Realwomen.co.nz

Loads of good luck to you Delta. I'll be thinking of you and sending a prayer your way. I hope this "does the trick" for you, and you come home healthier and happy.

I had to look this one up. This is really interesting.

What is radio frequency catheter ablation? (RFCA)
Uses of radio frequency catheter ablation

Radio frequency catheter ablation is a medical treatment that uses electrical energy to destroy - or ablate - tissues in the heart that are causing rhythm disturbances. As well as being used to treat Wolff Parkinson White syndrome, the procedure might also used for treating supraventricular tachycardia (SVT - the condition Tony Blair was recently treated for); atrial flutter; atrioventricular nodal reentrant tachycardia (AVNRT); unifocal atrial tachycardia; atrial fibrillation; ventricular tachycardia (VT); symptomatic monomorphic VT; and AV junction ablation for poorly controlled ventricular rates (usually as a secondary choice if drugs do not work). In some cases the procedure might also be used on patients displaying symptomatic drug-refractory idiopathic sinus tachycardia, and junctional ectopic tachycardia.

The radio frequency catheter ablation procedure

The need for radio frequency catheter ablation is assessed on an individual basis, according to the type of lesion in the heart; the risk to the patient; the patient's age; and the kinds of symptoms the patient has displayed.

Just before the radio frequency catheter ablation procedure, patients usually stop taking medications used to try and control their condition (such as beta-blockers, calcium channel blockers, digoxin and antiarrhythmia drugs). This is because on the day of the procedure, the electrophysiology (EP) doctor often needs to trigger an episode of the electrical disturbance in order to determine what type it is and where it is coming from.

After discussing the procedure and giving informed consent, the patient is brought to the EP laboratory. Local anaesthetic (or in a few cases, general anaesthetic) is used before the catheters (long wires) are inserted in the groin and perhaps also the side of the neck, the elbow, or the area under the collarbone. 3 to 5 catheters are often used simultaneously, in order to trigger and map electrical disturbances in the heart.

Once catheters are in the veins or artery, x-ray is used as they are moved toward the heart and positioned in strategic locations. With the catheters in place, recordings of the heart’s electrical activity can be made from inside the heart. By deliberately triggering an electrical disturbance, and then analysing the recordings of this disturbance, it is possible to locate which tissues in the heart are responsible for the electrical disturbance. This process is called mapping. A special ablation catheter is then maneuvered so that an electrode at its tip is in contact with the abnormal tissue.

At this point, radio frequency energy is turned on and, if the special ablation catheter location is correct, the abnormal heart tissue is eliminated (ablated). The delivery of radio frequency energy causes the tissue in direct contact with the electrode at the tip of the special ablation catheter to be heated. Deeper tissues are also heated by conduction of heat from this region. The size of the area to be eliminated (ablated) is determined by the balance between conduction of heat through the tissue and convective heat loss to the blood pool. The temperature at the electrode must be approximately 50°C or higher to destroy the tissue.

After ablation of tissue, testing is performed to see if the problematic electrical disturbance can be triggered again by the catheters. If it is still present, the process of mapping continues to locate further abnormal tissue, which is in turn eliminated (ablated). This 'mapping and ablation' continues until the electrical disturbance can no longer be triggered by the catheters, whereupon the catheters are withdrawn from the body. The procedure usually takes 2 to 4 hours.



After the radio frequency catheter ablation procedure

Patients are observed for a few hours for symptoms, rhythm problems, and bleeding from the areas where tissue ablation took place. In many cases, at the end of this observation period they may be discharged. Others stay overnight in the hospital. Aspirin is often prescribed for 2 to 4 weeks to minimize risk of clot formation at ablation sites. Patients can perform light activity (e.g. walking, stairs) almost immediately in most cases, with resumption of full work or school activities within a few days. A follow-up visit to the doctor is often useful to check the ablation sites and review the procedure.



Possible complications of radio frequency catheter ablation

Radio frequency catheter ablation has an extremely high success rate of around 90-95% for SVT, WPW, atrial flutter and VT. Because the procedure uses x-ray, there is a certain amount of exposure to radiation. However, the x-ray part of radio frequency catheter ablation is often less than 60 minutes, and the radiation risk is considered to be low - almost as negligible as the radiation risk from x-ray procedures for broken bones. Complications occur in about 3% of ablation procedures, though this rarely results in the death of the patient.