Percutaneous Cure of
Atrial Flutter Via Radio Frequency Ablation
by Alfonso
Estrada, M.D.
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Ablation, or the removal of a diseased or damaged body part or substance, is one of medicine’s most basic procedures. Advances in technology have allowed medical professionals to develop state-of-the-art procedures based on this simple technique. The fact that ablation is a common concept, however, doesn’t mean that today’s methods are simple or common.
One of the most recent developments is the use of radio frequency ablation to stop atrial flutter. Radio frequency ablation requires a thorough knowledge of electrophysiology and a skilled hand at cardiac catheterization.
When hearing the atrial flutter diagnosis, D.M. was relieved to learn that he had not suffered a heart attack, but he was also anxious to bring an end to his heart palpitations, shortness of breath, light-headedness and fatigue. (See Case Study) As a relatively young man, the prospect of taking side effect-laden antiarrhythmic drugs for the rest of his life was not appealing. This made him an ideal candidate for radio frequency ablation.
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Case
Study
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| Patient:
D.M., 59-year-old male from Evanston
History: Recurrent atrial flutter Symptoms: Dyspnea and fatigue Tests: ECG, echocardiogram Diagnosis: Atrial flutter-induced CHF Treatment: Radio frequency ablation of right atrial flutter circuit |
In order to permanently break the electrical short circuit that triggers atrial flutter, the circuit must be cut allowing normal sinus rhythm to prevail. This can be difficult because of the variability of the position of this short circuit from patient to patient.
Radio frequency ablation relies on careful tracking of the pathway of electrical impulses in the heart. To do this, catheters are inserted into the heart and positioned in multiple sites. (See Figure 1.) Once the precise location for the circuit is located, a radio frequency impulse generator is attached to the catheter and high frequency radio waves are emitted into the tissue. These radio waves create concentrated heat which is used to make the culprit tissue electrically inert and unable to transmit impulses, thus breaking the circuit. The catheter literally burns tissue causing a tiny scar of dead tissue and stopping the atrial flutter.
Figure
1:
Catheters placed in the right atrium and ventricle during ablation.
Theoretically, all patients with atrial flutter could be candidates for radio frequency ablation. However, a conservative approach reserves this procedure only for those with sustained or recurrent atrial flutter. It is especially useful in younger patients who otherwise face many decades of antiarrhythmic drug use.
As was the case for D.M., most patients are kept only overnight following radio frequency ablation and are able to return to work 2-3 days after discharge. Standard follow-up is simple—monitor the patient for a recurrence of symptoms. A holter monitor or other monitoring device may also be used.
The current success rate for radio frequency ablation used to stop atrial flutter, as defined by no recurrence after one year, is 75 percent. The risks involved equal that of cardiac catheterization.
In addition to relieving the patient of worry and symptoms, this procedure also reduces the number of visits to the cardiologist, making overall medical management easier and less costly.
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