Catheter-Based Treatment

Catheter Ablation for Heart Rhythm Disorders

Catheter ablation is a minimally invasive electrophysiology procedure used to target selected areas involved in abnormal electrical activity in the heart.

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The treatment

What Is Catheter Ablation?

Catheter ablation is a catheter-based treatment. Thin catheters are guided through blood vessels to the heart, where they are used to study the rhythm and, where appropriate, to treat a selected area.

  • Electrophysiological assessment of the rhythm
  • Identification of the target area
  • Delivery of energy to the selected area
  • Reassessment of electrical activity

Catheter-based treatment of a selected area

How it works

From Assessment to Treatment

The stages below are general. Which of them are needed depends on the arrhythmia and on the patient.

Rhythm assessment

The rhythm disorder is assessed.

Catheter placement

Catheters are guided to the heart.

Mapping

Electrical activity is recorded and mapped.

Target identification

The relevant area is identified.

Energy delivery

Energy is delivered to the selected area.

Reassessment

Electrical activity is checked again.

Energy technologies

Radiofrequency, Cryoablation and Pulsed Field Ablation

Different forms of energy can be used to create the small lesions needed in catheter ablation. They act on tissue in different ways.

Thermal energy

Radiofrequency Ablation

Radiofrequency energy produces heat at the catheter tip, creating small lesions in targeted tissue.

Controlled freezing

Cryoablation

Cooling delivered through the catheter freezes targeted tissue to create lesions.

Pulsed electrical field

Pulsed Field Ablation

Short pulses of an electrical field are delivered through the catheter to create lesions in targeted tissue.

The technologies are not ranked. The choice depends on the arrhythmia, the anatomy and clinical assessment.

Conditions

Rhythm Disorders That May Be Treated

Catheter ablation may be considered for selected patients with some rhythm disorders. Having one of these conditions does not mean that ablation is needed. It depends on clinical assessment.

Atrial Fibrillation

Disorganised electrical activity in the atria. Ablation may be considered in selected patients. AF ablation

Atrial Flutter

A rapid, regular rhythm arising in the atria, often from a re-entry circuit.

Supraventricular Tachycardia

A group of fast rhythms that begin above the ventricles, including AVNRT and rhythms involving an accessory pathway, such as WPW.

Ventricular Arrhythmias

Abnormal rhythms arising in the ventricles, including premature ventricular contractions (PVCs) and ventricular tachycardia (VT).

3D electroanatomical map

Mapping

The Role of 3D Mapping

3D electroanatomical mapping systems can support catheter ablation by helping with:

  • Anatomy: building a 3D model of the heart chamber
  • Catheter localisation in three-dimensional space
  • Localisation of the arrhythmia
  • Treatment planning
3D Electroanatomical Mapping
Electrophysiology Study

The procedure journey

Step by Step

A general outline of the journey. Details are explained to each patient.

Assessment

Review of symptoms, recordings and medical history.

Preparation

Practical preparation and instructions are explained.

Catheter access

Catheters are introduced through blood vessels.

Mapping

Electrical activity is recorded and mapped.

Ablation

Energy is delivered to the selected area where appropriate.

Reassessment

Electrical activity is checked again.

Recovery

Monitoring continues while the patient recovers.

Follow-up

A follow-up plan is arranged and explained.

Before, during and after

Three Stages of Care

Before

Clinical evaluation and preparation

Review of symptoms, tests and medicines, with practical instructions for the procedure. Before Your Procedure

During

Mapping, target identification and treatment

The rhythm is studied and mapped, the relevant area is identified, and treatment is delivered where appropriate.

After

Monitoring and follow-up

Recovery is monitored and a follow-up plan is explained. After Your Procedure

Educational comparison

Before and After Target Identification

A technical comparison of two stages of the same process. It is not a patient result.

Before Target Identification

  • Rhythm problem recognised
  • Exact target may not yet be defined

After Mapping and Target Identification

  • Electrical mechanism better characterised
  • Target region identified
  • Treatment strategy defined

Educational illustration of a general process. It does not represent an individual patient and does not imply any treatment result.

Treatment Decisions

Observation, Medication or Ablation?

Not every arrhythmia needs an ablation. The recommendation depends on the rhythm, how often it occurs, how it affects you and the state of your heart.

Observation

Some rhythm disturbances, such as occasional harmless extra beats, need explanation and follow-up rather than treatment.

Medication

Anti-arrhythmic or rate-controlling medicines may be appropriate, particularly if episodes are infrequent or the rhythm is well controlled.

Catheter ablation

May be discussed when episodes are frequent or disabling, when medicines are ineffective or not tolerated, or when a procedure is preferred to long-term medication.

Some persistent, fast rhythms can gradually weaken the heart muscle, a situation sometimes called tachycardia-induced cardiomyopathy. In selected patients, treating the rhythm may help the heart recover, which can make ablation a more pressing consideration.

The choice is individual and should follow a full assessment by an electrophysiologist.

What to Expect

A Catheter Procedure, Not Open-Heart Surgery

Catheter ablation does not involve opening the chest. Thin flexible catheters are introduced through blood vessels, most often via the groin, and guided to the heart under imaging and 3D mapping.

Most procedures are performed with local anaesthesia at the access site and sedation. Some complex procedures, or patient factors, may call for general anaesthesia.

Procedure time varies widely with the rhythm disorder and its complexity, from a relatively brief intervention to a long one. Your team will give an estimate for your own case.

The length of any hospital stay depends on the procedure and the patient, and your team will explain what to expect in your case.

Technology and Experience

How the Approach Is Chosen

The energy source and technique are selected for the rhythm, the anatomy and the patient. Radiofrequency, cryoablation and pulsed field ablation each have roles, and no single technology is right for every case.

Ablation is also technically demanding. The experience of the operator and team, together with appropriate mapping equipment, are important parts of safe and effective treatment.

Rhythm-specific pages describe how this works for atrial fibrillation, flutter, SVT, PVCs and VT.

After Ablation

Recovery, Recurrence and Risks

Recovery

Specific advice on the groin site, activity, exercise and driving is provided individually. See After Your Procedure.

Recurrence

The arrhythmia may return after a successful procedure, particularly in complex rhythms such as atrial fibrillation. A repeat procedure may then be discussed.

Risks

Include bleeding or bruising at the access site, vascular injury, heart or valve injury, stroke, and rhythm-specific risks such as heart block. Your physician will explain those relevant to you.

No ablation outcome can be guaranteed.

Questions

Frequently Asked Questions

A minimally invasive procedure in which catheters are used to target selected areas involved in abnormal electrical activity in the heart.

No. Whether it is appropriate depends on the rhythm disorder, symptoms, other treatments and clinical assessment.

Energy is delivered to a selected area through the catheter to create small lesions, which can change how electrical signals travel or start in that area.

They use different forms of energy to create lesions. The choice depends on the arrhythmia, the anatomy and clinical assessment.

It builds a three-dimensional picture of the heart chamber and shows electrical activity on it, supporting localisation and treatment planning.

Recovery depends on the individual patient and the procedure performed. The care team explains what to expect and how to look after yourself.

Yes. A follow-up plan is explained to review symptoms, rhythm and medicines.

In some patients an arrhythmia can recur after ablation. Follow-up is used to review the rhythm and discuss next steps.

Most procedures use local anaesthesia and sedation, but the approach depends on the rhythm and the patient. Your team will explain this in advance.
The length of stay depends on the procedure and your condition. Your team will explain what to expect in your case.

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