Cardiac ablation . Cardiac ablation is a procedure used to remove small areas of the heart that cause heart rhythm deficiencies, allowing you to rebuild your heart’s normal electrical pathways and resume your rhythm.
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- 1 Methods for applying cardiac ablation
- 2 Characteristics of catheter ablation
- 3 Preparations for ablation
- 4 Demonstrations during the ablation process
- 5 Complications during ablation
- 6 Recovery after ablation
- 7 Results of ablation
- 8 Sources
Methods of applying cardiac ablation
Two methods are known for performing cardiac ablation:
- Radiofrequency ablation that uses thermal energy to remove the problem area.
- Cryoablation using very low temperatures.
Characteristics of catheter ablation
The ablation catheter is a way to treat tachycardias using catheters that reach the heart through blood vessels . Currently all tachycardias are potentially treatable by this technique. The indication of an ablation will depend on your biological situation, the type of tachycardia , the frequency with which it appears and its repercussions, and consists of first finding the deficient area of the heart that causes the tachycardia and then destroying it by applying energy. generally radiofrequency. If this is achieved, tachycardiaThe ablation will not be able to occur again, so this is a potentially curative treatment. Ablation requires an electrophysiological study to be performed beforehand , which leads to the definitive diagnosis of tachycardia . Both procedures have several phases in common, hence they are usually carried out integrated into one.
To perform an ablation, several electrophysiology catheters are inserted through punctures into a large-caliber vein, usually the right femoral vein, accessed from the groin. Catheters are advanced fluoroscopically guided through the veins and placed at specific locations in the heart . This allows studying the electrical activation of the heart during tachycardia . Subsequently, an ablation catheter is inserted , the end of which is placed in points of the heart that are considered vital for the origin or maintenance of the tachycardia and radiofrequency, which produces a small burn, is applied to the contact area.
Depending on the size and accessibility of the area to be treated, several radio frequency applications may be required, in the same place or in different places, to complete the ablation, sometimes the tachycardia comes from the left cardiac chambers, which are not You can access it directly from the veins . In these cases, the ablation catheter must be inserted from the femoral artery , in the groin, or through the septum that separates the right atrium from the left by means of a transseptal puncture . The procedure can take 4 or more hours.
Preparations for ablation
Patients taking anticoagulants should stop taking these medications for 3 to 5 days before the procedure, because this causes the body to return to normal clotting.
Demonstrations during the ablation process
During the process some arrhythmias may appear that require termination by electrical shock or cardioversion , which is done under a short period of general anesthesia. Ablations in children or uncooperative patients are also done under general anesthesia . Patients undergoing ablation under local anesthesia are aware during the procedure and can contact specialists. These patients may experience palpitations, including those caused by their own tachycardia.. The discomfort of radio frequency applications are highly variable, depending on your location and personal issues. Some patients may not feel them at all, while others may perceive them as very painful. In the latter case, the pain is usually perceived as pressure on the chest, sometimes radiating to the back , shoulders, or neck , while radiofrequency is being applied. At the end of the application the pain should subside, although a slight residual discomfort may remain during the following minutes or hours. Some patients may manifest back pain , especially in the kidney area, for remaining motionless on the table in the electrophysiology room for the duration of the ablation. This type of discomfort improves significantly with intravenous pain relievers. The total duration of the ablation procedure varies by patient; and it can last from three to 4 hours.
Complications during ablation
The vascular complications that could arise are: pseudoaneurysms , arteriovenous fistulas , phlebitis , thrombosis of punctured vessels.
Radiofrequency is applied to treat tachycardia near structures necessary for the normal function of the heart , such as the sinus node or the atrioventricular node . Injury to these structures would produce an inappropriately low heart rate, so if this complication appears, the patient would require the implantation of a definitive pacemaker . The estimated risk of atrioventricular block during an ablation close to any of these structures is 1 to 2%. Rarely in less than 1% of cases, serious life-threatening complications may occur, such as a tear in the heart or in a large vessel, strokes , injury to acoronary artery or heart valve , injury to organs adjacent to the heart such as the phrenic nerve or esophagus , unremitting arrhythmias, problems arising from anesthesia, or severe allergic reactions. Also exceptionally, in very difficult cases requiring prolonged use of X-rays, skin lesions may appear due to irradiation. Pregnant women should not undergo ablation because of the risk of fetal malformations from exposure to X-rays.
Recovery after ablation
At the end of the procedure, the catheters are removed, the puncture sites are manually compressed for a few minutes and a compression bandage is applied without applying stitches or surgical staples. Patients should rest in bed for 6 to 12 hours after the procedure, depending on whether only veins have been punctured or whether an artery has also been punctured , the number of punctures performed and the thickness of the inserted catheters. They should not move their legs , especially during the first hours. It is wise to lightly compress the wound when coughing , laughing, or moving in bed . After the prescribed resting timeThe patient should begin to move the legs in bed to facilitate venous circulation. Afterwards you should sit in bed for a few minutes and if you are well, you will go to an armchair and finally you will start to walk with caution. This process must be progressive to prevent the patient from becoming dizzy.
Ablation success varies depending on the type of tachycardia , such as supraventricular tachycardia and common atrial flutter. When an ablation is not successful, the procedure can be repeated, provided that the probability of success of the second action is considered reasonable and justifies the intervention. It may happen that after an initially effective ablation, the injury produced also cures that the abnormal tissue returns to function and produce tachycardias. At other times, patients may develop tachycardias other than ablated, in these cases a new ablation procedure may be performed.
The efficacy of ablation varies depending on the type of tachycardia. In tachycardias such as supraventricular and common atrial flutter, the effectiveness is close to one hundred percent. Regarding the risks, the appearance of an ecchymosis or a slight bruise in the puncture area can be considered normal after an ablation, and does not require particular attention.