Cardiac Arrhythmia Ablation

What is Ablation?

Depending on the findings at the electrophysiological study (EPS), it may be possible to ablate the mechanism of the arrhythmia. Ablation is a procedure to treat some types of rapid heartbeats.

This is usually done at the same time as the EPS as the necessary catheters within the heart are already in place. Ablation may be performed using a suitable energy source, by introducing an additional catheter capable of delivery the chosen type of energy.

How do I prepare for Ablation?

Please refer to the section on EPS on how you would prepare for the procedure.

Why is Ablation performed?

The potential benefits and risks of an ablation procedure depend on the nature and complexity of your arrhythmia.

You will find more information on treatment options and ablation procedures for specific types of arrhythmia in the next sections.

What energy sources are used for ablation?

Three different energy sources are commonly available for ablation:

  1. Radiofrequency (RF). Radiofrequency is a low power, high frequency energy that causes a tiny region of the heart near the tip of the catheter to increase in temperature, thus ablating a small area of tissue. Radiofrequency has been used for decades by surgeons to cut tissue or to stop bleeding. For the treatment of arrhythmia, a much lower power of radiofrequency is used. Radiofrequency is a well-established method with a long and successful track record. It allows for precise control over the ablation area to within millimetres of accuracy, offering optimal versatility to treat almost any arrhythmia suitable for ablation. However, the heat generated can potentially damage nearby structures. Depending on how much and where ablation is required, it can be time-consuming, requiring a very high degree of skill and experience.

  2. Cryotherapy (cryo). Cryotherapy uses extreme cold to freeze and destroy the abnormal heart tissue. The cold energy is less likely to damage surrounding tissues compared to heat, and may therefore be safer. However, this comes at the expense of a small reduction in long term success rate of ablation of some arrhythmias. Thus, it is usually only selected where the proximity of critical neighbouring structures is approximately under 1-2 millimetres. The duration of freezing necessary to cause a similar amount of ablation is usually longer than the duration of heating required, making procedures longer, except when specialised equipment (cryoballoon) is used to treat atrial fibrillation.

  3. Pulsed Field Ablation (PFA). Pulsed Field Ablation uses short bursts of high-energy electrical fields to create pores in the cell membranes, leading to cell death in the targeted area. It is currently used primarily for ablation of atrial fibrillation. It is believed to be incapable of inadvertent damage to surrounding structures like the gullet, nerves, or pericardium (heart sac) since the electrical fields can specifically target heart muscle while sparing other tissues. Pulsed Field Ablation procedures are typically fast, due to the very short burst required to achieve ablation.