Radiofrequency ablation
Radiofrequency ablation, or RFA, is a minimally invasive cardiac surgery performed under the supervision of an X-ray machine. The procedure is carried out to treat arrhythmias, tachycardia, extrasystoles and other disorders in the work of the heart. The therapeutic effect is achieved due to the point effect of high frequency current on the damaged areas of the heart. The source of the currents is the endovascular catheter. The result of this intervention is the blocking of pathological impulses that are sent by areas of the heart with impaired conduction, as well as the normalization of the sinus rhythm.
Radiofrequency ablation is a low-risk surgery. At the same time, the effectiveness of the procedure is quite high, some violations of the heart rhythm after the application of RFA can be eliminated by 100%.
The main goal pursued by cardiac surgeons is the point destruction of those parts of the heart that reproduce pathological impulses. Their ablation allows you to maximally neutralize these pathogenic arrhythmogenic foci of excitation, due to which recovery occurs.
Radiofrequency ablation is a treatment for life-threatening cardiac arrhythmias. Moreover, in some cases, ablation is more preferable before a full-fledged cardiac surgery and more effective than drug treatment. RFA is performed in cardiological hospitals equipped with the necessary equipment to monitor cardiac activity. Location - X-ray operating room.
Content:
- Indications for radiofrequency ablation
- Contraindications to radiofrequency ablation
- How is radiofrequency ablation performed?
- Benefits of radiofrequency ablation
- Complications of radiofrequency ablation
Indications for radiofrequency ablation
The indications for radiofrequency ablation should be determined by a cardiac arrhythmologist who is familiar with the patient's history. Of great importance is the frequency of attacks, the presence of episodes of loss of consciousness, ECG data, 24-hour ECG, echocardiography, transesophageal electrical stimulation.
All patients with heart defects and ischemic heart disease should undergo cardiac MRI, coronography and ventriculography before performing RFA.
Direct indications for radiofrequency ablation of the heart are:
- The presence of atrial fibrillation and atrial flutter in atrial rhythm disturbances.
- The presence of a risk of developing heart failure due to cardiac arrhythmia.
- Supraventricular arrhythmias. In this case, the success after RFA can reach 98%.
- Ventricular, supraventricular and atrial malignant extrasystoles.
- Atrial fibrillation, suggesting the subsequent installation of a pacemaker.
- Cardiomegaly.
- Wolff-Parkinson-White syndrome.
- High risk of sudden cardiac arrest.
- Lack of effect from drug correction, or long-term evasion of the patient from therapeutic treatment against the background of malignant arrhythmia of the heart.
- The impossibility of carrying out drug treatment of cardiac arrhythmias in a patient.
Sometimes cardiac ablation is performed not only for planned, but also for emergency indications.
Contraindications to radiofrequency ablation
Naturally, there are contraindications to radiofrequency ablation in which the procedure is strictly prohibited, among them:
- Oncological diseases in stages 3 and 4.
- Severe cardiopathologies are acute myocardial infarction, acute cardiomyopathy, unstable angina pectoris, circulatory failure, pulmonary hypertension, polymorphic arrhythmias of the ventricles of the heart.
- Aneurysms and vascular thrombosis.
- Acute infectious diseases.
- Endocarditis.
- Heart thrombosis.
- Allergy to a radiopaque substance.
- Iodine intolerance.
- Lower limb vein occlusion.
How is radiofrequency ablation performed?
For radiofrequency ablation, the patient is given a combined local or intravenous anesthesia. Surgical intervention is performed in the operating room, where resuscitation equipment must be available. Each stage of RFA is strictly controlled by X-ray equipment.
Electrodes are passed along the arteries to the pathological sites of excitation in the heart using a flexible conductor. The subclavian and femoral veins are involved in right heart ablation. If the operation is performed in the left chambers, the catheter is inserted into the femoral artery, or access is carried out by puncturing the interatrial septum (transseptal insertion method).
An arrhythmogenic area of the heart is determined using electrode sensors, which record a cardiogram both during complete rest of the patient and during special tests that cause arrhythmia.
After the pathological focus is detected, a radio frequency pulse is supplied to the heart. At the same time, the thinnest tip of the electrode heats up to high temperatures (up to 70 ° C) and cauterizes the arrhythmic area pointwise. As a result, he becomes unable to reproduce pathogenic impulses.
To monitor the effectiveness of the procedure, the patient undergoes a repeated electrocardiogram at rest and after performing tests that provoke arrhythmia. It is important that a stable heart rate is recorded, which is not disturbed by either drug exposure or electrical impulse tests. If successful, the probes are removed from the vessels, and the catheter insertion site is clamped with a pressure bandage.
The timing of radiofrequency ablation varies and depends on the complexity of the operation. The average duration of the procedure is from 90 minutes to 3 hours. Sometimes a pacemaker or defibrillator is placed in patients after ablation.
Rehabilitation period after radiofrequency ablation
Immediately after the operation, the person will experience some discomfort in the heart, which is characterized by a feeling of pressure in this area. As a rule, after 30 minutes, the discomfort disappears.
The long-term rehabilitation period after radiofrequency ablation involves the use of antiarrhythmic drugs. On the first day, bed rest should be observed, which will stabilize the patient's condition.
You will also need to adhere to the following recommendations:
- Refuse to drink alcohol;
- Limit salt intake;
- Observe adequate physical activity;
- Quit smoking.
Benefits of radiofrequency ablation
The advantages of radiofrequency ablation are obvious and include:
- Good tolerability of the procedure.
- Short rehabilitation period.
- No incisions on the body, no scars.
- No need for further drug treatment with antiarrhythmic drugs.
- High efficiency of the procedure.
- Repeated RFA is rarely required.
Complications of radiofrequency ablation
Complications of radiofrequency ablation are rare. Sometimes local hematomas are observed at the site of catheter insertion. Deep vein thrombosis, arterial perforation, pneumothorax are not excluded.
From the side of the heart, damage to its valves, thrombosis of the coronary arteries, microembolism is possible. The very exposure to high-frequency currents can lead to perforation of the tissues of the myocardium or sinus node, to spasm of the coronary arteries, to the development of cerebrovascular disease.
Once again, it should be clarified that these complications are quite rare and the expected benefit from the procedure most often prevails over them. The risks increase if the patient is over 75 years old, if he has diabetes or blood clotting disorders.
The author of the article: Molchanov Sergey Nikolaevich | Cardiologist
Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".
