Catheter Ablation for Ectopic Beats

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 ectopic beats originate from and to modify the heart tissue in that region by delivering heat (radiofrequency energy). The end result of the modification is that the abnormal ‘triggering switch’ where the ectopic beats originate from is eliminated.

What are the success rates and potential risks?

The success rates of catheter ablation of ectopic beats vary depending on where the ectopic beats are originating from. The overall success rates are approximately 70%. For ectopic beats originating from the most common site (the right ventricular outflow tract), success rates are in excess of 80%.2

Complications associated with catheter ablation of ectopic beats are rare however can be significant. Potential complications include:

  • Significant damage to the artery or vein at the access site (1-2 in 100 risk)
  • Buildup of fluid in the sac around the heart needing a drain to remove the fluid (less than 1 in 100 risk)
  • Permanent pacemaker (1 in 1000 risk)

For certain less common types ectopic beats that originate from specific areas of the heart, there may be additional (uncommon) complications which your heart rhythm doctor will discuss with you in detail.

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).

The majority of ablation procedures for ectopic beats are performed 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. A hollow sheath will be introduced into the vein. Long thin tubes, called catheters are inserted into the into the hollow sheath 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 ectopic beats originate). The initial part of the procedure involves a detailed mapping procedure using a specialized electrical mapping system. The aim of mapping is to pinpoint where the abnormal electrical activity is originating from.

Once the source of the heart rhythm abnormality is identified, radiofrequency 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?

Patients may be discharged on the day of the procedure 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.

Dr Mahida’s publications on heart rhythm abnormalities from the ventricles

  • Berte B, Cochet H, Dang L, Mahida S, Moccetti F, Hilfiker G, Bondietti J, Ruschitzka F, Jaïs P, Scharf C, Kobza R. Image-guided ablation of scar-related ventricular tachycardia: towards a shorter and more predictable procedure. J Interv Card Electrophysiol. 2019 Dec 19. doi: 10.1007/s10840-019-00686-w.
  • Adlan AM, Campbell T, Fairbairn T, Aggarwal S, Nawaytou O, Penha D, Todd D, Mahida S. Retrograde aortic access during ventricular tachycardia ablation: indications, techniques and challenges. J Cardiovasc Electrophysiol. 2019 Nov;30(11):2629-2639. doi: 10.1111/jce.14163. Epub 2019 Sep 18.
  • Mahida S, Stevenson WG. Thoughts on inducibility. Heart Rhythm. 2019 Apr;16(4):e37-e38. doi: 10.1016/j.hrthm.2019.01.003.
  • Mahida S, Venlet J, Saguner AM, Kumar S, Baldinger SH, AbdelWahab A, Tedrow UB, Castelletti S, Pantazis A, John RM, McKenna WJ, Lambiase PD, Duru F, Sapp JL, Zeppenfeld K, Stevenson WG. Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: Results from a multicenter study. Heart Rhythm. 2018 Oct 23. pii: S1547-5271(18)31043-9
  • Mahida S, Sacher F, Dubois R, Sermesant M, Bogun F, Haïssaguerre M, Jaïs P, Cochet H. Cardiac Imaging in Patients With Ventricular Tachycardia. Circulation. 2017 Dec 19;136(25):2491-2507.
  • Kumar S, Baldinger SH, Kapur S, Romero J, Mehta NK, Mahida S, Fujii A, Tedrow UB, Stevenson WG. Right ventricular scar-related ventricular tachycardia in nonischemic cardiomyopathy:Electrophysiological characteristics, mapping, and ablation of underlying heart disease. J Cardiovasc Electrophysiol. 2018 Jan;29(1):79-89.
  • Derval N, Duchateau J, Mahida S, Eschalier R, Sacher F, Lumens J, Cochet H, Denis A, Pillois X, Yamashita S, Komatsu Y, Ploux S, Amraoui S, Zemmoura A, Ritter P, Hocini M, Haissaguerre M, Jaïs P, Bordachar P. Distinctive Left Ventricular Activations Associated With ECG Pattern in Heart Failure Patients. Circ Arrhythm Electrophysiol. 2017 Jun;10(6).
  • Berte B, Sacher F, Wielandts Y, Mahida S, Pillois X, Weerasooriya R, Bernus O, Jaïs  P. A new cryoenergy for ventricular tachycardia ablation: a proof-of-concept study. Europace. 2017 Aug 1;19(8):1401-1407. doi: 10.1093/europace/euw217.
  • Kumar S, Baldinger SH, Romero J, Fujii A, Mahida S, Tedrow UB, Stevenson WG. Substrate-Based Ablation Versus Ablation Guided by Activation and Entrainment Mapping for Ventricular Tachycardia: A Systematic Review and Meta-Analysis. J Cardiovasc Electrophysiol. 2016 Dec;27(12):1437-1447. doi: 10.1111/jce.13088.
  • Yamashita S, Cochet H, Sacher F, Mahida S, Berte B, Hooks D, Sellal JM, Al Jefairi N, Frontera A, Komatsu Y, Lim HS, Amraoui S, Denis A, Derval N, Sermesant M, Laurent F, Hocini M, Haïssaguerre M, Montaudon M, Jaïs P. Impact of New Technologies and Approaches for Post-Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up. Circ Arrhythm Electrophysiol 2016 Jul;9(7):e003901. doi: 10.1161/CIRCEP.116.003901.
  • Yamashita S, Sacher F, Mahida S, Berte B, Lim HS, Komatsu Y, Amraoui S, Denis A, Derval N, Laurent F, Sermesant M, Montaudon M, Hocini M, Haïssaguerre M, Jaïs P, Cochet H. Image Integration to Guide Catheter Ablation in Scar-related Ventricular Tachycardia. J Cardiovasc Electrophysiol. Jun;27(6):699-708
  • Baldinger S, Kumar S, Barbhaiya CR, Mahida S, Epstein L, Michaud G, John R, Tedrow U, Stevenson W. Epicardial Radiofrequency Ablation Failure during Ablation Procedures for Ventricular Arrhythmias – Reasons and Implications for Outcomes. Circulation Arrhythmia and Electrophysiology. 2015 Dec;8(6):1422-32.
  • Berte B, Sacher F, Venlet J, Andreu D, Mahida S, Aldhoon B, De Potter T, Sarkozy A, Tavernier R, Marius A, Deneke T, Kautzner J, Berruezo A, Cochet H, Zeppenfeld K, Jaïs P. VT Recurrence after VT ablation in Non-Ischaemic Cardiomyopathy: Incomplete Ablation or Disease Progression? A Multicentric European Study. J Cardiovasc Electrophysiol. 2016 Jan;27(1):80-7.
  • Berte B, Cochet H, Magat J, Naulin J, Sacher F, Ghidoli D, Pillois X, Casassus F, Yamashita S, Mahida S, Derval N, Hocini M, Quesson B, Bernus O, Haïssageurre M, Jaïs P. Irrigated needle ablation creates larger and more transmural ventricular lesions compared to standard unipolar ablation in an ovine model. Circulation Arrhythmia and Electrophysiology. 2015 Dec;8(6):1498-506.
  • Berte B, Komatsu Y, Denis A, Pillois X, Kim S, Yamashita S, Sacher F, Mahida S, Hooks D, Sellal JM, Amraoui S, Derval N, Hocini M, Haïssaguerre M, Jaïs P, Cochet H. Characterization of the Left-Sided Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy. Circulation Arrhythmia and Electrophysiology. 2015 Dec;8(6):1403-12.
  • Berte B, Relan J, Sacher F, Pillois X, Appetiti A, Yamashita S, Casassus F, Hooks D, Sellal JM, Amraoui S, Mahida S, Denis A, Derval N, Hocini M, Haïssaguerre M, Jaïs P. Impact of electrode type on mapping of scar-related VT. J Cardiovasc Electrophysiol. 2015 Jul 22. doi: 10.1111/jce.12761.
  • Kumar S, Barbhaiya C, Nagashima K, Balindger S, Choi, EK, Mahida S, Sobieszczyk P, Eisenhauer A, Couper GS, Epstein LM, John, RM, Michaud GM, Tedrow U, Stevenson WG. What to do when Percutaneous Endo and Epicardial Radiofrequency Catheter Ablation Attempts fail to treat Ventricular Arrhythmias? Approaches and Outcomes. Circulation Arrhythmia and Electrophysiology. 2015 Jun;8(3):606-15.
  • Sacher F, Reichlin T, Zado E, Field ME, Viles-Gonzalez JF, Peichl P, Ellenbogen KA, Maury P, Dukkipati S, Picard F, Kautzner J­, Barandon L, Koneru JN, Ritter P, Mahida S, Calderon J, Derval N, Denis A, Cochet H, Shepard RK, Corre J, Coffey JO, Garcia F, Hocini M, Tedrow U, Haissaguerre M, MD, d’Avila A, Stevenson WG, Marchlinski ME and Jais P. Characteristics of VT Ablation in Patients with Continuous Flow Left Ventricular Assist Devices. Circulation Arrhythmia and Electrophysiology 2015 Jun;8(3):592-7.
  • Kumar S, Bazaz R, Barbhaiya CR, Enriquez AD, Helmbold AF, Chinitz J, Baldinger SH, Mahida S, McConville JW, Tedrow U, John RM, Michaud GF, Stevenson WG. “Needle-in-needle” Epicardial access: Preliminary Observations with a Modified Technique for Facilitating Epicardial Interventional Procedures. Heart Rhythm. 2015 Jul;12(7):1691-7.
  • Shah AJ, Lim HS, Yamashita S, Zellerhoff S, Berte B, Mahida S, Hooks D, Aljefairi N, Derval N, Denis A, Sacher F, Jais P, Dubois R, Hocini M, Haissaguerre M. Noninvasive mapping of ventricular tachycardia’s. Card Electrophysiol Clin. 2015 Mar;7(1):99-107.
  • Yamashita S, Sacher F, Mahida, S, Berte B, Lim H, Komatsu Y, Amraoui S, Denis A, Derval, N, Laurent, F, Montaudon M, Hocini M, Haïssaguerre M, Jaïs P, and Cochet H. The role of high-resolution image integration to visualize left phrenic nerve and coronary arteries during epicardal ventricular tachycardia ablation. Circulation Arrhythmia and Electrophysiology. 2015 Feb 21. pii: CIRCEP.114.002420.
  • Hooks DA, Berte B, Yamashita S, Mahida S, Sellal JM, Aljefairi N, Frontera A, Derval N, Denis A, Hocini M, Haïssaguerre M, Jaïs P, Sacher F. New Strategies for Ventricular Tachycardia and Ventricular Fibrillation Ablation. Expert Rev Cardiovasc Ther. 2015 Feb 10:1-14.
  • Mahida, S; Derval, N; Sacher, F; Leenhardt, A; Deisenhofer, I; Babuty D; Schläpfer J; de Roy, L; Frank, R; Yli-Mayry, S; Mabo, P; Rostock, T; Nogami, A; Pasquié, J; de Chillou, C; Kautzner, J; Jesel, L; Maury, P; Berte, B; Yamashita S; Roten L; Lim H; Denis, A; Bordachar P; Ritter P; Probst, V; Hocini, M; Jaïs, P, and Haïssaguerre, M. Role of Electrophysiologic Studies in Predicting Risk of Ventricular Arrhythmia in Early Repolarization Syndrome. J Am Coll Cardiol. 2015 Jan 20;65(2):151-9
  • Berte B, Sacher F, Cochet H, Mahida S, Yamashita S, Lim HS, Denis A, Derval N, Hocini M, Haïssaguerre M, Jaïs P. J Cardiovasc Electrophysiol. 2015 Jan;26(1):42-50.
  • Berte B, Sacher F, Mahida S, Yamashita S, Lim HS, Denis A, Derval N, Hocini M, Haïssaguerre M, Cochet H, Jaïs P. Impact of septal radiofrequency ventricular tachycardia ablation: insights from magnetic resonance imaging. Circulation. 2014 Aug 19;130(8):716-8.
  • Mahida S, Berte B, Yamashita S, Derval N, Denis A, Shah A, Amraoui S, Hocini M, Haissaguerre M, Jais P, Sacher F. New Ablation Technologies and Techniques. Arrhythm Electrophysiol Rev. 2014 Aug;3(2):107-12.
  • Lim HS, Sacher F, Cochet H, Berte B, Yamashita S, Mahida S, Zellerhoff S, Komatsu Y, Denis A, Derval N, Hocini M, Haïssaguerre M, Jaïs P. Safety and prevention of complications during percutaneous epicardial access for the ablation of cardiac arrhythmias. Heart Rhythm. 2014 Sep;11(9):1658-65. doi: 10.1016/j.hrthm.2014.05.041

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