Catheter ablation, also known as cardiac ablation, is a minimally invasive procedure that uses energy to correct abnormal heart rhythms or arrhythmias. Catheters are long flexible tubes used during the procedure.
Ablation is used to treat different types of arrhythmias, such as atrial fibrillation, supraventricular tachycardia and ventricular tachycardia. Arrhythmias occur when the electrical system in the heart that coordinates heartbeats does not work properly.
Arrythmias may be benign or lead to serious medical conditions. Symptoms can range from mild to severe and include, palpations, shortness of breath, light headedness and chest pain.
Ablation is often recommended when arrhythmias can’t be controlled by medication.
“When medications fail to prevent arrhythmias or aren’t tolerated, catheter ablation may be recommended. In certain patient populations, ablation may be used as first line therapy,” says Douglas Gibson MD, director of cardiac electrophysiology at Scripps Clinic and Prebys Cardiovascular Institute.
Arrhythmias can affect the upper (atria) or lower (ventricles) chambers of the heart. There are different types of arrhythmias that describe the speed of heart rate they cause and where they originate in the heart.
- Tachycardia occurs when the heart beats too fast – with a resting heart rate greater than 100 beats a minute. A normal resting heart rate for adults is 60 to 100 beats per minute.
- Bradycardia occurs when the heart beats too slow – with a resting heart rate less than 60 beats a minute.
- Atrial fibrillation (AFib) (in upper chambers) or ventricular fibrillation (in lower chambers) occur when the heart beats erratically and fast.
Catheter ablation may be used to treat:
- AFib, the most common arrhythmia in adults.
- Atrial flutter
- Supraventricular tachycardia
- Atrial tachycardia
- Atrioventricular nodal reentrant tachycardia
- Wolff-Parkinson-White syndrome
- Ventricular tachycardia
- Premature ventricular contractions
An electrocardiogram or EKG is a noninvasive test used to record the heart’s electrical activity. It is used to help diagnose and monitor arrhythmias. Extended cardiac monitors can be used to diagnose arrhythmias that occur less frequently.
An electrophysiology study or EP study is a detailed evaluation of the electrical activity in the heart. It is used to diagnose an abnormal heart rhythm.
The minimally invasive procedure is usually performed by an electrophysiologists, a cardiologist with special training in heart rhythm disorders. The procedure is done using small punctures in the groin.
In most cases, medications are used as the first line of therapy for treatment of arrhythmia. If this doesn’t work, patients with symptomatic arrhythmias become candidates for ablation. In rare cases, asymptomatic arrhythmias are treated with ablation. There are certain patients in whom ablation may be considered as first line therapy.
Traditional catheter ablation uses thermal energy (heat of cold) to destroy the heart muscle tissue causing improper electrical activity.
During the procedure, catheters are inserted, usually through a small puncture in a blood vessel in the groin region, and passed to the heart. Types of catheters include those used to assist with the diagnosis of arrhythmia and those used for treatment.
“Sophisticated mapping equipment is used to track the flow of electricity in the heart and the locations of the catheters,” Dr. Gibson says. This system is known as electroanatomic mapping.
Once the arrhythmia is characterized and located, ablation is used to eradicate the arrythmia-causing areas in the heart and restore proper function of the heart.
The procedure is done at a hospital, usually in an EP lab or a cardiac catheterization lab. The amount and type of sedation depends on the type of arrhythmia and other health conditions.
Ablation procedures are usually under 3 hours, depending on the arrhythmia being treated and other factors. Complex procedures can last longer.
Following the procedure, the patient is transferred to a recovery area and may be discharged the same day or spend the night, depending on their condition.
Ablation is a safe procedure, however, as with all cardiac procedures, complications can occur.
“The complication rates and types of complications may vary with the type of arrhythmia being treated,” Dr. Gibson says.
“For most procedures, complication rates should be less than 1 percent for experienced physicians working at high-volume centers,” he says.
“While the risks are low, a patient should discuss the risks and benefits of catheter ablation with their doctor to make sure it’s the right choice for them.”
Catheter ablation of cardiac arrhythmias is a rapidly evolving field.
“Advances are being made along multiple fronts,” Dr. Gibson says. “Perhaps the most exciting improvement is the use of pulsed field ablation to eradicate abnormal heart muscle in patients with atrial fibrillation. Based on initial studies, this may be a more effective and safer way to treat cardiac arrhythmias.”
Pulsed field ablation (PFA) is a non-thermal modality used to destroy abnormal heart muscle. FDA-approval is pending.
Scripps physicians participated in the first FDA-sponsored, randomized clinical trial of this therapy in humans in the U.S. The Farapulse Advent Pivotal Trial was completed in June of 2022. Scripps physicians have also spent hundreds of hours in basic science research labs assisting with the development of future generations of this technology.
“Scripps physicians have the most experience in San Diego with this therapy,” Dr. Gibson says.
Research trials of different PFA modalities and catheters continue at Scripps. Access to this treatment prior to FDA approval may be available as part of research trials at Scripps. Check with your Scripps cardiologist for more information.
“Pulsed field ablation so far appears to be a revolutionary improvement in the treatment of cardiac arrhythmias,” Dr. Gibson says. “Advances such as these are uncommon and may only occur once or twice in a physician’s career.”