Ablation literally means to remove or eliminate. This relatively simple treatment option represents a cure for many patients who suffer from recurrent palpitations. One out of every 300 people in this country is born with an extra electrical connection in the heart. These abnormal connections cause electricity to short-circuit within the heart. Although people are born with these abnormalities, the rapid rhythms do not begin often until people reach the second, third, and even fourth decades of life.
Fortunately, ablation therapy, commonly called radiofrequency ablation (RFA), is one of the few treatments in medicine which results in a true cure. An electrophysiology study (EPS) is the diagnostic portion of this procedure and is performed using small, flexible wires which are placed in the heart through a large vein in the leg. This procedure differs from a cardiac catheterization by going through a low pressure vessel such as the femoral vein, and does not involve the injection of any dye or contrast, nor are any pictures or x-rays taken. The curative portion of this process (radiofrequency ablation) follows the diagnostic test, using the very same flexible wires. The entire process (EPS/RFA) takes approximately 30 to 45 minutes and is performed at the hospital. Patients are completely sedated during this process and are almost always discharged on the same afternoon as the procedure. Recovery from this procedure involves avoiding heavy lifting and vigorous physical activity for approximately 3 days. Most patients return to work on the day following the procedure.
Most ablation is performed for supraventricular tachycardia (SVT), but some forms of ventricular tachycardia as well as premature ventricular contractions (PVCs) can also be successfully eliminated with this procedure. The most common forms of SVT include atrio-ventricular nodal re-entrant tachycardia (AVNRT), orthodromic re-entrant tachycardia (ORT), and atrial flutter. These three rhythms account for the vast majority of rhythms which are ablated. The success rates for AVNRT and ORT are approximately 99%. Atrial flutter is cured 95% of the time after the first ablation. The complication rates for EPS/RFA are extremely low but include a one in 2000 chance of death. Minor complications include bleeding or bruising at the entry site for the catheters or around the heart, oversedation or an allergic reation from the medicines used for sedation, and a very rare chance of stroke. The one other complication from ablation comes only during RFA for AVNRT. Because this rhythm originates from a point very close to the heart’s normal conduction system, the possibility of damage to the normal conduction pathways is present. If this complication occurs, then a pacemaker must be implanted to restore some communication between the upper and lower chambers of the heart. The chances of this complication occurring, in well trained hands, is less than one in 500.