Ablation of atrial fibrillation
| Catheter Ablation | |
|---|---|
 |
|
| ICD-9-CM | 37.34 |
| MeSH | D017115 |
Catheter ablation is an minimally-invasive procedure used to remove or terminate a faulty electrical pathway from sections of 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. If not controlled, arrhythmias increase the risk of ventricular fibrillation and sudden cardiac arrest. The procedure can be classified by energy source: radiofrequency ablation and cryoablation.
Catheter ablation may be recommended for a recurrent or persistent arrhythmia resulting in symptoms or other dysfunction. Typically, catheter ablation is used only when pharmacalogic treatment has been ineffective.
Catheter ablation of most arrhythmias has a high success rate. Success rates for WPW syndrome have been as high as 95% For SVT, single procedure success is 91% to 96% (95% CI) and multiple procedure success is 92% to 97% (95% CI). For atrial flutter, single procedure success is 88% to 95% (95% CI) and multiple procedure success is 95% to 99% (95% CI). 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 2.6-3.2%.
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 - at 28% for single procedures. Often, several procedures are needed to raise the success rate to the 70-80% range. One reason for this may be that once the heart has undergone atrial remodeling 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 people with AF with paroxysmal, or intermittent, AF therefore have an increased chance of success with an ablation since their heart has not undergone atrial remodeling yet.
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