Cardiovascular Medicine Book

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Cardiac Catheter Ablation

Aka: Cardiac Catheter Ablation, Cardiac Ablation, Atrial Fibrillation Ablation, Supraventricular Tachycardia Ablation, Atrial Tachycardia Ablation, Atrioventricular Nodal Reentrant Tachycardia Ablation, AVNRT Ablation, Atrial Flutter Ablation, Atrioventricular Reciprocating Tachycardia Ablation, AVRT Ablation, Atrial Catheter Ablation
  1. Indications
    1. Atrial Tachycardia
      1. Ablation indicated in symptomatic Atrial Tachycardia refractory to medical therapy (e.g. Beta Blocker)
      2. Also indicated in Tachycardia-mediated Cardiomyopathy
    2. Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
      1. Ablation indicated in most AVNRT cases (Most common indication for catheter ablation)
    3. Atrioventricular Reciprocating Tachycardia (AVRT)
      1. Includes Wolff-Parkinson-White Syndrome (WPW)
      2. Ablation indicated in episodic Tachycardia and signs of accessory pathway conduction (delta wave)
    4. Atrial Flutter
      1. Ablation indicated in most cases of Atrial Flutter
    5. Atrial Fibrillation and very symptomatic (esp. in young patients)
      1. Ablation indicated in normal left atrial size and symptomatic and refractory Atrial Fibrillation
  2. Contraindications: Atrial Fibrillation Ablation
    1. Ejection fraction <35%
    2. Left atrial size >5.5 cm
    3. Mechanical Mitral Valve
    4. Age over 75 years old
  3. Efficacy
    1. Atrial Tachycardia
      1. Success rate: 86 to 100%
      2. Complication rate: 8% or less
    2. Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
      1. Success rate: 96%
      2. Complication rate: 1% or less
    3. Atrioventricular Reciprocating Tachycardia (AVRT)
      1. Success rate: 95%
      2. Complication rate: 2 to 4%
    4. Atrial Flutter
      1. Higher efficacy and lower complication rate than Atrial Fibrillation Ablation
      2. Success rate: 88-100%
      3. Complication rate: 2.5 to 3.5%
    5. Atrial Fibrillation
      1. Lower efficacy and higher complication rate than Atrial Flutter Ablation
      2. Best success is with normal left atrial size and paroxysmal Atrial Fibrillation
      3. Ablation is preferred for WPW and Atrial Fibrillation
      4. Success rate: 60-80%
      5. Complication rate: 6-10%
  4. Complications
    1. General risks (applies to all ablation procedures)
      1. Radiation exposure (fluoroscopy): 1.4 mSV to 50 mSv depending on length of procedure
        1. Electrophysiology study alone: 3.2 mSv
        2. Atrial Tachycardia Ablation: 4.4 mSv
        3. Atrioventricular nodal reentrant Tachycardia (AVNRT) ablation: 4.8 mSv
        4. Atrial Flutter Ablation: 12.1 mSv
        5. Atrioventricular Reciprocating Tachycardia (AVRT) ablation: 12.8 mSv
        6. Atrial Fibrillation Ablation: 16.6 mSv
      2. Cardiac perforation with tamponade
      3. Complete atrioventricular nodal block (complete Heart Block) requiring Pacemaker placement
    2. Atrial Flutter
      1. Ablation is at isthmus in right atrium and is a lower risk procedure
      2. Thromboembolic events
      3. Myocardial Infarction
    3. Atrial Fibrillation
      1. Ablation site is high risk due to proximity of major structures
      2. Recurrent Atrial Fibrillation (repeat procedure required in up to 20% of cases)
      3. Complications (as high as 6% complication rate)
        1. Pulmonary vein stenosis
        2. Cerebrovascular Accident
        3. Cardiac perforation
        4. Atrial-esophageal fistula (rare)
        5. Thromboembolic events
  5. Technique
    1. Typical Catheter Ablation Procedure
      1. Ablation probe applied in same pattern as MAZE procedure
      2. Ablation circumferentially around each set of pulmonary veins
        1. Also ablate a line between the two pulmonary veins within the left atrium
      3. Ablation circumferentially around superior and inferior vena cava entry within the right atrium
    2. Other procedures: AV Nodal ablation with Pacemaker placement indications
      1. Older patients with Tachycardia induced Cardiomyopathy
      2. Refractory rapid ventricular rate despite maximal medical therapy
    3. Anticoagulation
      1. Anticoagulation for one month before and several months after ablation
  6. Protocol: Refractory and symptomatic Atrial Fibrillation despite maximal therapy
    1. AV Node Ablation with Pacemaker placement
      1. Last resort method that is rarely indicated
      2. Ozcan (2001) N Engl J Med 344:1043-51 [PubMed]
  7. References
    1. Gutierrez (2017) Am Fam Physician 83(1): 61-8 [PubMed]
    2. Scheinman (2003) Pacing Clin Electrophysiol 26(3): 789-99 [PubMed]
    3. Shapira (2009) Am Fam Physician 80(10): 1089-94 [PubMed]

Cardiac ablation (C0162563)

Definition (NCI) A procedure intended to eliminate or modify a focus or re-entry circuit that causes an arrhythmia in the heart. (ACC)
Definition (NCI_CDISC) A procedure intended to eliminate or modify a focus or re-entry circuit that causes an arrhythmia.
Definition (MSH) Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DC-shock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D017115
English Ablation, Catheter, Catheter Ablation, ABLATION CATH, CATH ABLATION, catheter ablation, catheter ablation (treatment), ablation cardiac, ablation catheter, ablations catheter, ablations cardiac, cardiac ablation, Cardiac Ablation, Catheter ablation, Cardiac ablation
Italian Ablazione cardiaca, Ablazione mediante catetere
Japanese 心臓アブレーション, シンゾウアブレーション, 経静脈電気切除, 高周波カテーテルアブレーション, カテーテル切除術-経皮, 経皮カテーテル切除術, 高周波カテーテル切除術, 切除-経静脈電気, 焼灼切除-カテーテル-電気, 経静脈カテーテル切除術, カテーテル切除術-経静脈, 電気焼灼切除-カテーテル, カテーテル切除術-高周波, カテーテルアブレーション, カテーテル切除術
Swedish Kateterablation
Finnish Katetriablaatio
French Ablation par cathéter, Ablation cardiaque, Ablation endocavitaire
Russian KATETERNOE ISSECHENIE CHRESKOZHNOE, KATETERNOE ISSECHENIE CHREZVENOZNOE, KATETERNOE ISSECHENIE, ISSECHENIE CHREZVENOZNOE ELEKTRICHESKOE, KATETERNOE ISSECHENIE ELEKTRICHESKOE, KATETERNOE ISSECHENIE VYSOKOCHASTOTNOE, КАТЕТЕРНАЯ АБЛЯЦИЯ, КАТЕТЕРНОЕ ИССЕЧЕНИЕ, KATETERNAIA ABLIATSIIA, ИССЕЧЕНИЕ ЧРЕЗВЕНОЗНОЕ ЭЛЕКТРИЧЕСКОЕ, КАТЕТЕРНОЕ ИССЕЧЕНИЕ ВЫСОКОЧАСТОТНОЕ, КАТЕТЕРНОЕ ИССЕЧЕНИЕ ЧРЕЗВЕНОЗНОЕ, КАТЕТЕРНОЕ ИССЕЧЕНИЕ ЧРЕСКОЖНОЕ, КАТЕТЕРНОЕ ИССЕЧЕНИЕ ЭЛЕКТРИЧЕСКОЕ
Czech Srdeční ablace, katetrizační ablace, katétrová ablace
Polish Ablacja prądem o częstotliwości radiowej, Ablacja RF, Ablacja prądem RF, Ablacja przeznaczyniowa, Ablacja z użyciem cewnika, Ablacja przezskórna, Elektroablacja, Ablacja cewnikowa
Hungarian Katéteres ablatio a szívben
Norwegian Kateterablasjon
Croatian Kateterska ablacija
Portuguese Ablação cardíaca, Ablação por Cateter
Spanish Ablación cardiaca, Ablación por Catéter
Dutch hartablatie, Katheterablatio
German Katheterablation
Sources
Derived from the NIH UMLS (Unified Medical Language System)


catheter ablation for atrial arrhythmia (C2702799)

Concepts Therapeutic or Preventive Procedure (T061)
English catheter ablation for atrial arrhythmia (treatment), catheter ablation for atrial arrhythmia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


catheter ablation for atrial fibrillation (C2702800)

Concepts Therapeutic or Preventive Procedure (T061)
English catheter ablation for atrial fibrillation (treatment), catheter ablation for atrial fibrillation
Sources
Derived from the NIH UMLS (Unified Medical Language System)


catheter ablation for supraventricular tachycardia (C2702802)

Concepts Therapeutic or Preventive Procedure (T061)
English catheter ablation for supraventricular tachycardia, catheter ablation for supraventricular tachycardia (treatment), catheter ablation for SVT
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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