Do you feel like you have run a marathon when you've simply walked up a flight of stairs? Or are you concerned because your heart skips a beat ... often? Do you suffer from chronic fatigue and exhaustion? These are all common symptoms of heart arrhythmias. Fortunately, there is a low-risk procedure that can rid your life of these symptoms. It's called catheter ablation, and there are two common methods used today: radiofrequency (RF) and cryoablation (cryo).
"Many people can take medication for their rapid or irregular heartbeats," says Charan Kantipudi, M.D., a cardiologist and electrophysiologist with Piedmont Heart Institute. "But many arrhythmia patients require medication that has a high risk of lifelong, unpleasant and sometimes life-threatening side effects. That's when catheter ablation may be a good option."
How catheter ablation works
Catheter ablation works by killing a very small amount of the abnormal heart muscle that is causing the heart to beat irregularly. During RF and cryoablation, an electrophysiologist (a heart doctor experienced in treating heart rhythm problems) threads a catheter, which is a long, flexible tube, through a vein in the crease of the leg up into the heart. The tip of the ablation catheter then delivers energy to the problem spot, ultimately disabling it.
“RF and cryo are both safe and effective options for treating arrhythmias,” Dr. Kantipudi says. “The biggest difference is one method uses radio frequency waves to burn tissue while the other uses cold-energy."
Benefits of catheter ablation
Catheter ablation has a more than 90% success rate, a low risk of complications, and minimal side effects, allowing the patient to resume normal activities in just a few days. It is done under mild sedation with local anesthesia, often allowing the patient to be discharged on the same day as the procedure.
Radiofrequency ablation
Radiofrequency ablation has been around for years. Radiofrequency energy, not unlike microwave heat, is transmitted to the target site, which causes that tiny area to die and stop conducting the extra impulses that cause rapid heartbeats. Once this procedure is done, there are no long-term effects on the heart muscle.
"RF ablation is popular because it has proven, effective, long-term results for patients with heart arrhythmias of many kinds," Dr. Kantipudi says.
Advantages:
- It has been around since the 1980s
- Wide selection of catheters with easy handling
- Takes only 60 seconds to make a lesion
Disadvantages:
- Inability to create an irreversible effect
- Limited effectiveness in areas of low blood flow
Cryoablation
Cryoablation is a newer option for treating heart arrhythmias. It delivers extremely cold temperatures (-60 °C to -80 °C) to the target area. With cryoablation, a physician is able to perform "site testing" or "cryomapping" which involves reversible freezing of the tissue before permanently disabling it. If the result is undesirable, the tissue can be rewarmed without permanent damage. The procedure times for this method are quite a bit longer.
Advantages:
- Ability to site-test
- The catheter adheres tightly to the intended target and doesn't move around like RF catheters
- Effective in areas of reduced blood flow
Disadvantages:
- Newer procedure with less conclusive studies
- Slightly higher rate of recurrence at six-month mark
- Takes four to eight minutes to make a lesion
Dr. Kantipudi believes the treatment chosen comes down to the anatomic location of the arrhythmia and a physician’s skill level and comfort with each procedure. "The specific site of the arrhythmia and the physician's experience with RF and cryo, weigh greatly into the type of treatment a patient should receive. It should be decided on an individual basis. There is never a textbook answer to surgery."
To find an electrophysiologist who specializes in arrhythmias and catheter ablation, visit Piedmont Heart Institute.
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