Ablation – for heart rhythm

Ablation really just means the destruction of cells.  When applied to heart rhythm problems it means we can treat heart cells that are causing trouble.

It is done by using one of 2 technologies – either microwave energy to heat cells, or liquid nitrous oxide to freeze cells.  These cause the proteins in the cells to change their structure and stop the cell from working.

The heating or freezing is done via catheters which are introduced to the heart via the veins (or sometimes arteries) in the groin.  They are long and thin, usually about 3mm in diameter, though some can be significantly larger.

Different rhythm problems are due to different causes – either cells are over-active, so fire too much, or conduct slowly allowing electrical circuits to be set up inside the heart.

In atrial fibrillation we have learnt that dealing with the over-active cells in the veins as they enter the heart can lead to narrowing of the veins, so it is safer to electrically isolate the veins from the atria by burning or freezing around the veins.  This can be known as Pulmonary Vein Isolation (PVI) or Wide Antral Circumferential Ablation (WACA).  We doctors do like our acronyms!

Like any procedure, there are risks and benefits.

On the benefits side, they can cure rhythm problems, particularly supra ventricular tachycardias, or at least improve symptoms for example for atrial fibrillation.  The exact benefit depends on the condition being treated.

On the risks side they can cause problems inside the heart such as destroying normal conduction tissue so a pacemaker is needed, or causing a heart attack or stroke. There can be bleeding around the heart or damage to structures near the heart such as the veins, the gullet, or the nerve to the diaphragm.  There can also be problems in the groin where we access the veins such as clots in the veins or damage to the artery or nerves near the veins.  The risks do depend on the condition being treated.

Hopefully that is some information for you that will help you understand what might be happening.  If you want specific information, please don’t hesitate to get in touch and arrange an appointment.

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