From diagnosis to treatment: deciding if catheter ablation is right for you

Catheter ablation is a treatment option for arrhythmias, which are when the heart has an abnormal rhythm that is at times too fast or too slow. In this article, a consultant cardiologist explains the application of this treatment, and which patients may benefit from it.

What is an arrythmia?

An arrhythmia is when the heart has an issue with its conduction of electrical impulses, which tell the heart muscles when to contract and release. This can be due to structural problems within the heart. When these signals aren’t generating properly, the heart can beat too fast (tachycardia), too slow (bradycardia), or is unable to keep a consistent rhythm; these can be experienced in periods that can last a few seconds or a few days, and may not be constant.

How are arrhythmia diagnosed?

Arrhythmias are not in themselves heart conditions; rather, an arrhythmia is a symptom that indicates a heart condition such as coronary artery disease, valve disorders, cardiomyopathy, or high blood pressure. Some arrhythmias may cause passing discomfort and need no further intervention, whereas others may lead to cardiac arrest.

The two most common tests to diagnose an arrhythmia are electrocardiograms (ECGs), which measure the electrical activity of the heart through electrodes placed on the chest, and echocardiograms, which measure the soundwaves given off by the beating heart and convert them into images to show the strength of the heart, its structure and blood flow.

For arrhythmias that are infrequent, more long-term tests may be conducted so that data can be collected over a few days. This can be in the form of a Holter monitor, which is a portable ECG, or an implantable loop recorder for very infrequent cases, and is a device that is implanted under the skin in the chest to continuously record the electrical heart activity.

There are several kinds of arrhythmia, categorised by where in the heart they originate and the kind of rhythmic irregularity is occurring, such as:

• Atrial fibrillation. This is the most common arrhythmia, from the upper part of the heart, the atria, and is often a fast heartbeat.
• Supraventricular arrhythmia. This begins in the upper part of the heart, and is a very fast rhythm.
• Atrial flutter. This is also a fast heartbeat that originates in the top part of the heart, as compared to the bottom.
• Tachybrady syndrome. Also called sick sinus syndrome, this is prolonged periods of fast or slow beats.
• Heart blocks. Caused by an obstruction between the top and bottom parts of the heart, this can result in a very slow heartbeat.

How can catheter ablation treat arrythmias?

There are various ways to treat an arrhythmia, and it will depend on the preferences and condition of the patient. Sometimes they can take medications, undergo medical therapies, or can have a device like a pacemaker implanted, but these methods are not suitable for all patients.

One method, catheter ablation, is best used for atrial fibrillation and is explored as a treatment option when the arrhythmic heartbeat is interfering with a patient’s daily life, causing them pain and distress, preventing them from engaging with their work or normal activities, and other forms of intervention have been unsuccessful thus far. It is can be recommended as a primary treatment for professional athletes with and those who have had previously had heart failure.

Catheter ablation treatment involves thin, flexible tubes called catheters that are inserted into the blood vessels (typically the femoral artery at the groin) and passed through until they reach the heart, guided by X-ray visualisation. Once at the heart, blasts of heat (radiofrequency ablation), cold (cryoablation), or energy (pulsed-field ablation) are shot out to scar the tissue to disrupt the errant electrical signals.
 

The process can take up to four hours, depending on the complexity of the case, and during which the patient will be under a general anaesthetic. Some patients may stay overnight in the hospital, but most cases are a day procedure. There are risks to consider before undergoing catheter ablation. The possible complications include blood clots, damage to the heart tissue and valves, damage to the blood vessels, or even stroke – however, these risks are low. Patients with supraventricular arrhythmia have a higher success rate with this procedure, compared to those with atrial or ventricular tachycardia.

The healing process takes several weeks, as the heart tissue needs to heal and scar. During this time, there still may be the occurrence of arrhythmias, but this is normal. Most patients can return to work or school within a week, but they should avoid heavy lifting and strenuous physical activity for a little longer; their doctor should advise them when it is safe to return.

If you have experience irregular heartbeat, you can consult with a specialist on Top Doctors.