Catheter Ablation A Guided Approach for Treating Atrial Arrhythmias A P A T I E N T H A N D B O O K
This brochure will provide an overview of atrial arrhythmias (heart rhythm problems affecting the upper chambers of the heart) and catheter ablation, a guided treatment method that can improve the quality of your life. 1
What Is an Arrhythmia? Typically, a healthy heart beats 60 to 80 times per minute during rest. However, some people have an irregular heart beat or an arrhythmia which can cause the heart to pump poorly. If you have an arrhythmia, you may feel dizzy or tired or have other symptoms. An arrhythmia may also put you at increased risk of stroke, heart attack, or even sudden cardiac arrest depending on the specific type of rhythm problem. Arrhythmias can be categorized according to whether they cause a heartbeat that is too slow, erratic, or too fast and by the location in the heart where the irregular heart beat starts. This brochure will focus on arrhythmias that originate in the atria (the upper chambers of the heart). 2 AF is a very fast, uncontrolled heart rhythm. The upper chambers of the heart quiver and do not pump blood effectively.
Your Heart s Electrical System Your heart has an electrical system that causes it to beat and pump blood and nutrients throughout your body. The sinoatrial (SA) node is the electrical control center of the heart and sets the pace or rhythm of the heart. The SA node starts the electrical stimulation of the heart muscle. The electrical signal then spreads across the heart s upper chambers, causing them to pump. The electrical signal then travels to the atrioventricular (AV) node in the middle of the heart, where it is then sent to the lower chambers of heart. After the lower chambers have finished pumping, the SA node begins the cycle again. An arrhythmia may result from problems in the SA or AV nodes or in the electrical pathways throughout the heart. SA node AV node Heart showing the SA and AV nodes with normal rhythm. 3
Common Types of Atrial Arrhythmias This section will provide a brief overview of the most common types of atrial arrhythmias treated with catheter ablation, along with the cause and symptoms of each type. Atrial Fibrillation Atrial fibrillation (AF) is a very fast and disorganized heat beat that occurs in the upper chambers of the heart. During AF, the atria beat between 350 and 600 times per minute. If you have AF, you may experience symptoms such as dizziness, fatigue, shortness of breath, and palpitations. During AF, blood does not empty properly from the upper chambers of the heart. The blood can pool and sometimes clot. This can ultimately lead to a stroke. Atrial Flutter Atrial flutter is similar to AF, as it is a fast rhythm that originates within the upper chambers of the heart, but it is more organized and regular. During atrial flutter, the upper chambers of the heart can not empty properly. Symptoms of atrial flutter include palpitations or pounding of the heart. Episodes of atrial flutter can last for hours or days. Therefore, most people with atrial flutter require treatment. 4
AV Nodal Reentrant Tachycardia AV nodal reentrant tachycardia (AVNRT) is the term used to describe an arrhythmia that occurs when an extra electrical pathway is found in or near the AV node. Many people with AVNRT have a very rapid heart rate (160 to 220 beats per minute). Symptoms include a sensation of chest pressure, i.e., pain or shortness of breath, and palpitations. Some people may feel light headed or even faint. Wolff-Parkinson-White Syndrome In Wolff-Parkinson-White (WPW) syndrome there is an abnormal electrical connection between the atria and ventricles that allows electrical impulses to bypass the AV node. This accessory pathway or short circuit can cause the heart to beat very rapidly. WPW syndrome is associated with a slightly increased risk of sudden cardiac arrest due to dangerous arrhythmias in the ventricles (lower chambers of the heart). 5
Treatment Goals Recent advances provide new solutions for the millions of people suffering from atrial arrhythmias. The goals of treatment are to: Restore a normal heart rhythm Control your heart rate Reduce the risk of consequences including stroke, heart attack, and sudden cardiac arrest, depending on the type of arrhythmia that is involved. 6 Catheter ablation is performed in a cardiac catheterization lab, also known as a cath lab.
Treatment Options Your AF treatment plan may include: Medications A number of different medications may be prescribed to manage your heart s rate or rhythm. Electrical cardioversion AF can be treated electrically with a procedure called cardioversion. During the procedure, an electrical shock is delivered to your heart in order to restore a normal heart rhythm. The procedure is performed using short-acting anesthesia. Catheter ablation Catheter ablation is a procedure used to remove the tissue responsible for an atrial arrhythmia. During the procedure, small wires are threaded into the heart to map its electrical activity and help locate the problem areas. These problem areas are then burned away (ablated). Implantable devices In select cases of AF, a pacemaker may be implanted after an ablation procedure to keep the heart rate stable. Surgical therapy for AF Surgical therapy may be an option for people with persistent or permanent arrhythmias (usually AF) that cannot be managed with drugs or other therapies. These procedures require open heart surgery and general anesthesia. For patients who have AF in addition to heart problems requiring surgery, it may be possible to perform both surgeries at the same time. Surgery is rarely performed to treat atrial arrhythmias, other than AF. 7
How Is Catheter Ablation Performed? Catheter ablation involves inserting several long, flexible tubes called catheters into your heart. The procedure is performed in a specially equipped room called an electrophysiology lab. General anesthesia is not required for the procedure. Medications will be given to relax you and keep you comfortable during the procedure. Access to a vein and/or artery is obtained with needles and small tubes, and one or more catheters are then inserted and threaded into the heart. After the diagnostic catheters have been placed, they are used to map the particular areas of the heart responsible for your arrhythmia. In some cases, a small puncture may be made in the wall that separates the left and right atria in order to navigate a catheter into the left atrium. This is called a transseptal puncture. A computer may also be used to generate three-dimensional models of your heart and map its electrical activity. These models and maps can be used to locate areas responsible for an arrhythmia more quickly and accurately. After your arrhythmia has been mapped, a special ablation catheter is inserted into the heart. Electrical energy is then delivered to precisely targeted areas to disrupt the abnormal electrical pathways and restore a normal heart rhythm. 8
Special catheters are used to ablate precisely targeted tissue responsible for AF. 9
After a Catheter Ablation Procedure After the catheter ablation procedure has been completed, the catheters will be removed, and you will be monitored in the recovery area. Generally, you will be allowed to go home either on the day of the procedure or after an overnight stay in the hospital. Your doctor will provide you with a follow-up plan. This could include the continued use of medications and possibly other therapies. Therefore, it is important to stay in touch with your doctor, keep follow-up appointments, and take all of your medications as prescribed during the recovery period. Benefits of Catheter Ablation Relief from symptoms. In many cases, medications can be reduced or eliminated after catheter ablation. Is a minimally invasive procedure with a low risk of complications during and after the procedure. Catheter ablation is a good alternative for patients who still experience symptoms from atrial arrhythmias, following ineffective drug therapy or electrical cardioversion. 10
Patient Resources To learn more about atrial arrhythmias, talk to your doctor. You may also wish to check the following website: Heart Rhythm Society Patient and Public Information Center The Heart Rhythm Society is a professional society for doctors specializing in the diagnosis and treatment of heart rhythm problems. This site also includes extensive patient information on arrhythmias and their diagnosis and treatment including catheter ablation. http://tinyurl.com/3a5p6n 11
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