Most often, radiofrequency ablation is performed with the following heart rhythm disturbances:
- Atrial fibrillation, it is also atrial fibrillation, and atrial flutter. These cardiac arrhythmias occupy the first place among all types of arrhythmias. The danger is a 1-fold increase in the risk of stroke. Such strokes are accompanied by greater mortality and severe disability of patients.
RFA with atrial fibrillation is carried out in the case of ineffective drug therapy and frequent heart failure.
Sometimes, to achieve a lasting clinical effect, several procedures may be required.
- AV nodal reciprocal tachycardia. Absolute indications for ablation are resistance to antiarrhythmic treatment or intolerance to medications.
- Supraventricular or supraventricular tachycardia is: sinus tachycardia, sinoatrial tachycardia according to the re-entry mechanism, atrial tachycardia. The heart rate for these types of arrhythmias is usually between 150 and above beats per minute.
- Ventricular tachycardia is the most dangerous type of arrhythmia, because it can transform into ventricular fibrillation, which leads to cardiac arrest. Catheter ablation is indicated in the case of idiopathic, in the absence of any organic heart disease, ventricular tachycardia from the exit tract of the left ventricle, fascicular tachycardia, and in some other situations.
- Wolf-Parkinson-White Syndrome or WPW Syndrome. With this disease in the heart, there are additional ways of conducting along which the wrong impulse propagates, leading to the occurrence of AV-nodal reciprocal tachycardia.
Radiofrequency ablation may be delayed or canceled if the patient has the following contraindications:
- allergy to iodine-containing drugs, since an iodine-based contrast agent is injected into the vessels;
- acute myocardial infarction or stroke, both hemorrhagic and ischemic;
- the presence of intracardiac thrombi;
- bleeding disorders – hypocoagulation or hypercoagulation, severe anemia;
- acute inflammatory diseases;
- chronic diseases in the stage of decompensation – severe cardiac, renal, respiratory failure;
- infectious endocarditis.
For several days, it may be necessary to cancel antiarrhythmics and anticoagulants, for example, Warfarin or Aspeckard.
The day before, the patient is examined by an anesthetist; breakfast is excluded on the day of the procedure.
The patient needs to shave the inguinal areas on both sides.
Radiofrequency ablation of the heart is performed in an X-ray room.
- The patient is placed on the operating table and connected to the monitoring station ECG indicators, blood pressure and oxygen saturation.
- A peripheral catheter is inserted to inject drugs into a vein.
- The doctor carries out all the manipulations under the control of x-ray radiation. The image is displayed on the monitor in the operating room.
- The cardiac surgeon is located to the right of the patient and treats the surgical field with an antiseptic solution.
- Then it performs local anesthesia with a solution of novocaine or lidocaine in the inguinal regions and performs a puncture – a puncture of the femoral vein.
- Further manipulations are carried out using tools of small diameter, not more than 5 mm. Catheters are delivered to the heart through the inferior vena cava.
- With the help of an iodine-based contrast agent, for example, Omnipack, Ultravist, Optirea, Tomohexol, the doctor finds the necessary heart zone.
It can be either the left or right atrium.
The focus of arrhythmia is diagnosed by conducting an electrophysiological catheter and building a card of cardiac impulses.
If the patient has no symptoms of arrhythmia, the operator provokes its occurrence by introducing special medications.
Or Isoproterenol, or by electrical action on the inner wall of the heart.
With atrial fibrillation, the focus is located around the mouth of the pulmonary veins. With atrial flutter or WPW syndrome – in different parts of any of the atria.
Radiofrequency ablation is performed by local high-temperature effects on the focus of rhythm disturbance. Which leads to the destruction and necrosis of the heart tissue.
So the propagation of pathological impulses along the myocardium is interrupted. When ablation can also be used laser, ultrasonic energy or cauterization at low temperatures – cryodestruction.
After RFA is completed, the operator waits 15-20 minutes and again tries to provoke an arrhythmia attack. If arrhythmia does not appear, the operation is recognized as completed and ends.
The time for ablation is strictly individual. As a rule, it depends on the type of arrhythmia and the individual characteristics of the patient.
With WPW syndrome, AV-nodal reciprocal tachycardia, the average duration of the procedure is about 1 hour. While atrial fibrillation may take up to 3-4 hours, and sometimes more.
Catheters are removed from the femoral vessels, occasionally the access site is sutured with 1-2 sutures to stop possible bleeding.
A sterile dressing is applied to the inguinal area and bandaged tightly. After this, the patient is transferred to the ward.
Indications for catheter ablation are determined by an arrhythmologist after consulting the patient and examining the result of the examination. The expediency of the method under consideration is observed in the following cases:
- The development of AV-nodal reciprocal tachycardia.
- The onset of WPW syndrome.
- The presence of atrial fibrillation (flutter).
- The appearance of ventricular tachycardia.
To perform the operation, the patient is sent to the operating room on an empty stomach, in a slightly sedated state. The areas of intended punctures are carefully treated and covered with sterile linen. Catheters are always inserted using transdermal techniques. As a rule, femoral veins, as well as arteries of the subclavian and jugular areas, are used for puncture.
Doctors puncture a vein with a needle. Next, the introducer sheath is inserted through the conductor, and then the catheter is inserted into the corresponding cardiac chamber. After that, it is connected to a junction box that transfers the electrical signal from the electrodes to the recording device, which stimulates the pulse from the ECS and makes it possible to reach the surface of different organ chambers. Then an EFI of the heart is performed.
Electrical signals that are received from the endocardial surface are filtered, and at the same time amplified and displayed on a computer monitor. Programmable ECS is endowed with the ability to programmable and continuous stimulation, adjust the amplitude and duration of the pulse.
When conducting radiofrequency catheter ablation of the heart, the patient may feel discomfort in the chest area, palpitations and slight soreness are not excluded. Sensations that appear against the background of an EFI, in the form of cardiac interruptions, a second stop, slowdown or acceleration of the rhythm, are the result of the doctor’s work, that is, with the help of an electrical impulse delivered directly to the organ, the doctor completely controls the heartbeat and triggers such attacks.
As part of the detection of arrhythmogenic regions (additional ventricular compounds), they are affected by radio frequency energy using a therapeutic electrode. After this, it is mandatory that approximately twenty minutes later, another EFI is performed to evaluate the effectiveness of the exposure. In the event that the electrophysiological indicator satisfies the doctor, the operation ends. Catheters are removed. A pressure bandage is applied to the puncture site.
The patient is transferred to the ward, and he is assigned to bed rest in the supine position for several hours (in some cases, it takes only knocks) to prevent bleeding from the puncture area. Observation within the hospital occurs from one day.
Immediately after catheter ablation is performed, atrial fibrillation removes catheters. In this case, the doctor presses on the injection site in order to prevent bleeding. A bandage may also be applied to the site of application of the catheter. At this time, it is extremely important to maintain immobility. After the procedure, it is mandatory to observe bed rest. On the next day after surgery, the patient can already be discharged from the clinic.
According to reviews, the ablation operation is very effective.
Heart rhythm disturbances are common heart diseases in which immediate surgical intervention is not always necessary, but which significantly reduce the patient’s quality of life. If untreated, arrhythmia can result in serious complications. A good alternative for this disease is treatment with radiofrequency ablation.
Radiofrequency ablation (RFA) is a method of treating arrhythmias, in which thin catheters-electrodes are inserted into the patient’s heart through large vessels under constant x-ray control.
A radio frequency signal arrives through them, which cauterizes a pathological focus that delivers abnormal impulses to the heart and causes arrhythmia.
Since the procedure is minimally invasive, that is, it does not require large tissue damage, there are practically no complications during its implementation.
RFA has proven to be an effective treatment for many heart rhythm disorders, which allows the patient to completely refuse to take antiarrhythmic drugs and lead a normal lifestyle.
The RFA procedure originates in the 80s of the last century, when it was first tested on animals, and then, after receiving good results, they began to do to people. At the moment, this is one of the most effective procedures in the treatment of arrhythmias.
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- Types of Ablation
- Heart RF: postoperative period
- Aortic surgery
- Types of heart ablation
- Relative contraindications
- How is surgery performed during arrhythmia?
- Preparing for the procedure
- Types of Ablation
- Risks associated with the procedure
- Complications after execution
- How the procedure is performed
- Reviews of patients and doctors
- RFA ablation method: indications for preparation, preparation and rehabilitation
- Types of Ablation
- Equipment for surgery
- Technique and effectiveness of RFA operation on the heart
- Expected Result
- Execution algorithm
- Types of Ablation
- Operation benefits
- Rehabilitation period
- Rehabilitation period
- Types of Ablation
- Lifestyle and prognosis after surgery
- Is the procedure effective?
- Reviews of patients and doctors
Types of Ablation
The destruction of the pathological focus, which causes malfunctions in the normal functioning of the heart, can be carried out with the help of several physical influences, therefore, the following types of ablation exist:
- Radio frequency.
However, radiofrequency ablation has gained the most popularity among them, since cauterization of a pathological site using high-frequency electric energy is a safe and painless treatment method. Sometimes this procedure is also called catheter ablation due to the fact that catheters are inserted into the heart to perform it.
Heart RF: postoperative period
Chernysheva Larisa edited by the doctor of the first category Z. Nelli Vladimirovna
Surgery in the event of heart disease often has as its goal not only an increase in the quality of life of the patient, but also its salvation. This applies, in particular, to such a procedure demanded in cardiac surgery as radiofrequency ablation of the heart.
The decision on the need for an operation based on diagnostic examination data is made by a cardiologist or cardiac surgeon. It determines the type of upcoming heart surgery and the scenario for subsequent postoperative recovery.
Along with drug therapy, some diseases of the cardiovascular system at some point may require direct surgical intervention, which is performed by opening the chest, directly exposing the heart and forcing it to stop (while the blood circulation in the patient’s body is maintained using a heart-lung machine lungs”).
Such cardiac arrest is performed, for example, with the aim of heart transplantation, valve replacement, elimination of congenital defects of the heart and blood vessels, bypass surgery, etc. After a successful operation, the heart “starts up” again – its normal activity is restored.
In case of atherosclerosis of the coronary arteries, aorto-coronary bypass grafting (CABG) may be prescribed to the patient. Thickening and narrowing of the arteries due to deposits of cholesterol, calcium, dead cells, etc. on their walls threatens the patient with a heart attack, stroke, etc., and not always “opening” the arteries by catheterization or implantation of a stent (dilator of the vessel) solves the medical problem that has arisen.
Today, there are several ways to bypass: traditional – with the opening of the sternum and forced cardiac arrest, and new ones performed on a beating heart – OPCAB and MIDCAB techniques. As a result of a shunt operation using a shunt system, the surgeon creates an additional path to bypass the affected area of the vessel.
Four heart valves (tricuspid, mitral, aortic and pulmonary) supporting the correct direction of blood flow, i.e.
from the left ventricle to the aorta, for various reasons (congenital heart disease, various infections or injuries, arthritis, tissue weakness, calcification, etc.) can wear out ahead of time over the years.
As a result, the work of the heart is disrupted, which leads to the need for surgery to correct or replace the valves in order to avoid heart failure and a possible fatal outcome.
Most often, this type of operation does not require chest opening.
Surgeons can gain access to the valves by thoracotomy — a midline section of the sternum, but surgical laparoscopy — an operation involving a small incision (0,5–1,5 cm) between the ribs on the chest — is becoming increasingly popular.
Thus gaining direct access to the heart, the surgeon, through the camera and special tools, corrects the valve or replaces it with another — biological or mechanical — valve, restoring normal blood flow.
Being the largest blood vessel in the human body (about 3 cm in diameter), the aorta is responsible for the delivery of blood to all organs. In the case of some of its pathologies (aneurysm, i.e., expansion, stratification, or rupture of the aorta) that threatens the patient with a fatal outcome, he may be prescribed an invasive operation to replace the affected area with a synthetic tube made from lavsan.
Such an operation involves opening the chest, connecting to the heart-lung device, resecting the damaged aortic region and replacing it with a lavsan implant.
Atrial fibrillation (AF) in medical terminology is called heart rhythm disturbance (atrial fibrillation).
It can be triggered by an increased number of electrical circuits in the atria, which lead to random contractions of the ventricles of the heart and to the failure of an effective reduction of the atria.
This, in turn, causes the formation of blood clots in the atria, which may ultimately lead to blockage of the brain vessels and death of the patient.
Among the main methods of treatment for atrial fibrillation today – drug therapy, catheterization, as well as the surgical labyrinth technique (Maze) – are quite complex and therefore not very popular among cardiac surgeons.
The “new word” in the treatment of atrial fibrillation was radiofrequency ablation of the heart (RFA) – a minimally invasive operation through small punctures performed using the latest computer technology and under constant x-ray control.
Types of heart ablation
Normal abnormal heart rate is restored during ablation by cauterizing a small area of the heart with the help of various physical factors and thus creating AV blocks: as a result of cauterization, this area blocks the conduction of the pulse, and the functioning of the heart muscle tissue adjacent to the scar obtained , not violated, tachycardia stops.
This technique began to be actively used in surgery in the 80s, and already in the 90s the method of radiofrequency ablation was first applied.
Modern cardiac surgery is “armed” with several types of ablation.
It is performed using combined anesthesia and represents the following sequence of actions: after performing local and intravenous anesthesia, a catheter is inserted through one of the vessels to the patient’s heart (therefore, this surgical procedure is also called “catheter ablation”).
Next, firstly, the installation of endocardial probe electrodes (they will perform constant pacing, as well as temporary stimulation of the right ventricle), and secondly, the installation of an ablation electrode in the anterior septal zone of the right atrium.
The next stage of the operation is the diagnosis of the activity of the His bundle by repeated permutation of the electrodes and the subsequent high-frequency exposure with the help of a high temperature of 40-60 ° C, in order to destroy the focus that generates pathological electrical impulses leading to tachycardia.
The resulting complete artificial AV blockade requires maintaining a heart rate by temporarily stimulating the right ventricle – using the above endocardial electrodes. If the effect obtained is characterized by stability, RF ablation ends with the implantation of a constant pacemaker – if there is such a need.
After ablation: chaotic impulses that provoke arrhythmia cannot enter the atrial cavity
All stages of the operation, lasting from 1,5 to 6 hours, are under constant monitoring of the necessary electrophysiological equipment and X-ray television.
Such destruction of the pathological focus can also be carried out by other physical influences, in accordance with which other types of ablation are distinguished:
- Laser ablation
- Ultrasound ablation
- Cryodestruction, i.e., ablation using low temperatures.
However, at the moment, the use of high-frequency electric energy to create an AV blockade in tachycardia is recognized as the safest and at the same time the most effective method. That is why catheter surgical ablation remains the most “popular” type of heart ablation.
Preparation for this operation is to conduct an electrophysiological study (EFI) of the heart. The need for RFA in a particular patient is ascertained by his attending physician on the basis of a medical history and data from such diagnostic methods as:
- Electrocardiography (ECG) is a popular method of electrophysiological instrumental diagnostics, based on the registration and study of electric fields that are formed during the work of the heart;
- Long-term ECG recording (Holter monitoring) is an electrophysiological diagnosis, the essence of which is the continuous recording of an electrocardiogram for at least 24 hours.
Immediately before the operation, the patient stops taking food and water for 8-12 hours. This also applies to many medicines.
Along with indications for RFA, ablation also has a list of contraindications:
- Severe general health of the patient.
- Acute infectious diseases.
- Severe diseases of the respiratory system and (or) the kidneys.
- Endocarditis is an inflammation of the inner lining of the heart.
- Unstable angina for 4 weeks.
- Acute myocardial infarction.
- Heart failure in a patient at the stage of decompensation.
- Severe arterial hypertension.
- Aneurysm of the left ventricle with a thrombus.
- The presence of blood clots in the cavities of the heart.
- Hypokalemia and other manifestations of electrolyte imbalance in the blood.
- Anemia, i.e., the pathology of the cellular composition of the blood.
- An allergic reaction caused by a radiopaque substance.
- Iodine intolerance and others.
Complications after RFR of the heart are extremely rare: the probability of negative consequences of ablation does not exceed 1%. Because RFA is classified as a low-risk operation. However, for the prevention of complications, there are a number of special measures taken at each stage of the detection and treatment of tachycardia.
Among the risks associated with RFA are the following likely complications:
- Bleeding in the area of catheter insertion.
- Violation of the integrity of blood vessels during the advancement of the catheter.
- Accidental violation of the integrity of the tissues of the heart muscle at the time of ablation.
- Malfunctions in the electrical system of the heart, exacerbating heart rhythm disturbances and requiring implantation of a pacemaker.
- The formation of blood clots and their spread through the blood vessels, threatening death.
- Stenosis of pulmonary veins, i.e. narrowing of their lumen.
- Kidney damage with dye used in RFA.
Patients are not recommended to perform radiofrequency catheter ablation in the following situations:
- The development of chronic renal failure.
- The appearance of allergic reactions to the contrast component and iodine intolerance.
- The presence of severe coagulopathy and severe anemia.
- The development of uncontrolled arterial hypertension.
- The appearance of fever and acute infectious diseases.
- The presence of endocarditis.
- The presence of a severe underlying non-cardiological disease.
- The development of decompensation of heart failure with pulmonary edema.
- The appearance of intoxication with glycosides and severe hypokalemia.
How is surgery performed during arrhythmia?
Most likely, the doctor will advise the patient to undergo such a procedure (sometimes it is also called radiofrequency catheter ablation) if other methods of therapy for arrhythmia do not give the desired and expected effect.
During this manipulation, an electrode is supplied to the heart tissues with a low voltage and high frequency, which can modify the area of the organ that is responsible for the occurrence of arrhythmia. In most patients who underwent catheter ablation of the heart, the following occurs:
- Long-term reduction in the incidence of arrhythmias and the severity of symptoms.
- The return of a healthy heart rate.
This means that after the successful completion of the intervention, you may not need to take medications that are used in the treatment of this disease, or the dosage of the drug can be reduced. True, any change in drug treatment is possible only after consulting a doctor.
Cardiac catheter ablation is considered a safe intervention, so the likelihood of complications is extremely low. The doctor will discuss with the patient all the possible risks. Catheter surgery always begins with an electrophysiological study.
Before the patient is taken to the department of X-ray surgery, he is examined by an anesthetist to determine possible contraindications to anesthesia. Anesthesia is combined, that is, sedatives are administered intravenously to the patient, and a local anesthetic is injected into the skin at the site of the catheter. The most common choice is the femoral artery or vein in the inguinal region.
Next, the introduction of a conductor (introducer) is carried out, through which a thin probe is carried out with a miniature sensor at the end. Each stage is controlled using the latest x-ray equipment until the probe is installed in one or another part of the heart, depending on where the arrhythmia comes from – in the atrium or in the ventricle.
The next step after accessing the heart “from the inside” is to establish the exact localization of an additional source of excitation of the heart muscle. “By eye,” such a place, of course, cannot be established, especially since the fibers are the smallest sections of muscle tissue. In this case, endoEFI, an endovascular (intravascular) electrophysiological study, comes to the aid of the doctor.
An EFI is carried out as follows – through the introducers, which are already installed in the lumen of the leading artery or vein, an electrode is inserted from special equipment, and the heart muscle is stimulated by physiological discharges of current. If this stimulated area of the heart tissue conducts impulses in the normal mode, then a significant increase in heart rate does not occur. This means that this section does not need to be cauterized.
Further, the electrode stimulates the following areas until the pathological pulsation from the heart muscle is obtained by ECG. Such a site is the desired one and requires ablation (destruction). It is in connection with the search for the desired tissue site, the duration of the operation can vary from one and a half to six hours.
After the procedure, the doctor expects 10-20 minutes, and if the normal heart rhythm continues to be recorded on the ECG, the catheter is removed and a pressure aseptic dressing is applied to the puncture site (puncture) of the skin.
After this, the patient must observe strict bed rest during the day, and after several days can be discharged from the hospital under observation in the future at the clinic at the place of residence.
Preparing for the procedure
Hospitalization in the hospital where the ablation will be carried out is carried out as planned. To do this, the patient should be examined as much as possible in the clinic at the place of residence by the attending arrhythmologist, and he also needs to get the advice of a cardiac surgeon.
The list of examinations before the operation includes:
- General blood and urine tests,
- Analysis of the blood coagulation system – INR, prothrombin time, prothrombin index, APTT, blood coagulation time (VSC),
- Ultrasound of the heart (echocardioscopy),
- ECG, and if necessary, monitoring of ECG according to Holter (assessment of heart rate by ECG per day),
- CPEPI – transesophageal electrophysiological examination – may be needed if the doctor needs to more accurately establish the localization of the source of pathological excitation, as well as if rhythm disturbances by ECG are not recorded, although the patient still has complaints of paroxysmal heart palpitations,
- Patients with myocardial ischemia may be shown to undergo coronary angiography (CAG) before surgery,
- Exclusion of foci of chronic infection – consultation of a dentist and ENT doctor, as well as a urologist for men and a gynecologist for women – as before any operation,
- A blood test for HIV, viral hepatitis and syphilis.
After the patient is scheduled for surgery, he must be hospitalized in a hospital two to three days before the appointed date. The day before the operation, you should refuse to take antiarrhythmic or other drugs that can affect the heart rhythm, but only by agreement with your doctor.
On the eve of surgery in the evening, the patient can afford a light dinner, but breakfast should not be in the morning.
It is important for the patient to maintain a positive attitude, because the success of the intervention and the postoperative period largely depends on the psychological situation around the patient.
Types of Ablation
For a successful radiofrequency ablation of the heart before the procedure, the patient must undergo a series of diagnostic studies:
- blood tests: clinical, biochemical, blood group and Rh factor, tests for hepatitis B and C, HIV, Wasserman reaction;
- ECG with 12 leads;
- daily Holter ECG;
- stress test;
- MRI of the heart.
After establishing the focus of the development of arrhythmia, a date for radiofrequency ablation can be assigned. Before the procedure, the patient receives detailed recommendations from the doctor about the correct preparation for the procedure:
- stop taking certain medications 2-3 days before the procedure (antiarrhythmic drugs, hypoglycemic drugs, etc.);
- the last meal and liquid before the procedure should take place the night before (at least 12 hours of hunger should pass before the procedure);
- before examination, remove hair from the area of access to the artery (in the groin or in the armpit);
- conduct a cleansing enema before the study.
Before performing the procedure of radiofrequency ablation, the patient must undergo a standard list of examinations:
- general clinical blood and urine tests;
- biochemical blood test, coagulogram;
- determination of blood group and Rh factor;
- markers of viral hepatitis, HIV;
- Wassermann reaction, i.e. analysis for syphilis);
- -hour ECG monitoring – Holter-ECG;
- echocardiography – ultrasound of the heart.
An arrhythmologist may order additional diagnostic tests.
Exercise test on a treadmill or bicycle ergometer, FGDS, coronary angiography, transesophageal echocardiography.
Risks associated with the procedure
Heart ablation carries several risks, including:
- Bleeding at the site where the catheter is inserted.
- Damage to blood vessels during catheter advancement.
- Accidental damage to heart tissue during ablation.
- A violation in the electrical system of the heart, which can worsen arrhythmia and require the installation of a pacemaker.
- The formation of blood clots (blood clots) that can spread through the blood vessels, causing heart attacks or strokes.
- Narrowing of the veins that carry blood between the lungs and the heart (pulmonary vein stenosis).
- Damage to the kidneys due to the dye that is injected during the procedure.
The risk of complications increases if the patient suffers from diabetes mellitus, bleeding disorders or kidney disease. The risk of heart ablation complications is considered very high in patients older than 75 years.
Complications after execution
Radiofrequency ablation belongs to the category of procedures with a low degree of risk: the probability of negative consequences does not exceed 1%. Complications are more often observed in patients suffering from coagulation disorders, diabetes mellitus and overcoming the 75-year-old age threshold.
Among the possible complications of radiofrequency ablation, there is a risk of development:
- bleeding at the site of the puncture of the artery;
- violation of the integrity of the vascular wall during the advancement of the conductor or catheter;
- blood clots and their transfer with blood flow;
- violation of the integrity of myocardial tissue during ablation;
- pulmonary vein stenosis;
- failure in the conduction system of the heart, aggravating arrhythmia and requiring implantation of a pacemaker;
- Bleeding from a punctured vessel – occurs most often in the first postoperative period, there are not many causes of bleeding:
- bleeding disorder,
- improperly applied postoperative pressure dressing,
- improper behavior of the patient after surgery, it is necessary to adhere to the recommendations of the surgeon.
- Impaired renal function – since the contrast is eliminated precisely through the kidneys and it is toxic enough, therefore, acute renal failure may occur against the background of the initial kidney disease;
- Thromboembolic complications – due to the need to cancel blood clotting drugs (warfarin) before surgery, blood clots can develop in the vessels that can come off and cause various thromboembolic complications;
- Heart rhythm disturbance – the development of new types of arrhythmias is possible, and there are a huge number of reasons for this;
- This is not all, but only the main possible complications of the procedure, you can find out in more detail from your surgeon;
- With the development of any complications, the rehabilitation period after rch is lengthened.
The frequency of adverse effects during radiofrequency ablation is low and does not exceed 2-3%.
They are divided into 4 groups of complications:
- Complications associated with puncture and catheterization of blood vessels:
- hematoma in the inguinal-femoral region
- femoral thrombosis
- false aneurysm
- perforation of a vein or artery wall
- caused by manipulations with a catheter in the heart:
- heart valve injury
- damage to the heart wall
- massive bleeding and tamponade
- due to the ablation itself:
- atrioventricular block
- myocardial injury
- acute cerebrovascular accident.
- associated with x-ray: burn, radiation sickness. Currently, they are almost never encountered due to the use of modern equipment, as well as the short time of radiation exposure.
The most common local complications from the puncture – hematomas, minor bleeding.
They do not require additional therapy and pass on their own. Potentially dangerous are persistent AV block and cardiac tamponade. In which there is a need for repeated emergency surgical intervention.
Their frequency barely reaches 1%, and mortality in RFA does not exceed 0,2%.
Like any intervention in the body, the postoperative period and long-term consequences are characterized by a number of complications. They are mainly caused by injuries of adjacent organs and tissues.
Let’s consider some of them:
- Thermal damage to the phrenic nerve, which is anatomically located close to the superior vena cava and the right superior pulmonary vein. It is asymptomatic, but some people may experience shortness of breath, coughing.
- Damage to the vagus nerve leads to a feeling of fullness of the stomach, bloating, possibly impaired gastrointestinal motility.
- Damage to the esophagus, the formation of fistulas is manifested by pain when swallowing, fever, inflammatory changes in the blood.
- Violations of the integrity of blood vessels (hematomas, arteriovenous fistulas, pseudo-aneurysms, bleeding).
- Pericardial effusion and cardiac tamponade are life-threatening conditions (potential risk of any operations).
- Hypervolemia of the pulmonary circulation. In patients with heart failure and low myocardial contractility, hypervolemia is manifested by signs of stagnation: shortness of breath, unproductive cough, heart palpitations.
- Pulmonary vein stenosis. The first signs appear after six months, which is misleading to the doctors. Shortness of breath, cough, hemoptysis, frequent pneumonia are noted.
- Thromboembolism due to the formation of intracardiac blood clots.
- Death. A fatal outcome is extremely rare, but it is possible with a severe somatic condition of the patient.
The ablation operation is less traumatic, therefore complications can appear in extremely rare cases (less than 1%). However, the following adverse conditions are recorded after surgery:
- Infectious and inflammatory – suppuration of the skin at the puncture site, infectious endocarditis (inflammation of the inner cavity of the heart),
- Thromboembolic complications – the formation of blood clots due to trauma to the vascular wall and their spread through the vessels of internal organs,
- Heart rhythm disturbances
- Perforation of arteries and heart walls with a catheter and probe.
Complications of this procedure can be divided into four groups:
- The appearance of problems due to radiation exposure (approximately 1 millisievert).
- The consequences that are associated with catheterization and vascular puncture (we are talking about damage to arteries, thrombophlebitis, arteriovenous fistula, pneumothorax).
- Complications during catheter manipulation (damage to the heart valves, development of embolism, perforation of the coronary sinuses or myocardial walls, as well as tamponade and infection at the puncture site).
- Complications after surgery are cardiac ablation, which are caused by radiofrequency (arterioventricular block).
This operation is classified as minimally invasive intervention. The advantages of the surgical intervention in question are quite obvious. First of all, this is minimal trauma along with the lack of the need to prescribe general anesthesia to the patient. Another plus is the short duration of the procedure in combination with a short postoperative bed day.
How the procedure is performed
The procedure of radiofrequency ablation of the heart is carried out after hospitalization of the patient. In specialized operating rooms, the following equipment must be present to perform this minimally invasive operation:
- heart catheterization instruments;
- catheter electrodes;
- system for radiography or fluoroscopy;
- devices for monitoring the vital functions of the body;
- a device for recording intracardiac and surface electrograms;
- equipment for resuscitation.
Before starting the procedure, the patient is sedated and local anesthetized in the puncture area. The following is directly radiofrequency ablation of the heart:
- For arterial access, the right or left femoral artery or radial arteries can be selected. The area of the puncture of the vessel is sterilized with an antiseptic solution and covered with sterile material.
- A special needle is inserted into the vessel with a conductor of the required length. Then, the doctor, under X-ray control, introduces a catheter electrode into the artery through the hemostatic sheath, which is delivered to the heart.
- After placing the endocardial catheter electrodes in the chambers of the heart, the doctor connects them to the equipment recording ECG signals, conducts an intracardiac electrocardiological examination and establishes an arrhythmogenic focus of the formation of a pathological impulse that provokes arrhythmia. If necessary, the patient can be tested to provoke arrhythmias.
- The implementation of ablation can be carried out in the AV node, the mouth of the pulmonary veins, or in another section of the conducting system. After exposure to the ablative electrode, the heart tissues are heated to 40-60 degrees, a microscar forms on them and an artificial AV block is created.
- During artificial AV blockade, previously introduced endocardial electrodes are used to maintain heart rate.
- To assess the effectiveness of the effect of the ablation electrode on the arrhythmogenic focus, a repeated electrocardiological study is performed.
In the absence of the desired effect at this stage of the operation, if necessary, radiofrequency ablation can be combined with implantation of a pacemaker, and with a satisfactory result, the operation is completed and catheters and electrodes are removed.
The duration of radiofrequency ablation of the heart can be from 1,5 to 6 hours (depending on the depth of the arrhythmogenic focus in the thickness of the myocardium and its location). The patient is discharged 2-5 days after the procedure.
Reviews of patients and doctors
Cardiac RFA procedure, according to cardiologists, was a real breakthrough in the treatment of severe arrhythmias. Previously, this required complex surgery on an open organ, which had a significant percentage of risks and complications. The patient recovered for a long time, could not lead a normal lifestyle. If untreated, arrhythmias often became a cause of disability.
Sergey, doctor, work experience 35 years.
When I started my practical activity, heart rhythm disturbances were only fought with medication. Typically, the condition of patients worsened over time, seizures became prolonged, persistent, surgical intervention was required.
But not everyone decided on such treatment; the state of health could not allow it. So people had to sit on their tablets all their lives and endure problems to death. The advent of the RFA procedure methodology made it possible to help a very large number of patients without injuring the body, without incisions and complicated rehabilitation.
Mikhail, cardiologist, work experience 10 years
I know from colleagues with great experience that not so long ago arrhythmias were treated in severe cases only by surgical intervention in an open heart. Patients recovered for a long time, could not return to a normal lifestyle for a long time. Well, that created such a method. I have already had a number of patients go through such a procedure. Everyone endured it easily, very satisfied, no one had a relapse.
Radiofrequency catheter ablation is performed as planned. It is carried out in an x-ray room. General principles of preparation include:
- The last meal should occur on the evening before the procedure (you must endure twelve hours of hunger).
- In the area of catheter placement, the subclavian and inguinal region must be shaved.
- On the night before the study, bowel cleansing is performed.
- You must ask your doctor if you need to take standard medicines in the morning.
- Any antiarrhythmic drugs are canceled three days before the study.
- In the event that a person has diabetes, then you need to ask your doctor if you should take insulin or other sugar-lowering oral medications before the test.
RFA ablation method: indications for preparation, preparation and rehabilitation
Types of Ablation
Radiofrequency ablation of the heart is an intervention that is performed to eliminate arrhythmia. To normalize the rhythm of the heart, its portion provoking arrhythmia is cauterized, which creates an AV block. The area of the heart on which cauterization was performed blocks the passage of the pulse.
This is a procedure, the essence of which is the registration of biological potentials from the inner surface of the heart. For its implementation, catheter electrodes connected to the recorder are used. Also, a heart test before surgery includes:
- electrocardiography, including daily monitoring;
- laboratory blood tests;
- magnetic resonance imaging of the heart.
At least 8 hours before RFA, the patient should not take food or medicine. Radiofrequency ablation is performed with the introduction of combined anesthesia: first, the patient is given anesthetic locally, and then intravenously. After that, they begin to conduct RFA:
- A special catheter is passed through the vessel to the heart. It allows you to remove the necessary information about the state of the heart and provide monitoring of the procedure.
- Electrode probes are installed for the patient, which provide continuous pacing and left ventricular stimulation. In the anteroseptal region of the right atrium, an ablation electrode is installed.
- At this stage, the RFA examines the functioning of the His bundle: for this, multiple permutation of the electrodes and a high-frequency effect on the source of arrhythmia are performed. Exposure is carried out at a temperature of about 60 degrees.
- After creating an AV block, temporary electrical stimulation is necessary. If the normal rhythm is stable, cardiac ablation ends, however, if necessary, a pacemaker may be implanted into the patient.
RFA with atrial fibrillation lasts up to 6 hours. In addition to radio frequency, there are other types of ablation:
However, ablation of the heart with the creation of AV blockade, judging by the reviews of patients, is considered the safest way to treat atrial fibrillation.
The term “ablation” comes from the Latin ablatio and refers to the process of evaporation of a substance from the surface of a solid under the influence of radiation and the flowing stream of hot gas.
Cardiac catheter ablation involves the use of alternating current radio frequency energy ranging in power from 300 to 750 kHz. Under its influence, the destruction of certain parts of the heart occurs. The resource for it is a standard electric generator that produces an unmodulated bipolar current of a set frequency.
Energy acts between the active end of the catheter supplied to the desired point of the myocardium and the external adhesive electrode located on the left side of the chest or lower back. The destruction of tissue occurs by cauterization. Thus, the necrotic area loses the ability to generate impulses.
Equipment for surgery
Such an operation as radiofrequency ablation of the heart is carried out in a special equipped operating room, which is equipped with:
- X-ray television system for radiography and fluoroscopy.
- Equipment will be needed to track the vital functions of the body and implement resuscitation measures (usually a defibrillator is used along with a breathing apparatus and monitors).
- Specialized EFI equipment for recording electrocardiograms.
- The presence of pacemakers and tool kits for catheterization.
- Protective equipment for the patient and staff (we are talking about suits, aprons, glasses, movable walls and so on).
Technique and effectiveness of RFA operation on the heart
Ablation is performed by minimally invasive method with special catheters. They are introduced into the artery of the femur and along it reach the desired site inside the organ. The essence of the procedure is the destruction of the focus, causing a pathological rhythm of the heart. In addition to radio frequency waves, laser and ultrasound can be used.
Local anesthesia is used, control is carried out by a special x-ray unit. The resulting section of necrosis does not affect the function of the organ, the contractions are performed in full. But the patient gets rid of attacks of arrhythmia forever.
Radiofrequency ablation is a surgical procedure for the heart. It carries a certain risk, has its own indications and recommendations when the procedure should not be carried out. Manipulation is prescribed in the following conditions:
- lack of a positive reaction to medications;
- persistent atrial fibrillation;
- paroxysmal tachycardia;
- hypertrophic cardiomyopathy;
- persistent extrasystole.
The doctor recommends the use of this method after a detailed examination. It takes into account the disease, the condition of the body and the previously used methods of therapy. Typically, RFA is prescribed in cases where other algorithms have been tried and a positive result is not achieved. If necessary, this procedure can be carried out simultaneously with the installation of the mitral valve prosthesis.
There are a number of conditions that are a contraindication for ablation. Performing the technique with them carries a risk to the life of the patient. The operation is not performed in the following cases:
- acute respiratory failure;
- high numbers of blood pressure;
- aortic aneurysm;
- acute myocardial infarction;
- pathology of the coagulation system;
- disturbances in salt balance;
- large decompensation in heart failure;
- reaction to iodine and X-ray contrast;
- pathology of the kidneys.
Some of these disorders can be eliminated, and after appropriate treatment, manipulation will be carried out. Other symptoms are absolute contraindications.
Attention! You can not perform ablation with a high degree of stenosis of the left coronary artery, aortic valve. There are moments that prevent the insertion of a catheter into the femoral vessel: thrombophlebitis, infectious lesions of the lower limb, lack of legs.
If the RFA procedure of the heart is performed according to indications and at an excellent level, the patient follows all the recommendations, the result is visible from the first days. The most good review for Wolf-Parkinson-White syndrome (ERW) in young people, ventricular paroxysmal tachycardia.
Manifestations of atrial fibrillation permanently disappear in 80% of patients, in the rest it goes into prolonged remission or the intensity decreases significantly. This operation is performed with minimal risk, mortality is less than 0,7%.
RFA operation is carried out as planned. The day before, only light food should be consumed, 12 hours before the procedure it is already impossible to eat. In the evening they put a cleansing enema.
Hair is shaved in the groin and clavicle. Be sure to consult with your doctor and anesthetist about the use of medicines the day before the intervention and immediately before the manipulation.
The procedure for eliminating arrhythmias lasts about two hours. The operating period begins with the setting of venflon, which allows you to enter the necessary medications directly into the bloodstream. A patient can be prescribed sedatives to reduce anxiety. Then local anesthesia is performed. The femoral artery is punctured for insertion of electrodes.
Sensors of an EFI-system designed to record external and internal electrocardiograms are connected. Data is transmitted to a computer, which helps management. A contrast agent is applied to identify areas that cause abnormal contractions. Heating of the focus, giving a bunch of false pulses, to 60 degrees, which causes necrosis.
After performing the procedure of catheter ablation of the heart, the patient is sent to the ward, where the work of the organ is monitored, pressure is measured. A person remains in the department for 1-2 days. The intervention is less traumatic, after it there is no strong pain, requiring the use of special drugs. There are no seams that need to be processed for a long time. There is no subsequent cosmetic defect in the form of a scar.
Advice! If there are no complications, the patient returns to his usual life a few days after the manipulation. But you should follow all the doctor’s recommendations for good health and performance.
It is necessary to continue to lead a correct lifestyle, abandon bad habits, and reduce salt intake. Moderate exercise should be the norm. Rehabilitation after RFA of the heart is easy, relapses are extremely rare.
There is a risk of complications arising from the procedure. Their frequency is minimal, usually the manipulation proceeds safely. In rare cases, one or more of the following consequences may occur:
- damage to heart tissue;
- complication of kidney function due to exposure to contrast;
- violation of the integrity of blood vessels.
Most often, such conditions occur in elderly patients whose history is burdened by serious concomitant diseases. Less than 1% of people experience worsening arrhythmias. All these conditions are successfully stopped by qualified doctors. If the patient follows all the recommendations, the recovery process takes place without unpleasant consequences.
Radiofrequency ablation of the heart provides for mandatory electrophysiological examination (EFI). It is done in the conditions of an operating specialized center or equipped cardiac dispensary. Intervention does not require anesthesia, since the procedure is minimally invasive and does not foresee incisions or severe pain.
The patient is sedated, the necessary parts of the body are treated. Then, a femoral, subclavian or jugular vein is punctured through the skin. Sometimes use the femoral or radial artery. A guide and catheter of such length is inserted to reach the necessary chamber of the heart. After the electrode hits the right place and connects to a special device, electrical discharges are supplied that stimulate intracardiac signals.
The computer evaluates and displays the response of the heart to the stimulus. Thus, the doctor recognizes foci of ectopic excitement (those areas of the myocardium that trigger arrhythmia or tachycardia). During an EFI, the patient feels an unpleasant tingling sensation, palpitations, fading, or somersaults. However, do not worry, because this is the answer to stimulation.
When the problem center is found, the actual radiofrequency ablation is done. The affected area is affected by the flow of high-frequency energy. Then, an EFI is repeated to evaluate the effectiveness of the treatment. If the result is positive, the operation is completed, the patient is transferred to the ward for further observation.
How the operation goes, see the video below.
Reviews about cauterization of the heart during arrhythmias are mostly positive for both cardiologists and patients, which confirms the effectiveness of the method. However, remember: RFA is suitable only for certain pathologies of rhythm disturbance, and this is the key to the success of its conduct. Most procedures end with a positive result and significantly increase the duration and quality of life of the patient.
Previously, the patient is hospitalized. The procedure is carried out in an X-ray room, in which the following devices and tools should be available:
- catheter electrodes;
- devices and instruments for cardiac catheterization;
- devices for monitoring body functions;
- systems for radiography;
- a device for recording electrograms (superficial, intracardiac);
- all the necessary tools and preparations for resuscitation.
Typically, the intervention is performed under local anesthesia with additional sedation (for example, using Relanium). Treatment lasts 1-6 hours (as a rule, no more than 4 hours), which will depend on the number of pathological foci and their location. The sequence of actions of a doctor and three assistants during RFA is as follows:
- The surgeon selects for access an artery on the thigh (right or left), or one of the radial arteries (less commonly, the subclavian artery).
- The skin in the vein is treated with an antiseptic and anesthetic, covered with a special sterile material.
- The artery is punctured – a special needle is inserted into it with a conductor of the desired length.
- Using the obtained puncture, an electrode-catheter is introduced into the vessel through a hemostatic introducer sheath.
- The electrode is introduced to the cavity of the heart, performing all the manipulations under x-ray control.
- When the electrode is already in the heart, an organ examination is performed – EFI (intracardiac cardiogram) – to identify arrhythmogenic zones. For this, the doctor provokes tachycardia, because only in this way the pathological site will be found (usually it is located in the mouth of the pulmonary veins, AV node).
- The arrhythmia focus is affected by an ablation electrode, heating the tissues to 40-60 degrees and, thus, creating an artificial atrioventricular block. To maintain the rhythm during this period, the work of the introduced electrodes is necessary.
- After 20 minutes, an EFI is done again to evaluate the effectiveness of the procedure. If necessary, all manipulations are repeated again, or, in the absence of a positive result, an artificial pacemaker is implanted.
- Catheters, electrodes are removed, a pressure bandage is applied to the puncture area.
- After the operation, the patient should not bend his legs if the femoral vessel was punctured during the day (sometimes 12 hours), and also not get out of bed (strict bed rest) at the same time.
Atrial fibrillation is one of the most frequent arrhythmias in people of middle and old age. At the same time, the upper chambers of the organ contract uncoordinated and chaotically with a frequency of approximately four hundred times per minute. Such a rhythm can have an adverse effect on the ventricles and as a result leads to the formation of insufficiency.
In most examples, patients may complain of a strong heartbeat along with dizziness, shortness of breath, or fatigue. In some people, atrial fibrillation is completely asymptomatic. Rhythm restoration can be achieved with the help of tablets or by intravenous administration of the drug or electric shock (we are talking about electro-pulse therapy).
Types of Ablation
This modern method of treating arrhythmias has many advantages compared to open interventions on the heart:
- Low invasiveness – during radiofrequency ablation, wide cavity sections and accesses are not used. The introduction of special equipment is carried out using a thin catheter through a puncture in the thigh.
- Much easier tolerance of the procedure by the patient – if during the open surgical intervention the integrity of the body is significantly violated, the circulatory system and the patient spend several weeks in the hospital, then with radiofrequency ablation the patient is in the hospital for only a few days.
- Cosmetic effect – during abdominal surgery, median laparotomy is used as an access to the heart, in which the incision is made in the middle of the front surface of the chest.
Naturally, a large scar remains after the operation, but during ablation, the incision is not performed. After a few millimeters of puncture in the thigh area after a few weeks there is no trace left.
Lack of pain – undoubtedly, during a traumatic open operation, the patient in the postoperative period feels severe pain, requiring the use of strong painkillers.
With radiofrequency ablation, the patient can feel only a slight feeling of pressure in the chest, which disappears after a few hours. Painkillers are not prescribed.
Radiofrequency ablation of the heart is a modern and radical way to treat arrhythmias.
At the end of the procedure, the patient is prescribed compliance with bed rest for 12-24 hours. It is necessary to increase the amount of fluid drunk to 1,5–2 liters of water per day of surgery, in order to quickly remove contrast.
Pain is not characteristic. The patient is discharged the next day or a maximum of a few days.
At the rehabilitation stage, depending on the pathology of the heart rhythm, anticoagulants and antiarrhythmic drugs may be required for 2–4 weeks.
After 1 month, a control daily Holter-ECG is performed to confirm the persistence of the achieved effect.
At home, it is necessary to limit activity over the next few days and avoid physical stress. Most people tend to return to their standard lifestyle within three days.
A small hematoma along with a walnut-sized swelling in the area of catheter insertion is considered common. In the event that a person feels that this area has become hot to the touch, and at the same time swollen and painful, or if the patient has a fever with malaise or any other suspicious symptom, you should immediately contact a doctor. It is required to strictly follow the doctor’s recommendations regarding therapy and appointing a date for a second visit.
Immediately after surgery, the operated person may experience some discomfort associated with a sensation of pressure at the site of the surgical incision. However, this condition rarely lasts more than 25-30 minutes. If this sensation persists or worsens, the patient must inform the doctor about this.
Bed rest with control of the heart rhythm and blood pressure is shown to the patient only in the very first days after the operation, during which there is a quick recovery and stabilization of the patient’s normal general health. The need for repeated RFA, as practice shows, is extremely rare in operated patients, especially if the patient reconsiders his usual lifestyle:
- Limit the consumption of drinks with alcohol and caffeine;
- Reduce the amount of salt in your diet;
- Will adhere to an appropriate diet;
- Choose the optimal mode of physical activity;
- Quit smoking and give up other bad habits.
Thus, we can confidently talk about the following undoubted advantages of radiofrequency ablation of the heart in comparison with traditional invasive heart operations:
- Low invasiveness, eliminating the need for significant incisions.
- Easy tolerance of the operation by the patient, the integrity of the body and the work of the circulatory system of which are not significantly violated.
- Reducing the period of postoperative rehabilitation – up to 2-7 days.
- The cosmetic effect is the absence of any significant scars after puncture of the skin for the introduction of catheters.
- Painless recovery in the postoperative period, which eliminates the need for painkillers.
If after RFA you follow all the necessary rules and recommendations of a doctor, then the restoration of the heart and the whole body will take place as soon as possible. To prevent bleeding from the puncture site among the consequences of the intervention, you should not get out of bed in the early postoperative period under any pretext.
A person is prescribed, as a rule, 2-5 days after radiofrequency ablation, and all this time he is under vigilant medical supervision. While in the hospital, regular heartbeat monitoring is performed, for which an ECG is done every 6 hours on the first day, pressure, body temperature, urine output are measured, heart ultrasound is performed 1-2 times.
Rehabilitation after RFA lasts 2-3 months. At this time, the patient will need antiarrhythmic drugs, as well as indirect anticoagulants and other drugs as indicated. During rehabilitation, it is also possible to conduct therapy for concomitant diseases and somatic pathologies.
There are tips, the implementation of which will allow the patient to quickly restore his health:
- exclude alcohol, smoking from your life;
- refuse to consume large amounts of salt;
- try to reduce weight by normalizing the diet, reducing fatty and animal foods in the diet;
- Do not drink coffee and strong tea;
- reduce physical activity, but a special exercise therapy is mandatory.
If the treatment was carried out by a qualified doctor, and all postoperative recommendations were followed, then the likelihood of complications and relapses of the pathology is rather low.
Surgical intervention in this case is an extreme method when the use of conservative methods does not give positive results.
The operation should be performed after a thorough medical examination and entails a sufficiently long rehabilitation period.
Cardiac speech or radiofrequency ablation is a surgical procedure related to minimally invasive methods of treatment, which involve access to the heart not through an open incision, but by introducing endoscopic instruments through one or more punctures in the skin and tissues of the human body.
The advantages of this method can be called less invasiveness, which greatly reduces the recovery period.
It should be borne in mind that the duration of this procedure increases due to the lack of open access, which entails the need for a longer use of general anesthesia.
Radiofrequency ablation of the heart is carried out in cases when a person has such diseases of this organ as:
- atrial fibrillation;
- ventricular or supraventricular tachycardia;
- heart failure;
- WPW syndrome.
The inability to perform this surgical intervention even in the presence of these diseases may occur in the case of:
- the course of acute infectious processes;
- blood vessel thrombosis;
- acute myocardial infarction;
- decompensated heart failure;
- angina pectoris;
- violations of water and electrolyte balance;
- allergies to radiopaque substance;
- hypertension of 3 degrees;
- heart aneurysms;
- iron deficiency anemia;
- general serious condition of the patient.
After conducting RFA of the heart, the postoperative period begins from the moment when a person leaves the operating room into the ward. Being in intensive care after this surgery is not required.
You can monitor the patient’s condition in a regular inpatient ward. It consists in undergoing an electrocardiographic examination, first 6 hours after the operation, then after 12 hours and the last after 24 hours.
In addition, during the first days after surgery, the patient is measured body temperature and pressure.
For half an hour after the operation, a person may feel slight tingling in the chest area, as well as slight pain at the puncture site.
These sensations are quite normal and pass quickly without the use of special painkillers.
If the pain does not stop over time, does not subside, but rather becomes more intense, then this is an occasion to immediately contact your doctor.
An irregular heartbeat is also a normal occurrence after an RFA during the first few days. This condition should pass soon. If this does not happen, then contacting your doctor about this matter is also mandatory.
The first day the patient is prescribed bed rest. He is allowed to get up and move independently in extreme cases, since, despite the fact that during RFA, the tissues were not cut, and small punctures were made in them, even they can begin to bleed.
After the patient undergoes all the necessary planned ECG and taking readings of body temperature and pressure during the first days after the operation, he can be prescribed. Further rehabilitation after RFA surgery on the heart will take place at home, subject to planned visits to the attending physician.
Within three or four days, the patient is not recommended to perform actions related to the need for concentration. Therefore, you should not drive or go somewhere unaccompanied. It is best when a relative or a hired medical worker is with the patient during this time.
Rehabilitation after cardiac speech continues for two to three months. In this case, the use of antiarrhythmic drugs such as propafenone or propanorm is prescribed as a medical treatment. Other rules of the rehabilitation period include:
- compliance with the normal regime of physical activity;
- proper nutrition;
- rejection of bad habits.
Smoking and drinking alcohol always has only a negative effect on the human body. After conducting RFA of the heart, the organ itself and the body as a whole are in a weak state, and it is impossible to “finish” it with smoking and alcohol.
Otherwise, the patient’s lifestyle will not be limited to anything. In this case, he himself must pay attention to all his sensations, and if any complaints arise, immediately visit a doctor.
Types of Ablation
Lifestyle and prognosis after surgery
The lifestyle after surgery must comply with the following principles:
- Balanced diet. Due to the fact that the main cause of cardiac arrhythmias is coronary heart disease, one should strive for preventive measures that reduce the level of “bad” cholesterol in blood plasma and prevent its deposition on the walls of blood vessels that feed the heart muscle. The most important of these events is to reduce the consumption of animal fats, fast food products, fried and salty foods. The use of cereals, legumes, vegetable oils, low-fat varieties of meat and poultry, dairy products is welcome.
- Adequate physical activity. Exercising in light gymnastics, walking and jogging is good for heart and vascular health, but should be started a few weeks after surgery and only with the permission of the attending physician.
- Rejection of bad habits . Scientists have long proved that smoking and alcohol not only damage the vascular wall and heart from the inside, but can also have a direct arrhythmogenic effect, that is, provoke paroxysmal tachyarrhythmias. Therefore, smoking cessation and refusal of strong alcohol in large quantities is the prevention of rhythm disturbances.
In conclusion, it should be noted that despite the fact that RFA is a surgical intervention in the body, the risk of complications is relatively small, but the benefits of the operation are undeniable – most patients, judging by the reviews, cease to experience unpleasant symptoms and are less at risk of vascular accidents associated with paroxysms of tachyarrhythmias.
After ablation of the affected foci or ostium of the pulmonary veins, it is recommended to adhere to the following principles:
- A balanced diet with the exception of trans fats, reducing the intake of saturated fatty acids. Most of the diet is fruits and vegetables, not meat products. Limit salt to a teaspoon per day.
- Reasonable alcohol. A complete rejection of alcoholic beverages is not necessary, 20 g of alcohol per day for men and 10 g for women are considered acceptable.
- To give up smoking. Nicotine constricts blood vessels, which causes an increase in pressure, oxygen starvation of the myocardium and ischemia.
- Caffeine acts like cigarette smoke.
- Regular physical activity. Running, swimming, walking, cycling positively affects the cardiovascular system. It is preferable to do a bias on cardio training, rather than power loads.
- Control of blood pressure and related diseases.
If you observe a healthy lifestyle, a complete recovery of the body occurs, the risk of repeated breakdowns of the rhythm decreases, the prognosis for a speedy recovery and active longevity improves.
The target of ablation are those areas of the heart tissue that generate electrical pathological impulses that cause the development of atrial fibrillation. Through neutralization and blocking of these areas, the activity of the organ is controlled, and it returns to its normal rhythm.
After such surgical intervention, the patient can return to a normal lifestyle in a few days. But bad habits should be ruled out. It is not recommended to drink coffee.
During the year, the patient must be registered with the cardiac dispensary. Observes his arrhythmologist.
It’s important to know! General rehabilitation takes 2-3 months. A stay in a sanatorium may be prescribed. The question of the possibility of labor is taken by the doctor in each case individually.
The lifestyle after surgery must comply with the following principles:
Due to the fact that the main cause of cardiac arrhythmias is coronary heart disease, one should strive for preventive measures that reduce the level of harmful cholesterol in blood plasma and prevent its deposition on the walls of blood vessels that feed the heart muscle.
The most important of these events is to reduce the consumption of animal fats, fast food products, fried and salty foods. The use of cereals, legumes, vegetable oils, low-fat varieties of meat and poultry, dairy products is welcome.
Scientists have long proved that smoking and alcohol not only damage the walls of blood vessels and the heart from the inside, but can also have a direct arrhythmogenic effect, that is, provoke paroxysmal tachyarrhythmias.
Therefore, smoking cessation and refusal of strong alcohol in large quantities is the prevention of rhythm disturbances.
In conclusion, it should be noted that despite the fact that RFA is a surgical intervention in the body, the risk of complications is relatively small, but the benefits of the operation are undeniable – most patients, judging by the reviews, cease to experience unpleasant symptoms and are less at risk of vascular accidents associated with paroxysms of tachyarrhythmias.
Is the procedure effective?
As a rule, after a certain time, patients who underwent this operation have a significantly lower number of recurrences of atrial fibrillation compared to those who received medications (drug therapy).
According to the results of the study, catheter ablation is significantly more effective treatment in the presence of a paroxysmal form of atrial fibrillation. In sixty-six percent of patients who underwent this manipulation, a year after the procedure, the disease was not fixed, that is, they completely returned to the normal rhythm of the organ.
In the case of drug treatment, this figure is only sixteen percent. What is the likelihood of complications and side effects? With catheter ablation, this is almost five percent, and with drug treatment nine.
Reviews of patients and doctors
Doctors in reviews of catheter ablation write that it is a fairly safe procedure to help reduce the manifestations of arrhythmia. As noted, in many patients after it, either a long-term decrease in the number of episodes of arrhythmia with a decrease in their severity, or the restoration of a healthy organ rhythm is observed.
Patients, in turn, share the opinion that due to successful ablation, they were lucky to reduce the dosage of drugs, and some completely stopped taking the drugs that they were forced to use to control their rhythm (we are talking about antiarrhythmics). People write that because of the use of such drugs, they often recorded undesirable manifestations in the form of weakness, shortness of breath, dizziness, as well as intoxication and more serious complications.
True, in their reviews of catheter ablation of the heart, doctors focus on the fact that with this manipulation there is a certain risk. Thus, there is a risk of bleeding, swelling and hematomas in the area of catheter insertion, as well as problems with infection of this place. More serious complications, as doctors note, occur quite rarely.
But, as experts soothe, the risks of adverse events during catheter ablation, according to a retrospective large clinical study, are quite low and make up only one and a half percent.
Thus, cardiac ablation is a procedure that is performed using a flexible thin wiring called a therapeutic catheter. It is injected through a vein into the area of the organ, so that you can study and correct the electrical impulse. In the event that the doctor detects a heart rhythm malfunction in a patient, a special device can be used that transmits an RF wave and generates sufficient heat to form a small scar in a specific tissue area.
We examined radiofrequency catheter ablation of the heart and reviews on this operation.
The procedure for radiofrequency ablation of the heart is a modern way of treating a large number of arrhythmias. This minimally invasive manipulation helps to get rid of rhythm disturbances to those patients who are contraindicated for extensive intervention.
Previously, they were forever doomed to live with such a serious problem, to endure excruciating attacks, to observe restrictions in everyday life. Now this pathology is eliminated without cuts and returns the joy of a full life to many people.