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A-FIB AND CATHETER ABLATION

Posted Feb 04 2012 12:00am
Feb
04

       There are numerous cardiac arrhythmias, but the most common is called atrial fibrillation, A-fib for short.  Any arrhythmia simply means you have an abnormal heart rate.  Approximately 0.4% of the population, increasing with age, will develop this cardiac problem.  It appears that A-fib involves an interplay between electrical triggering events and the myocardial substrate that permits propagation and maintenance of the aberrant electrical circuit.  The most popular focal trigger of A-fib is located between the cardiac muscle that extends into the pulmonary veins.

       Today atrial fibrillation accounts for 1/3 of the hospitalizations for cardiac rhythm disturbances.  The most common symptoms include dyspnea, palpitations and decreased exercise tolerance.  Patients with A-fib are at increased risk for stroke and more often than not, anticoagulation is recommended.  I have had several of my elderly clients in home health care that have had this disturbance and are on Coumadin therapy.  Although episodes of A-fib can be converted to normal sinus rhythm by pharmaceutical means or electroshock conversion, the natural history of A-fib is one of recurrence, and many times a catheter ablation is necessary to correct the problem.

       Cardiac ablation is a procedure that can correct heart rhythm disturbances and typically involves the use of a catheter; a long, flexible tube inserted in a vein in the groin and threaded to the heart.  It works by destroying tissue in your heart that triggers an abnormal heart rhythm.  Sometimes ablation prevents abnormal electrical signals from traveling through the heart and thus stops the arrhythmia.  Occasionally cardiac ablation is done through open-heart surgery, but using the catheter ablation method is much less invasive and shortens the recovery time.  This procedure is a treatment option for people that have tried medication without success, have had serious side effects from tried medication or have a high risk of complication from their arrhythmia, such as sudden cardiac arrest.

       Ablation usually takes about 3-6 hours, although some cases are longer if there are any complications.  During the procedure, one might feel some minor discomfort when the dye is injected in the catheter or when energy is run through the catheter tips.  Ablations are always performed in the hospital and even on an outpatient basis if there are no complications.  Sedation is given through an intravenous line to help you relax.  Next, they will numb a small area near a vein on the groin, neck or forearm, a needle is inserted in the vein, and a tube called a sheath is placed through the needle.  The catheter that is used for the ablation is threaded to the heart through the sheath. 

       Finally, a dye is injected that will show up on x-ray images so that the doctor can see the part of the heart that needs to be treated.  The catheter has special electrodes at the tips that will be used during the procedure.  Once the abnormal tissue that is causing the arrhythmia is identified, the catheter is aimed at that area.  Lastly, energy will travel through the catheter tips to create a scar or destroy the tissue that triggers the arrhythmia.  The energy used in this ablation may come from radiofrequency (heat), lasers or cryoablation (extreme cold).  Catheter ablation for A-fib is becoming quite popular for patients that are unable to get relief from other means.

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