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)

Links

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.