ECG signal

Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Treatments - Ablation / PVI

The role of ablation in the treatment of various abnormal heart rhythms has evolved over the last two decades and now has an established place in the management of various arrhythmias, such as atrial fibrillation, atrial flutter, Wolff-Parkinson-White syndrome, AVNRT, and, less commonly, ventricular tachycardia (VT). Ablation has the potential to offer a permanent cure and obviate the need for daily anti-arrhythmic drugs. Some rhythms, such as atrial flutter, can usually be treated very quickly and with excellent long-term outcome; others, such as atrial fibrillation, are more complex, may take several hours to ablate and may recur, requiring further treatment. Atrial fibrillation is the most common rhythm disturbance and requires not only daily medication to control the rate/rhythm but also blood thinners, such as aspirin or warfarin, to minimise the risk of clot formation and stroke. If ablation can “cure” atrial fibrillation, daily drug treatment would potentially be avoided. Some types of atrial fibrillation are more amenable to ablation than others and careful evaluation to determine the likelihood of a good and long term outcome should be weighed against the potential for procedural complications and the likelihood of recurrence. Recognition that the origin of atrial fibrillation is frequently at the point where the pulmonary veins enter the left atrium has directed ablation therapy to these areas; using various imaging techniques the pulmonary veins can be electrically isolated from the rest of the heart with exceptional precision, to prevent the generation and spread of the abnormal rhythm from these points; this is known as pulmonary vein isolation or PVI.

An ablation involves passing one or more fine tubes, catheters, from the blood vessels in the groin to the heart under local anaesthetic with sedation. Using X-ray and other imaging guidance, the electrical activity within the heart can be precisely located, following which a form of energy, usually radiofrequency, is delivered through the catheter to precise points within the heart to cauterise specific areas and so prevent generation and spread of the abnormal heart rhythm. There is a risk of complications, some minor and some serious, which need to be weighed against the perceived benefits from successful treatment. In straightforward cases only an overnight stay in hospital is required.

Related pages:

AF Association guide to catheter ablation

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