Ablation..

Ablations

The Ablation Procedure
What is catheter ablation?
Catheter ablation is a technique whose purpose is to destroy (ablation means "to eliminate or remove") abnormal heart tissue that is causing an arrhythmia. Catheter ablation is used primarily to treat people who have problems with heart racing or rapid beating of their heart. In simple terms, a catheter is inserted into the vein or artery, guided into the heart and placed against the heart tissue identified by the EP study as causing the problem or needing to be destroyed in order to alleviate symptoms. Most commonly, electricity or heat is used to "burn" the heart tissue causing the tachycardia. The catheter is connected to equipment that sends electricity up to the catheter tip, causing it to heat up and burn the heart tissue. It is often necessary to deliver more than one burn. When the physician feels that sufficient burns have been applied, he/she will test to see if the heart arrhythmia is still present or has been successfully destroyed. If it is felt that the problem has been eradicated, the doctors will wait up to 30 minutes more before testing again to make sure that the problem does not return.
Medical research is developing newer ways to try and perform catheter ablation. One of the newest is to use a catheter to freeze the abnormal tissue or "cryoablation". Cryoablation has some advantages and is used for certains kinds of ablation procedures. When people hear about catheter ablation, they automatically think that a "laser" is used but that is not true. At the present time, laser energy is not used for catheter ablation because it is too powerful or strong and could easily burn a hole through the heart.
There are variations in how catheter ablation is performed and the precise risks depend upon the location of the abnormality causing the heart rhythm problem and the exact method used to ablate it. More detailed information specific to each type of arrhythmia and ablation is provided below.
What risks are associated with all types of catheter ablation?
Because an EP study is usually performed before catheter ablation, patients undergoing the ablation procedure face all the risks described for EP studies as well as any risks specific to the ablation procedure itself. Some risks are limited to specific arrhythmias or ablations and are described in the appropriate section. In general, catheter ablation is a safe procedure and complications are infrequent (less than 5% at London Health Sciences Centre). Ablation may cause some mild chest or back discomfort during burning but can usually be relieved easily with pain-killers or more sedation. It is possible for the ablation catheter to poke through the heart muscle wall (or perforate) or for burning with the ablation catheter to create a hole in the heart wall . This may cause chest pain and rarely, cause bleeding that can cause a dangerous buildup of blood around the heart. This could impair the ability of the heart to pump blood and lead to low blood pressure. If severe, it may be necessary to have the blood drained and the hole in the heart wall closed surgically. If the tissue that needs to be ablated is in very close proximity to the normal main pathway or cable (the AV node) at the centre of the heart, ablating the abnormal tissue may injure the AV node, causing "heart block". If this persists, a permanent pacemaker may need to be inserted. If the ablation catheter must be placed on the left side of the heart where blood flows on the way to being pumped out to the rest of the body, there is a small risk that blood clots could form on the catheter or at the site of each ablation burn. These small clots could come loose at any time during or after the procedure and could be carried by the blood to other organs of the body. A blood clot to the brain would cause a stroke. To minimize the risk of blood clots forming, heparin is given during the ablation procedure. Death during an ablation is very rare and has not occurred at London Health Sciences Centre but should always be considered possible no matter how unlikely. Your physicians and care team have taken all measures necessary to minimize these risks to you. However, in consenting to have such a procedure, you must accept that these risks exist.
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