ABLATION INSTEAD OF LIFELONG MEDICATION?
WHAT IS RHYTHM CONTROL?
Rhythm control is a therapy strategy, where we aggressively try to keep a normal sinus rhythm to get the symptoms under control and avoid the development of a heart failure. This is initially done with lifestyle adjustments, medication and cardioversions and afterwards with ablations.
ABLATION INSTEAD OF LIFELONG MEDICATIONS?
Modern studies have shown that catheter ablation offers better long-term results than lifelong medication. Especially when patients don’t tolerate medications. They often suffer from the similar symptoms through the intake of those medications that try to prevent them from said symptoms. Medications and cardioversion can only help to a limited extent. With the progression of the disease a more aggressive approach becomes necessary.
WHAT IS A CATHETER-ABLATION?
The procedure is performed under local anaesthesia. With a catheter that is inserted through the groin into the heart a “3D mapping” is done (an electrical map) and a live electrical image can be obtained from within the heart. With this precise picture of the arrhythmia, the responsible tissue can be specifically targeted inside the heart, so that the cardiac arrhythmia is terminated. This arrhythmia most often occurs in the pulmonary veins. This is why the procedure is called pulmonary vein isolation (PVI).
Electroanatomical 3D Map showing the electrical signals from the left atrium (purple) and the ablation points (red) done by radiofrequency. The endpoint achieved is pulmonary vein isolation.
RADIOFREQUENCY OR CRYOTHERMIA?
The goal is to create a scar. This happens by denaturing the proteins in the cells. This can be achieved with heat or cold. The heat is achieved thanks to radio frequency electricity, which denatures the tissue, creating a scar. It is also possible to achieve the same effect through freezing. The scar leads to electrical isolation. A very old surgical principle, that is now newly performed with a catheter over the groin.
WHY WITH THE CATHETER?
The big advantage of this procedure, which is done under local anaesthesia with a twilight sleep (anesthesia if desired), is the possibility to measure the cardiac current pathways and to understand them better. Reaching the heart through a puncture in the groin is the great advantage of this method. But also, to deliver the therapy at the same time and then check the results. In certain cases, however, and in order to achieve a sustainable result, several interventions may be necessary.
WHO PROFITS THE MOST?
In paroxysmal atrial fibrillation, catheter ablation is the method of choice to suppress the annoying atrial fibrillation episodes by eliminating the triggers. These interventions are not very invasive, and patients can usually go home after a night in the clinic. It must be noted that in some situations repeated interventions are required to improve the symptoms and to control atrial fibrillation. The situation is different for non-paroxysmal atrial fibrillation, since it must be assumed that several interventions will be necessary depending on the patient. In this constellation, the collaboration with the cardiac surgeons is very interesting. A tailored approach for patients with atrial fibrillation is best for long term outcomes.
THE HEARTEAM AND THE PATIENT
The latest (2016) guidelines of the European Society of Cardiology recommend the cooperation of various specialists (cardiologist, electrophysiologist and cardiac surgeon) in the field of atrial fibrillation treatment in order to achieve an optimal result for the patient. This collaboration is called HeartTeam. Our HeartTeam accompanies you on this way.