What is Catheter Ablation?
Ablation is an interventional electrophysiological procedure aimed at eliminating the cardiac cells responsible for rhythm disturbances.
How is Catheter Ablation Performed?
The procedure is typically combined with an electrophysiological study. Thin electrodes (electrocatheters) are introduced through the groin and guided to the heart under X-ray and/or mapping system guidance. Using the study and electroanatomical mapping, a precise diagnosis of the arrhythmia type is made, and the location of the cells causing the arrhythmia is identified.
At this point, ablation is performed: a special catheter capable of delivering energy is placed at the origin of the arrhythmia. The energy delivery destroys the underlying tissue, definitively eliminating the arrhythmia (Fig. 1).
Various forms of energy can be used for this purpose: Radiofrequency (heat) Cryoenergy (cold) Ultrasound Laser Pulsed Electric Energy (electroporation) (Fig. 2).
A: Radiofrequency Ablation – The radiofrequency energy heats the tissue it contacts, neutralizing its electrical activity.
B: Cryoablation – The ablation balloon catheter is filled with refrigerant gas, freezing the tissue and electrically deactivating it.
C: Pulsed Energy Ablation – Pulsed electrical fields disrupt the excitable cells in the tissue, rendering it electrically inert.
The procedure is performed while the patient is awake, with local anesthesia at the groin for simpler cases. For longer or more complex procedures, sedation is used.
What Is the Efficacy of Ablation?
The goal of catheter ablation is to cure arrhythmias permanently by eliminating the responsible cells. Its efficacy varies depending on the type of arrhythmia treated and is consistently higher than pharmacological therapy: Paroxysmal supraventricular tachycardias: Efficacy exceeds 95%. Paroxysmal atrial fibrillation: Efficacy reaches 80%.
What Are the Risks of Ablation?
Catheter ablation is generally considered low-risk. However, complications can arise, including: Insertion site issues: From minor swelling that resolves on its own within days to significant bleeding requiring surgical or transcatheter vessel closure. Cardiac tamponade: Blood leakage into the pericardium (the sac surrounding the heart), requiring drainage to remove the fluid. Bleeding usually stops spontaneously in most cases. Thromboembolic events: Rare but possible complications related to blood clots.
In high-volume centers with extensive experience, good clinical practices significantly reduce procedural risks. Furthermore, any complications that arise can be effectively managed in a protected setting. The risk associated with ablation is much lower than the risks posed by the arrhythmia itself, making ablation a favorable option.
Does the Ablation Procedure Require Hospitalization?
The ablation procedure is performed during a short hospital stay, which generally includes the night before and the night after the procedure. Simpler ablations can be performed on a day hospital basis.