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A catheter ablation is a procedure in which a small part of the heart
is burned or frozen with the tip of a catheter to prevent unwanted electical activation from passing through the heart.
The ablation is done to get rid of (or modify) tissue in the heart.
A common ablation procedure is treatment of SVT by removing the extra pathway adjacent to the AV node of the heart. The AV node is located in the center
of the heart, and acts as a gateway of electrical activity from the top to the bottom of the heart. Normally, there
is only one "bridge" of electical conduction. However, in patients with AV nodal type SVT, there is an extra "bridge".
Electricity can flow down one pathway, up the next, and back down the first in a short-circuit loop. This loop
causes an abnormally fast heart rate, and can be successfully treated with an ablation.
Another common ablation procedure is the treatment of atrial flutter. In most cases, atrial flutter is a typical circle of electrical activity through the right atrium. The ablation
involves creating a burn-line of tissue between the tricuspid valve and the inferior vena cava in the right atrium, and is
very successful for eliminating atrial flutter.
Another ablation procedure is done for WPW syndrome, in which an extra pathway must be located, and then stopped. This pathway can be more difficult to find, and may be
located on the left side of the heart.
Finally, ablation for atrial fibrillation remains one of the most difficult ablation procedures. This procedure has evolved over the past decade, with new approaches
and tools. Some patients with atrial fibrillation who continue to have symptoms that are not controlled with medications
may elect to have a catheter ablation. This procedure works fairly well for patients who are in and out of normal rhythm,
but less successful for patients who have been stuck in this rhythm for a long time.
For all of these procedures, patient are brought to the catheterization
or EP laboratory at a hospital. Patients are given sedation for the procedure, which takes several hours. Catheter
sheaths are placed in the leg/groin veins. X-ray, or fluoroscopy, is used to see where to place the catheters.
Specialized mapping is done to determine where the problem is. The catheter is placed in the correct location, and heat
is applied to the catheter to disrupt any possible electrical activation in that area.
There is a small risk of complications during the procedure, including need
for a pacemaker, stroke (if ablation is done on the left side of the heart), poking a small hole in the heart (perforation,
which is usually treatable without surgery), and a very small risk of death. The risks and success will
depend on which type of ablation is done.
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