What is ablation of the heart in arrhythmia? How to prepare for an operation on cauterization, a description of the method of conducting, as well as rehabilitation in the postoperative period.
Often the violation of the boundary rates of the rhythm of the heartbeat is the initial symptom of arrhythmia. The impulse causing excess signals, provokes additional blows. The emergence of thrombi, ischemic diseases, heart failure, strokes – these diseases are the result of arrhythmia.
Characteristics of the procedure of ablation
In the treatment of an illness, two methods are usually used: medication or surgical intervention. Method ablation – surgery, in which the pathological areas are removed.
The procedure of radiofrequency ablation (RFA), which has received an alternative popular name – cauterization with cardiac arrhythmia, allows you to get rid of unnecessary pulses spent in the heart muscle forever.
It is not difficult to explain what ablation is as a method of surgical intervention, it is a direct influence on the focus of arrhythmia, which conducts an impulse. Perform the procedure with the help of special catheters emitting a high-frequency electric current. It neutralizes this focus by means of scarring or complete removal.
Indications and contraindications for the intervention
Drug treatment helps with arrhythmia in the initial stages. But not everyone can not run an easy form of ailment or later a heavier form is found. Such patients are prescribed ablation of the heart. The method also helps when the patient with arrhythmia can not be treated with medication. On the question: whether it is possible to do this procedure, only the cardiologist will answer. Below are common indications for ablation of the heart:
- Ventricular tachycardia or supraventricular;
- An increased rhythm accompanied by a pulse deficit;
- Left ventricular dysfunction (heart failure);
- Syndrome WPW – a syndrome of premature excitation of ventricles abnormally by carrying out impulses (possible occurrence of supraventricular tachyarrhythmias);
- Cardiomegaly – increased mass and size of the heart;
- Atrial fibrillation;
- a superfluous frequency of contractions, which provokes constant pain;
- If long-term therapy with arrhythmias with drugs does not have an effect.
Prior to the appointment of the procedure and the examination, the doctor decides which treatment method will be used to improve health. At this stage, the patient is examined for a list of contraindications for ablation of the heart. The list of them is as follows:
- Intolerance to anesthesia;
- Chronic heart failure;
- A recent heart attack or stroke of the myocardium;
- High fever, SARS;
- Kidney disease;
- Anemia is a disease of the blood;
- Endocarditis – inflammation of the inner membrane;
- Severe health condition;
- Poor state of health of the patient;
- Poor blood count;
- Malaise of the respiratory tract;
- Individual intolerance to iodine or other chemical elements involved in anesthesia.
Possible complications or even a ban on such manipulation of people with diabetes or having a degree of obesity. Elderly people (over 75 years) are a category of people who are extremely difficult to tolerate any surgical interventions.
RFA with atrial fibrillation is prescribed when the patient is not helped by medications. In the case of complications with atrial fibrillation, the success of cauterization is due to the fact that the process does not occur in the open area of the heart. As with classical ablation, the doctor uses a catheter to cauterize areas that cause chaotic contractions.
Despite all the positive or negative factors of the procedure, it must be borne in mind that every case when deciding whether to implement RFA is considered individually. According to the primary examinations (ECG, echocardiography, and others), the arrhythmic doctor resolves all the risks and the predicted effectiveness of catheter ablation.
Preparation for RFA procedure
In the process of preparing an operation for RFA, the patient should carefully listen to all the doctor’s recommendations, clearly follow the cardiologists’ instructions.
- For the beginning it is necessary to hand over analyzes (paramount urine, blood) and to pass or take place some inspections. For a successful result – to pass tests for stress resistance, tolerability of anesthesia.
Necessary to be tested for HIV, viral hepatitis, syphilis.
- It is important to diagnose which arrhythmia the patient has, its shape and stage.
- For anesthesia, additionally tested before the procedure, a combined anesthetic is preferred when topical preparations are combined with intravenous anesthesia.
A few days before the planned operation, the patient should be hospitalized. When the day of surgery is scheduled, the patient and the doctor should work together. The level of agreement at all stages right up to the operation itself plays a crucial role. Some general recommendations for the preparation of the RCA:
- Hygiene of the place from where the catheter will enter (groin or armpit);
- Fasting for 12 hours or more;
- Strict refusal of some medicinal preparations (it is agreed with the doctor 3-5 days before the procedure);
- The presence of a cardioverter-defibrillator or rhythm regulator implant in the patient will cause additional caution.
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The surgeon-cardiologist during the procedure creates an artificial AV-blockade of the heart, with the help of which it performs scarring or completely withdraws the tissue that provokes an extra impulse. The doctor, through a specially designed electrode, acutely affects the affected areas, which carry out a cardiac impulse. There is a so-called moxibustion on the heart from arrhythmia, which contributes to the further non-conductivity of excessive impulses.
To gain access to the artery during the intervention, the area of the vessel is sterilized, covered with an antiseptic patch. For this procedure use:
- Right or left femoral artery;
- Radial arteries.
Further, the doctor with the help of endocardial electrodes produces for the duration of the procedure the stimulation of the right ventricle, so that constant cardiac loading is present. The process of the operation to eliminate rhythm disturbances is performed under the radiographic control of the heart.
The next step is the detection of the origin of the impulse, which provokes abnormal contractions of the heart. If the patient easily tolerates the interference, the doctor can test the sites for the conductivity of the pulses. After detecting the potential of the affected area, the surgeon radio frequency affects the heart tissue, which heats up to a temperature of 40-60 degrees. A small scar forms on the tissue, which creates an AV blockade.
When the desired result is achieved, the rhythm is maintained by stimulation of the right ventricle. Further, after investigating the stability of the performed operation, the pacemaker is implanted.
Surgery lasts about 3-7 hours. Everything depends on the experience of the doctor and the presence of complications during the process. Many years of experience show that radiofrequency ablation has been successful in a significant number of cases.
Immediately after the operation, the patient is sent to the ward, where he must lie, not getting up, for a day. This is necessary so that there is no bleeding in the place where the entry to the artery was made. Doctors should monitor all cardiac outcomes and monitor blood pressure. Depending on the results, the patient is discharged for 3-5 days.
After the cessation of burning, pain in the chest area or pain in the place where the penetration into the artery was made. The patient does not need to worry if this condition lasts a few minutes. When such ailments accompany more than thirty minutes, do not pass after taking medication, you should immediately inform the doctor.
After discharge, there comes a rehabilitation period (2-5 months), when you still need to follow the medical recommendations:
- Taking medications prescribed by the treating cardiologist;
- Refrain from smoking, drinking alcohol;
- Use only healthy food, take a low-calorie diet, replace animal fats with vegetable;
- Less salt, spices;
- Exercise therapy and outdoor exercise.
Such an operation with arrhythmia very rarely requires an update of the procedure and has a slight coefficient of lethal cases – less than one percent.
Most of the surgical procedures performed guarantee the normalization of the heart muscle. However, a certain group of patients should continue conservative therapy to support cardiac pacemaking due to concomitant pathologies. This is due to the anatomical features of arrhythmia or diseases such as ischemic heart disease, arterial hypertension, atherosclerosis.
Pros and Cons of RFA
Advantages of therapy:
- Relatively short rehabilitation period: 2-5 days after the operation itself, 2-4 months at home;
- Slight invasiveness – the trace if left remains almost invisible on the inside of the thigh or on the armpit;
- A non-painful operation with local anesthesia is not felt by the patient during the intervention;
- Tolerability of surgery – this kind of manipulation is well tolerated even by those patients who are strictly prohibited from doing traditional surgical interventions;
- The usual rhythm of life after the procedure is returned for 5-7 days.
Disadvantages of therapy:
- Requires impeccable adherence to medication;
- Possible bleeding in the first day after surgery;
- Because of careless movement of the catheter, vascular damage is possible;
- Possible inflammatory processes – suppuration of the skin at the puncture site;
- Infectious endocarditis (inflammation of the internal cavity of the heart),
- Damage to healthy heart tissue during testing;
Cost of operation and comments
The procedure of radiofrequency ablation is from 2000 to 5000 USD in cardiological clinics in Eastern Europe and Israel. With cardiac arrhythmia, doctors recommend this manipulation, since it is relatively cheaper than traditional surgery. The price depends on the state of human health. The cost is called after diagnosis and testing.
The cost also includes the ability to perform surgery with a new catheter or used. Patients often prefer used, because they have already been tested, and new ones can bring unpleasant surprises. In addition, with repeated use of the catheter, intervention is much cheaper.
Since the operation itself is painless and more than 95% successful, the patients’ reviews are also positive. It is also necessary to take into account the fact that people who do not face complications do not want to flaunt their impressions.
Ablation of the heart is an excellent alternative to drug therapy for heart rhythm pathologies. There are cases when it is the only option for treating arrhythmia, if the use of drug therapy is no longer effective or if the rhythm disturbance is in principle unresponsive.
There are contraindications (in most cases personal) limiting the use of this catheter procedure. Today, the most famous and effective operation is radiofrequency ablation. It provokes cauterization of areas and prevents “extra” shocks, and the minimum number of complications attracts those who want to get rid of the disease. Therefore, it is rightly considered the best alternative surgical methods.