There are times when the insertion of a pacemaker or an implantable cardioverter defibrillator is not necessary to treat an arrhythmia. Montefiore Medical Center has been a forerunner in the development and advancement of ablation techniques.
Ablation is an option when an electrophysiology study shows that the arrhythmia is starting from a specific point in the heart. At this point, it is possible for the cardiologist to ablate – or remove – that area. There are different methods of ablation that can be performed to correct the problem area.
During this procedure, thin, flexible wires called electrode catheters are introduced through vessels in the groin and guided to problem areas of the heart. Cardiologists direct a continuing low level of radio frequency at the area causing the problem. In most cases, cauterizing the problem area will put an end to abnormal rhythm.
In this procedure, the surgeon uses a telescope; special minimally invasive instruments, which are inserted through three small holes on either side of the chest cavity; and in some cases, robotic assistance. The pulmonary veins are electrically isolated with either microwave energy or radio-frequency energy applied to the outside of the heart. Multiple ablation lines are created, if needed, and the left atrial appendage is removed. As a result, anticoagulant medications can be eliminated in select patients.
The heart must be stopped during this procedure, requiring patients to be placed on a heart-lung machine for the duration of the surgery. With robotic assistance, the operation can be performed through a five-centimeter incision between the ribs of the right chest cavity. The surgeon makes small cuts in the heart, resulting in a maze-like formation of scar tissue that blocks abnormal electrical impulses, while creating corridors where the appropriate electrical impulses can travel. In this way, communication between the nodes that control the heart rhythm is restored, and the heart returns to a normal beat. During the procedure, the left atrial appendage is also completely removed, eliminating the need for medication to prevent blood clots.
Regardless of the procedure, follow-up visits are necessary to go over the results, determine if you can stop taking heart rhythm medications, and discuss the next steps if new or returning symptoms occur.