks, such as bleeding, damage to blood vessels or surrounding organs, and arrhythmia recurrence. However, the risks overall are very small (often less than 1% risk
Fig 20 cathlab
Catheter ablation is a valuable tool in the treatment of arrhythmias and its value depends on several factors, including the type and severity of the arrhythmia, the patient’s overall health, and the experience and skill of the medical team performing the procedure. In general, catheter ablation has been shown to be an effective first-choice treatment option for many types of arrhythmias particularly when other treatments, such as medications or lifestyle changes, have not been successful.
Overall, the decision to undergo catheter ablation for arrhythmia is a complex one that should be made in consultation with a cardiologist or electrophysiologist who can help weigh the potential benefits and risks based on the individual’s specific situation.

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