Catheter Ablation for Arrhythmias

The doctors at the Smidt Heart Institute's Electrophysiology Program have extensive experience with catheter-based radiofrequency and cryoablation, procedures that use heat energy or freezing technology to eliminate abnormal electrical pathways in the heart and restore normal heart rhythms.

During an ablation procedure, a local anesthetic is used to numb the legs at the crease where the leg attaches to the pelvis. Small needles are placed into the veins of the legs, and a series of small tubes are inserted into the veins. Wires are then passed through the tubes and guided to the heart using fluoroscopy (X-rays). The arrhythmia is induced and carefully analyzed using different modalities of three-dimensional electroanatomic mapping systems (3D virtual pictures formed by computer analysis).

Once the abnormal pathway or area causing the arrhythmia is found, heat or cryo energy is applied to the pathway through the catheter to eliminate the arrhythmia. The procedure can be performed either as an inpatient or outpatient service.

Our team of heart rhythm specialists has many years of experience in treating complex rhythm disorders and using state-of-the-art technologies to treat arrhythmias. A team approach assures that all aspects in the diagnosis, treatment and follow-up of our patients are addressed.

Ablation for Atrial Fibrillation

Catheter-based ablation techniques can be used in the treatment of atrial fibrillation. Rapid electrical impulses begin in the upper chambers of the heart. The goal of ablation procedures is to isolate and eliminate these areas of rapid impulses.

Years of research have shown that the areas most responsible for these impulses are around the pulmonary veins that drain blood from the lungs into the heart. By isolating these regions with radiofrequency or cryoablation, episodes of atrial fibrillation can be stopped or significantly decreased.

With extensive experience in the field, our heart rhythm doctors specialize in treating complex cases in which previous ablation procedures have failed. One of our heart rhythm specialists will perform a detailed evaluation before deciding the treatment strategy recommended for a specific case.

Ablation for Ventricular Tachycardia

Radiofrequency and cryoablation may be used to destroy any small, abnormal area of the ventricles (bottom chambers of the heart) that produces a fast/abnormal rhythm. When catheter ablation is performed targeting the origin of these arrhythmias, it can eliminate or reduce the frequency of this abnormal rhythm.

This can be successful for patients with a history of heart attacks and scarred areas of the heart that predispose them to ventricular tachycardia. This also is used with high success rates for patients with normal hearts who have these ventricular rhythm disturbances not due to scarring in the heart (idiopathic ventricular tachycardia).

Our team of specialists uses state-of-the-art technologies to treat complex, recurrent cases for which prior therapies have failed. After a careful evaluation, a decision is made about the therapeutic modality recommended for a given case. Given that most ventricular tachycardia related to scarring in the heart occurs in patients with heart failure or other major health conditions, catheter ablation for these disorders is one of the most challenging and complex for the physician.

Our team strives to provide safe and effective techniques while minimizing the risk to the patient—providing excellent care, from planning the procedure to follow-up defibrillator checks after the procedure.

Ablation for Supraventricular Tachycardia

Supraventricular tachycardias are a group of heart rhythm disorders characterized by fast heartbeats arising from the upper chambers of the heart. Catheter ablation can be used to treat recurring episodes of supraventricular tachycardia.

Catheter ablation focuses on cauterizing abnormal electric impulses, and can eliminate and cure episodes of supraventricular tachycardia and the need for further medication. This is a highly effective treatment for different forms of supraventricular tachycardia, including atrioventricular nodal re-entrant tachycardia, Wolff-Parkinson-White syndrome, atrioventricular re-entrant tachycardia, atrial tachycardia and atrial flutter.

Our heart rhythm specialists have been involved in the development and study of treatment modalities for supraventricular tachycardia that are now used worldwide.

Symptoms of Supraventricular Tachycardia

The rapid heart rate of supraventricular tachycardia usually starts and ends abruptly. It can last anywhere from a few minutes to several hours. It usually is felt as an uncomfortable palpitation of the heart, but can also include other symptoms, such as:

  • Chest pain
  • Lightheadedness
  • Shortness of breath
  • Weakness

Usually, the heart is otherwise normal.

Causes and Risk Factors of Supraventricular Tachycardia

Supraventricular tachycardia may be caused by an abnormality, such as having:

  • Abnormally rapid impulses generated in the atria; this uncommon condition is called paroxysmal atrial tachycardia
  • An abnormal electrical pathway between the upper chambers of the heart and the lower chambers, called an accessory pathway or bypass tract
  • Two electrical pathways in the atrioventricular node

Young people are more likely than older people to experience supraventricular tachycardia.

Treatment for Supraventricular Tachycardia

Several methods can be used to stop supraventricular tachycardia by stimulating the vagus nerve, which slows the heart rate. These usually are performed by a doctor or under a doctor's supervision, but people who frequently have this problem can learn to perform the methods themselves, including:

  • Plunging the face into a bowl of ice-cold water
  • Rubbing the neck just below the angle of the jaw to stimulate an area on the carotid artery
  • Straining as if having a difficult bowel movement

These methods are most effective when performed soon after the irregular heartbeat or arrhythmia starts.

Medical intervention to control arrhythmia is needed if:

  • The above methods are ineffective
  • The episode lasts more than 20 minutes
  • Symptoms are severe

A doctor can usually stop an episode by giving an injection of a drug. If the arrhythmia does not stop and symptoms are severe, electrical cardioversion may be necessary. This procedure uses an electrical current to reset the heart's rhythm and is performed under sedation.

Although drugs such as betablockers and digoxin are used to prevent arrhythmias and may be prescribed to help prevent future episodes, radiofrequency ablation is often performed to destroy the tissues where supraventricular tachycardia starts, as this is highly curative.

The ablation procedure begins with a diagnostic electrophysiology study to carefully map the origin of the arrhythmia, followed by treatment of delivering radiofrequency energy in a precise area determined during the diagnostic study.

Our team of heart rhythm specialists has extensive experience in treating and following patients with these conditions.