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Radiofrequency Catheter
Ablation
(Cardiac Ablation)
By: Silvia Wong
RDSC 326—CVT
March 1, 2006
What is Cardiac Ablation?
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A fairly non-invasive treatment for cardiac arrhythmias
(irregular heartbeat)—mostly painless, some discomfort
Uses mild sedation and local anesthesia—so patient is awake
most of the time
Only takes about 2-4 hours to complete, sometimes up to 8
hours
Specifically for treatment of different types of
TACHYCARDIAS (rapid heartbeat)
Other names for cardiac ablation include:
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Cardiac catheter ablation
Radiofrequency ablation
Catheter ablation
Or just simply—ablation
Normal Electrical Activity—a beat
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Electrical impulse begins in the
sino-atrial (SA) node located in the
upper right chamber (right
atrium) of the heart. The impulse
spreads across both atria causing
them to contract simultaneously
and squeeze blood into the lower
pumping chambers (ventricles).
While the atria are contracting, the
electrical impulse continues
through the atrio-ventricular (AV)
node. The AV node is the "gatekeeper" to the lower chambers
and is normally the only electrical
connection between the upper and
lower chambers.
After a split second pause, the
impulse then continues down
through both of the ventricles
causing them to contract and
squeeze blood out to the body and
lungs.
Types of Treated Tachycardias
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AV Nodal Reentrant Tachycardia (AVNRT)
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Accessory Pathway
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Atrial Fibrillation and Atrial Flutter
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Ventricular Tachycardia
AV Nodal Reentrant Tachycardia
(AVNRT)
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An extra pathway
that lies in or near
the AV node and
causes the
impulses to move
in a circle and reentering areas it
has already passed
through
Accessory Pathway
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Extra pathways
that exist from
birth that connect
to the atrium and
ventricles and
causes signals to
travel back to the
atrium, making it
beat faster
Atrial Fibrillation and Atrial
Flutter
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Extra signals originating in
different parts of the atrium
causing the atria to beat rapidly
(A. flutter) or quiver (A. fib)
Ventricular Tachycardia
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A rapid, potentially
life-threatening rhythm
originating from
impulses in the lower
chambers of the heart.
The rapid rate prevents
the heart from filling
adequately with blood
so that less blood is
able to circulate
through the body
Who’s involved?
Cardiologist
 Electrophysiology (EP) doctor
 Interventional Radiographer
 Nurses
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Equipments Used
 For
guidance:
Fluoroscopy (most common)
 Ultrasound
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 RF
Catheter Ablation
System (Chilli system)
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Price: $72,827
Most Common Ablation Catheter
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RF CONTACTR
Dual-curve
Ablation Catheter
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8F and 7F tip offers
unique tip movement
allowing for precise
mapping and ablation
in and around
anatomical structures
Other Ablation Catheters
Livewire TC
Bi-directional
Ablation Catheter
 Livewire Spiral
HP Steerable
Electrophysiology
Catheter
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Pre-Treatment Care
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Stop taking blood thinning medication three days prior
to the procedure
Other medications that controls heart rate also need to
be stopped, as well as aspirin products
Diabetics may need to adjust their diabetes medications
or insulin
NPO past midnight prior to the procedure, including
water, gum, mints, etc.
If medications are to be taken, then small sips of water
is allowed
Even while brushing teeth, patients are not allowed to
swallow any water
How does it work?
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EP doctor inserts a catheter into the
femoral artery and feeds it to the heart
Tachycardia induction
Ablation catheter is maneuvered so its
electrode tip is in contact with the abnormal tissue
Location of the ablation target is determined by a process
called “electrical mapping,” in which the catheter is moved
from spot to spot to find the appropriate area
Energy known as Radiofrequency (RF) energy is turned on
This energy “disconnects” the pathway of the abnormal
rhythm by destroying small amounts of tissue, ending the
disturbance of the electrical flow through the heart
If the catheter location is correct, the tachycardia is
eliminated
Testing is performed to see if tachycardia can be initiated
again, if so—procedure is repeated, if not then the catheter is
withdrawn out of the body
Other forms of energy used: intense cold—cryoablation,
freezing the tissue
Real Procedure Images
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Specially-designed,
multiple-electrode loop
ablation catheter
deployed in the left
atrium (Left anterior
oblique view)
Catheter position during
a successful ablation of a
slow pathway of
AVNRT
Success Rates
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It exceeds over 90 percent when used to
treat:
Supraventricular tachycardia—95%
 Atrial flutter
 Rare types of ventricular tachycardia
 Atrial fibrillation
 Ventricular tachycardia after a heart attack
(lower only 40-50%)
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Risks
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Perforation of the heart with leakage of blood into the
sac surrounding the heart
Perforation of a blood vessel with leakage outside of it
Inadvertent interruption of normal conduction (which
requires a pacemaker)
Stroke
Heart attack
Death
All very rare:
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A pacemaker is needed in less than 1 in 200 cases
Serious complications occur in less than 1 in 500 cases
Post-Treatment Care
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Patients should monitor the procedure site for any
redness, swelling, or drainage
Incision site should be kept clean and dry
During recovery process, patient is placed on a special
monitor—Telemetry Monitor
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Telemetry consists of a small box connected by wires to your
chest with sticky electrode patches
The box displays the patient’s heart rate and rhythm on
several monitors in the nursing unit for the nurses to observe
the patient’s condition closely
Recovery Time
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After procedure, patients need to stay in bed for about
1 to 6 hours to prevent bleeding
No stitches involved
Most patients are discharged the same day, some may
have to stay overnight at the hospital
During the first 48 hours, fatigue or chest discomfort
may be experienced
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Some may experience skipped heartbeats or short episodes
of atrial fibrillation after the procedure
After the heart has healed, these abnormal heartbeats should
subside
Many resume normal activities within a few days