Radiofrequency catheter ablation

Radiofrequency catheter ablation (RFA) is the definitive non-pharmacological treatment for arrhythmias; follows the electrophysiological examination. This is a procedure with which we can specifically influence the pathological electrical activity of a certain area of ​​the cardiac myocardium. Selective radiofrequency ablation aims to destroy the arrhythmogenic focal deposit in the myocardium or break the reentry circuit.

 Mechanism of radiofrequency ablation 

Radiofrequency energy represents high-frequency alternating electric current, for the purposes of catheter ablation, we use a current with frequencies of 500–1000 kHz.


 * We introduce the ablation catheter via the vein or femoral artery under X-ray control into the heart cavities (the ablation catheter is connected to a radiofrequency ablator and a multi-channel ECG recorder).
 * The passage of electric current through the myocardium accelerates the movement of ions, which generates heat. Temperatures above 46 ° C result in denaturation of proteins, coagulation necrosis develops, which then heals with a non-cytogenic scar. Commonly used temperatures are 60-70 ° C for 40-50 seconds.
 * We verify the effectiveness of RFA by electrophysiological examination.

 Indication  Principle of orthodromic AV reentry tachycardia: the excitement reaches the chambers in a physiological way (via the AV node), from which, however, the accessory pathway in the septum between the left atrium and left ventricle (James's bundle) returns to the atrium, creating a reentry circuit leading to tachycardia. Interruption of this circuit would be the essence of RFA,


 * Supraventricular tachyarrhythmias (SVT),


 * AV nodal reentry tachycardia (AVNRT),
 * AV reentry tachycardia (AVRT),
 * Risk SVT (with hypotension, unconsciousness, after failure of antiarrhythmic treatment),
 * Atrial fibrillation,
 * Flutter atrium,


 * Ventricular tachycardia (ventricular tachycardia, VT),
 * Monomorfní komorová tachykardie,
 * Bundle-branch reentry komorová tachykardie.

Complications
.The complications of radiofrequency ablation are generally low. These can be:


 * complications at the site of vascular puncture (vascular damage, bleeding, hematoma, painful swelling);
 * damage to the cardiac conduction system;
 * infection;
 * heart wall damage;
 * thrombus formation (in the vessel or heart)

Související články

 * Electrophysiological examination
 * Flutter atria
 * Atrial fibrillation

 References 




 * 1) KAUTZNER, Josef. Katetrizační ablace srdečních arytmií. Kardiologická revue. 2006, roč. 0, vol. Suplementum, s. 4, ISSN 1801-8653.


 * DÍTĚ, P., et al. Vnitřní lékařství. 2. vydání. Praha : Galén, 2007. ISBN 978-80-7262-496-6.