Cardiac arrhythmias, also called arrhythmias, are problems for patients and can be life-threatening in some cases. Arrhythmias cause problems for several hundred thousand people in Poland. Arrhythmias can be treated in a number of ways, but ablation is the most effective. What is ablation, who can get it, and what are the reasons it shouldn’t be done?
What is ablation, and what is the procedure?
Ablation is a percutaneous procedure that eliminates or isolates places in the heart that are responsible for heart disorders. It involves entering the heart through veins and arteries with a catheter, looking for places responsible for arrhythmia, and heating or freezing them. A qualified electrophysiologist can see the places that cause and sustain the arrhythmia and heat or freeze them, forming a scar to prevent electrical conduction. This prevents arrhythmias from occurring.
What are the indications for ablation?
The most common sustained arrhythmia is atrial fibrillation. Other arrhythmias that qualify for ablation include Wolff-Parkinson-White (WPW) syndrome, nodal tachycardia, atrial flutter, and ventricular arrhythmias. All of these arrhythmias should be treated with ablation according to European and Polish guidelines.
Not everyone can take advantage of this treatment option
For example, we can’t do ablation on a person with atrial fibrillation who weighs 150 kg, has sleep apnea, and has a blood pressure of 200/100. Then, it doesn’t make sense to do such a thing because the risks are worse than the benefits. There are also medical reasons why it shouldn’t be done, like if there is a thrombus in the heart. If we “scratch” it with an electrode, we will cause a stroke. There are a lot of patients whose underlying disease can be fixed, and they should work on that first. After that, we should do ablation.
How effective is ablation compared to other methods?
Treatment of atrial fibrillation with drugs is most often ineffective – 15, 20, 30% – this is assessed differently in studies. Either way, pharmacotherapy will not improve the patient’s situation as we would like. The effectiveness of ablation is much higher, reaching 70-80% .
Does the ablation procedure need to be repeated?
Each arrhythmia must be treated in a different way, because, in some cases, the treatment is nearly 100% effective and in others, it is only 60–70% effective. In one case, ablation only needs to be done once, but in another, it needs to be done more than once as the disease gets worse over time. It has its own style.
Ablation is considered a safe procedure. Can it cause complications?
Different things can go wrong. I always tell my patients that this is a problem that could lead to death. It is, after all, a surgery on the heart. How complicated a procedure is depends on what kind it is, when it is done, and who does it. It depends on how healthy the person is in general. Less than 1% of young, healthy people who have WPW ablation are at risk. If this is an 80-year-old man who was hurt in an electrical storm and is on a ventilator, sedated, limping, and in the ICU, the risk is very, very high. In general, only 4% of all complications are mentioned in large registries. It can cause death, a hole in the heart from an electrode, or a stroke, but these things don’t happen often because we know how to stop them.
Ablation is a major operation that reduces the risk of cardiac surgery by controlling the pressure of the electrode. Blood thinners are used to keep patients from having a stroke during surgery, which happens rarely.