Ablation is a procedure used to treat atrial fibrillation and other forms of arrhythmia. Arrhythmia occurs when the electrical charges that regulate heart rate become disorganized and are rerouted through errant pathways. The result is irregular, rapid or slow heart rate, depending on the type of arrhythmia. Ablation destroys the extra pathways so the electrical impulses can properly route through the heart. It is performed when a patient’s condition has not responded to medicine.
The most commonly performed ablation procedures fall into two categories: variations of the Maze procedure and catheter ablation.
The Maze procedure was developed to redirect electrical impulses in the heart that do not follow proper channels and, therefore, result in irregular heartbeat. The procedure creates strategically placed scar tissue lesions within the atria that electrical impulses cannot travel through. The lesions serve to redirect the impulses to intended pathways and to restore proper heart rhythm. There are three variations of the Maze procedure that are used to treat atrial fibrillation. They are:
- Cox-Maze procedure is an open heart procedure during which the patient’s chest is opened up and the heart is accessed via a major incision that cuts through the sternum (breastbone). Tiny incisions are made in the atria that heal to form lesions.
- Modified-Maze procedure
does not create lesions by making incisions but instead uses radiofrequency, cryothermy (extreme cold), laser, ultrasound or microwaves.
- Mini-Maze procedure
is an alternative for patients who don’t require additional open heart procedures. Surgeons are able to reach the heart through very small incisions made on each side of the patient’s chest. The surgeon attaches a tool that resembles a clamp to these extra pathways, found in the left upper left chamber (atrium) of the heart. The tissue between the teeth of this clamp is destroyed using ablation. The sites of the destroyed tissue to heal to form lesions.
There are three variations of catheter ablation therapy used to treat arrhythmia. Each of these types of ablation is minimally invasive. These procedures are performed through a thin, flexible tube that is inserted in an artery near the groin and threaded up into the heart.
uses a catheter with a cooling tip attached. This tip reaches sub-zero temperatures and freezes targeted cells and tissue on contact. This alters the cells, making them unable to conduct the heart’s electrical charges.
- Radiofrequency (RF) ablation
is a procedure that uses real-time fluoroscopy (x-rays) to visualize the route of the catheter and navigate it to specific cells. Once in place, a radiofrequency wave is emitted directly toward the desired tissue, destroying the disruptive cells. This wave is relatively painless.
- Robotic ablation (stereotaxis) uses computerized, magnetic technology to guide and navigate the equipment to the heart, allowing for precise placement. Once in place, this robotic equipment destroys damaged or affected tissue to restore normal valve function. Because the robotic catheter is very flexible and soft, there is a greater chance that the heart wall will not be damaged during the procedure.