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Ablation: a win-win for arrhythmia patients

This Circulation study is the largest to date focusing on the effectiveness and safety of RF catheter ablations, and the results mirror those in my practice. Although I specialize in pediatrics, the results hold true for both young and adult patients. For select patients, RF ablation represents a permanent end to rhythm disturbances and the need to take one or more medications several times each day.

Permanent therapy for cardiac arrhythmias has been around for more than two decades. Early procedures were performed with DC electrical current. About a decade ago, we began using catheters inserted through veins into the heart to deliver radiofrequency waves, which is much less traumatic to the patient and more successful.

Arrhythmias are extremely common, especially as we get older, and each year millions of people are affected by them. Ablations are used to treat tachycardia, a rhythm disturbance that results in a fast heart beat.

Medical management
There are a whole slew of medications to treat arrhythmias. Many are effective, but most do have side effects and patients need to be monitored regularly. Those that are the most effective in controlling arrhythmias are also the ones with the most side effects.

That’s one of the biggest advantages of ablation. It stops the arrhythmia and ends the need to take medications. The procedure is generally considered safe for patients three years or older who weigh more than 33 pounds. It’s most often a one-day procedure.

RF ablation
The procedure entails the placement of four catheters through veins in the leg or neck into different areas of the heart. We begin by locating the tissue responsible for the rhythm disturbance, and then deliver the RF energy to that area. The procedure takes between two and six hours depending on the location of the site or sites of the rhythm disturbance.

After the ablation, we wait about 30 minutes and retest the area to make sure the tissue is dead. We have a much lower incidence of recurrence than the 6 percent cited in this study because of this recheck stage. After an ablation, patients rest for several hours and are sent home the same day or the following morning. They may resume normal activities in three days.

Risks
Serious risks are extremely rare. The three patients who died in the study were older patients with long-term serious heart disease as were the two patients who suffered strokes. The incidence of stroke is about one in 1,000. There is about a 1 percent risk of damage to the heart’s normal conduction tissue, which is treated with insertion of a pacemaker.

Safe for very young patients
Because of the low risk and effectiveness of ablations, we are performing several a week in Connecticut. Not long ago, physicians were recommending youngsters wait until they turned 21 before having the procedure, but all of the data indicate children as young as three are good candidates. Arrhythmias can seriously interfere with a youngster’s active lifestyle, and families are increasingly opting to have the surgery sooner rather than later.

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Dr. Snyder is the director of pediatric electrophysiology at Yale-New Haven Children’s Hospital and associate professor of pediatrics at the Yale University School of Medicine.