Heart ablation is a procedure used to treat heart conditions that include a number of heart rhythm problems or in some cases enlargement of the heart known as hypertrophic cardiomyopathy. Heart ablation is in general a catheter-based procedure (such as TAVR for aortic stenosis or Mitraclip for mitral regurgitation) that means it is performed through small tubes usually inserted through the arteries or veins of the leg. These tubes are then passed up to the heart. In some cases however heart ablation can be performed as part of an open-heart surgery. The most common use of heart ablation is for rhythm disturbances known as SVT (supraventricular tachycardia from the upper chambers of the heart) a common cause of palpitations, or atrial fibrillation. The use of heart ablation has advanced over the years and is now commonly applied to heart rhythm problems from the lower part of the heart known as ventricular tachycardia. Another procedure known, as a heart ablation is alcohol septal ablation, a procedure used to treat enlarged heart tissue known as hypertrophic cardiomyopathy, a form of structural heart disease. In this article we will discuss the commonly performed heart ablation procedures.
What Happens in a Heart Ablation?
When used for heart rhythm problems such as palpitations, the goal of a heart ablation is to get rid of the tissue that is causing the problem. For example, lets say palpitations are being caused by a small focus of tissue in the upper chamber of the heart. A small tube known as a catheter is passed up to the heart and directed to the area where the palpitation are arising. Electrical energy is then passed through the tube to the end by a wire, essentially burning away the affected area. If successful, this will serve to stop the palpitations.
An alcohol septal ablation for a thick heart is different. In this condition the thick heart obstructs blood that is trying to leave the heart. A catheter is advanced into the coronary arteries that supply the heart with blood. The artery that supplies the thick area is located and alcohol delivered to that area to kill it off so it shrinks. If successful, this will allow blood to flow normally again.
Heart ablation for SVT
SVT is short for supraventricular tachycardia, a common cause of palpitations with a fast heart rate. An SVT can be thought of as a short circuit within the heart, usually near one of the pacemakers of the heart. An impulse can get enter the short circuit and essentially get trapped in there, basically firing off heartbeats in a fast and regular fashion. In a heart ablation for SVT, burning an area through the circuit preventing it from conducting the impulses disrupts the short circuit. Heart ablation for SVT is a successful procedure with a low risk of recurrence.
Heart Ablation for Atrial Fibrillation
Atrial fibrillation is a common heart rhythm problem and can lead to palpitations and associated symptoms, and increases the risk of stroke. In those patients with symptoms, especially in those who have not found anti-arrhythmic medications to be helpful, catheter heart ablation can be useful. The main triggers for atrial fibrillation are felt to arise from the veins known as the pulmonary veins that empty into the heart. Heart ablation is usually performed in those areas to prevent the triggers that start the atrial fibrillation. In carefully selected patients this can be a remarkably effective treatment. In some cases, heart ablation for atrial fibrillation is performed as part of a surgical open-heart procedure, usually when mitral valve surgery is also being performed.
Heart Ablation for Atrial Flutter
Atrial flutter is a form of heart rhythm problem where a short circuit in the top chamber of the heart often causes a rapid regular heart rate. Catheter ablation for most forms of flutter is remarkably successful, approaching 100%.
Heart Ablation for PVC’s
PVC’s are common and harmless in most people. Some people have remarkably high numbers of PVC’s and are also symptomatic from these. Heart ablation for PVC is increasingly being used as a successful treatment strategy. PVC’s arise from an irritable focus of tissue in the heart. If this area can be identified and is felt in a good location for heart ablation, then it can work to stop the PVC’s.
Heart Ablation for Ventricular Tachycardia (VT)
VT is a dangerous heart rhythm that can lead to sudden death if not treated. The treatment of VT depends on the underlying cause. There is increasing use of catheter ablation for VT, particularly in those who have not responded to medicines. In a VT ablation, the area of the heart where the dangerous rhythm is starting is identified and then energy applied to that area to prevent it from occurring.
Heart Ablation for Hypertrophic Cardiomyopathy
This is different from the other described heart ablations. In hypertrophic cardiomyopathy there is a thick area of tissue that obstructs the flow of blood out of the heart. In a procedure known as alcohol septal ablation, a small wire is passed into the artery that supplies the thick area of the heart with blood. A balloon is passed up to that artery and expanded to prevent blood flow beyond that point and alcohol injected through the balloon into that area, basically killing the thick area. This results in it shrinking over time and improving the blood flow out of the heart. It is now a widely used alternative to open heart surgery in many patients.