cardiac catheter ablation for arrhythmia

Cardiac catheter ablations are now quite widely used to treat abnormal heart rhythms in patients. They're relatively safe and we are using them more and more because of improving technology and what they essentially involve is placing catheters up through the veins of the arteries in the groins and they then feed up into the heart and we then use these catheters which are essentially long wires to stimulate the heart and get the heart into abnormal heart rhythms so that we are then able to map the circuit of the heart and we can then go on to treat the abnormal circuit by burning very small bits of the heart to eradicate the short circuits. This procedures are reserved for patients where the drugs haven't really worked or in in patients where the drugs have worked but they don't want to be on drugs for the rest of their life. As mentioned, they're relatively safe but unfortunately with any procedure that involves putting in wires in the heart, there may well be complications and they are small. Complications of bleeding, damaging the veins or the arteries in the groin, or damaging the heart muscle during the procedure, I would say the complication rates for these are less than 1 in 100. serious complications are even more rare of a heart attack or a stroke. And there's also, depending on where the short circuit is, there's possibility of damaging the electrics of the heart during the procedure and this varies from various different heart rhythms that we treat. So ablations for very simple abnormal heart rhythms, for example, what we would term as and supraventricular tachycardias have a very good success rate of up to 95%. And again, as I mentioned, the risks are very low, sort of less than 1 in 100 risk of any serious complications. So a lot of patients do choose this option as a potential treatment for the abnormal heart rhythm and this will allow them to remain off medications for the rest of their life. abnormal rhythms like atrial fibrillation, unfortunately, the success rates aren't as good and if you have what we term as paroxysmal atrial fibrillation where your heart goes in and out intermittently out of this atrial fibrillation, the success rates are about 70-80% but once again, most patients will have to have at least 2 if not 3 procedures to achieve the success rates. If your heart is in atrial fibrillation all the time, what we term as persistent atrial fibrillation, unfortunately, the success rates are even lower and probably in the realm of 50 to 60%. And once again, most patients were required to have at least two if not three procedures and some even have a fourth procedure to get and achieve the success rates that we want. In more complex ablations like atrial fibrillation, There are more serious complications on top of the complications that we see with the simple ablation procedures. So we do still get bleeding in the groins or in the arteries or veins where we put the catheters. There's risk of damaging the heart muscle when we do the procedure. And on occasion, fluid can accumulate around the heart and we need to put in a drain or a tube in a sac surrounding the heart to relieve this pressure and then get rid of the fluid. And particularly to atrial fibrillation ablation, there is a rare but potentially fatal complication of what we term as an atrioesophageal fistula where we actually have a connection between the top left chamber to the gullet. And this complication normally arises about three months after the procedure and patients normally present with a stroke and unfortunately this presentation is normally fatal. But fortunately the incidence of this complication is extremely rare, less than 1 in 5,000. So on the rare occasion where we do damage the heart muscle during the procedure and the bleeding is not being able to stop with simple measures of reversing the blood thinning medications that we give during the procedure, we may well have to get our colleagues from the cardiothoracic department to help locate and actually stop the bleeding and that involves open heart surgery unfortunately.