What is catheter ablation?

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What is Catheter Ablation?

Catheter ablation is a minimally invasive procedure that uses energy (most commonly radiofrequency) delivered through a catheter to destroy specific areas of heart tissue responsible for generating or maintaining cardiac arrhythmias. 1

Mechanism and Technique

The procedure works by creating well-demarcated ablative lesions at the catheter-tissue interface through the application of continuous-wave unmodulated radiofrequency energy that heats the myocardium. 1 This allows for very specific and focal energy delivery, which permits the cure or modification of many arrhythmias through two primary mechanisms:

  • Targeting the specific site of origin of the arrhythmia (such as atrial tachycardia or ventricular tachycardia) 1
  • Interrupting a critical pathway needed for the maintenance of a reentrant arrhythmia (such as an accessory pathway in Wolff-Parkinson-White syndrome or the slow pathway in AV nodal reentrant tachycardia) 1

Historical Evolution

Catheter ablation initially used high-energy direct current (DC) shocks in the early 1980s, but these procedures had significant limitations due to barotrauma and carried risks of cardiac tamponade and sudden death. 1 Technological advancements in the late 1980s led to radiofrequency energy delivery, which has now completely replaced DC energy and has supplanted open-heart surgery for several arrhythmias. 1

Clinical Applications and Success Rates

The procedure has grown tremendously since its inception, with annual procedures in the U.S. increasing from 450 in 1989 to 15,000 by the mid-1990s. 1 Success rates vary by arrhythmia type:

  • AV node ablations: 97% success rate 1
  • Accessory pathway ablations (all locations): 90% success rate 1
  • AV node modifications for AV nodal reentry: 94% success rate 1
  • Atrial flutter: 72% success rate 1
  • Atrial tachycardia: 71% success rate 1

For ventricular tachycardia in scar-related heart disease, catheter ablation decreases the likelihood of subsequent ICD shocks and prevents recurrent VT episodes. 1, 2

Safety Profile

While complications are relatively uncommon, they can be serious. Overall complication rates include:

  • AV node interruptions: <4% 1
  • Accessory pathway ablations: 2.6% 1
  • AV node modifications: 1.7% 1
  • Flutter and atrial tachycardia ablations: 1.6% 1

Serious complications can include valvular disruption, coronary occlusion, cerebrovascular accident, and death. 1 Procedural deaths occur in 0.2% of patients undergoing AV node ablation and 0.1% of patients with accessory pathways. 1 The most common complication in AV node modification is inadvertent complete heart block (4.7% overall, with higher rates when targeting the fast pathway at 5.3% versus 2% for slow pathway). 1

Current Role in Treatment

Catheter ablation has become the treatment of choice for some arrhythmias and an important alternative to long-term drug therapy for others. 1 It is particularly valuable for:

  • Urgent situations: Class I recommendation for patients with scar-related heart disease presenting with incessant VT or electrical storm 1
  • Recurrent ICD shocks: Class I recommendation for patients with ischemic heart disease and recurrent ICD shocks due to sustained VT 1
  • Drug-refractory arrhythmias: When antiarrhythmic medications fail, are not tolerated, or the patient prefers not to take long-term medications 1, 3

The procedure requires specialized training, with operators needing to perform at least 100 diagnostic electrophysiology studies per year to maintain competence. 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Scar-Related Ventricular Tachycardia (VT)

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

Radiofrequency Ablation Success Rates and Considerations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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