Catheter ablation

Catheter ablation is an invasive procedure used to remove a faulty electrical pathway from the hearts of those who are prone to developing cardiac arrhythmias such as atrial fibrillation, atrial flutter, supraventricular tachycardias (SVT) and Wolff-Parkinson-White syndrome.

It involves advancing several flexible catheters into the patient's blood vessels, usually either in the femoral vein, internal jugular vein, or subclavian vein. The catheters are then advanced towards the heart and high-frequency electrical impulses are used to induce the arrhythmia, and then ablate (destroy) the abnormal tissue that is causing it.

Catheter ablation is usually performed by an electrophysiologist (a specially trained cardiologist) in a cath lab.

Catheter ablation of most arrhythmias has an extremely high success rate. For SVT, WPW, and atrial flutter, the success rates are 95-98%. For automatic atrial tachycardias, the success rates are 70-90%. The potential complications include bleeding, blood clots, pericardial tamponade, and heart block, but these risks are very low, ranging from 0.5-3%.

For atrial fibrillation, several experienced teams of electrophysiologists in US heart centers claim they can achieve up to a 75% success rate. However one recent study claims that the success rates are in fact much lower. Single procedure success rates have been published in this study at 28%. Often, several procedures are needed to raise the success rate to the 70-80% range.1 One reason for this may be that once the heart has undergone atrial remodelling as in the case of chronic atrial fibrillation sufferers, largely 50 and older it is much more difficult to correct the 'bad' electrical pathways. Young AF sufferers with paroxymal, or intermitent AF, therefore have an increased chance of success with an ablation since their heart has not undergone atrial remodelling yet.

Risks of catheter ablation for atrial fibrillation include, but are not limited to: stroke, esophageal injury and death.

Amongst others, Tony Blair (ex prime-minister of Britain) has undergone a successful catheter ablation.

1 Cheema, et al. Long-term single procedure efficacy of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol (2006) 15:145-155.