Atrial flutter ablation

What does a catheter ablation procedure involve?

Catheter ablation is a minimally invasive procedure. The basic principle of the procedure is to identify the region of the heart where the abnormal electrical circuit that causes atrial flutter is located and to modify the heart tissue in that region by delivering heat (radiofrequency energy). The end result of the modification is that the abnormal circuit and consequently atrial flutter is eliminated.

What are the success rates and potential risks?

For the common type of atrial flutter (typical atrial flutter), the success rates associated with ablation of atrial flutter are 95%. In the remaining 5%, an additional procedure maybe necessary to eliminate the arrhythmia.

While complications associated with catheter ablation for atrial flutter are rarely seen, they can be significant. For the common type of atrial flutter (typical atrial flutter), the risk of serious complications is 1 in 100 (1%)  or less (specific numbers are included below). The risk of death from an atrial flutter ablation procedure is very small (less than 3 in 1000). Your physician will have a detailed discussion with you about the procedure in order to allow you to make an informed decision. You will subsequently be asked to sign a consent form.

Potential complications include:

  • Damage to blood vessels needing further procedure or blood transfusion (1-2 in 100 risk)
  • Buildup of fluid in the sac around the heart needing a drain to remove the fluid (1 in 200 risk)
  • Blood clots resulting in stroke (1 in 200 risk)
  • Need for permanent pacemaker (1 in 100 risk)

For less common types of atrial flutter, the success rates and risk of complications may vary and will be discussed in detail by your heart rhythm specialist.

What is the procedure like from a patient’s perspective?

A catheter ablation procedure is performed in a specific environment within a hospital referred to as a cardiac catheterization laboratory. During the procedure, multiple members of a team will be involved, including the heart rhythm specialist doctor (who will perform the procedure), cardiac physiologists and cardiac nurses. The cardiac nurses assist with ensuring that the patient is comfortable and monitor vital signs while the physiologists monitor various technical parameters associated with the procedure. The procedure maybe performed with a patient under conscious sedation (awake with medications administered though the vein to help the patient to relax) or in certain circumstances, under general anaesthesia (in which case an anaesthetist will also be present).

Amongst patients undergoing the procedure under conscious sedation, after the sedative has taken effect, local anaesthetic will be injected using a small needle on the top of the leg to numb the puncture site. Once the area is numb, a needle will be used to puncture the vein. Hollow sheaths will be introduced into the vein. Long thin tubes, called catheters are inserted into the into the hollow sheaths and carefully advanced into the heart.

X-ray guidance and/or specialized electrical mapping systems will be used to guide the physician to target specific areas of the heart (where the abnormal electrical circuit originates). Once the source of the heart rhythm abnormality is identified, radio frequency energy is applied to eliminate the abnormal electrical activity. Patients may experience mild discomfort during the ablation procedure. The procedure is predicted to last between 2-4 hours.

After the procedure, the catheters and sheaths will be removed, and manual pressure will be applied over the puncture site to stop bleeding. Patients are subsequently required to lie flat for a period of 2-4 hours to ensure that the bleeding remains controlled. During this period, nursing staff will monitor the puncture site and also vital signs.

What happens after hospital discharge?

The majority of patients are discharged either on the same day or after an overnight stay. Patients may return to work one week after the ablation procedure. However, if a patient’s occupation involves heavy lifting, the physician may recommend increasing the time off work to two weeks.

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