Arrhythmia is a heart disorder in which the heartbeat rate or rhythm is irregular—too slow, too fast or completely chaotic. Arrhythmias are caused by a problem in the internal electrical system of the heart that is responsible for controlling its rate and rhythm. Arrhythmias can be divided into two categories:
- Ventricular Arrhythmias
- Supraventricular Arrhythmias
Before the great advancements in medical science, open-heart surgeries were the only option for the treatment of life-threatening arrhythmias. Today, however, we have much faster, safer and more effective modalities for abnormal heart rhythm. Two of the best, minimally invasive treatment options for Arrhythmias include Catheter Ablation and Pacemakers.
Catheter Ablation Therapy
Catheter ablation, also known as radiofrequency ablation, is a procedure that utilizes radiofrequency energy to get rid of the heart tissue that is responsible for causing fast and irregular heartbeats. Once the tissue is destroyed, your heart’s normal rhythm can be restored. Your cardiologist or electrophysiologist will recommend catheter ablation under the following circumstances:
- When you have difficulty tolerating medicines or they have been proven to be ineffective in treating your arrhythmia.
- Even if medicines are able to control the arrhythmia-causing abnormal heart tissue, the doctor may recommend a catheter ablation to destroy the tissue.
Why Catheter Ablation?
Some unique cells in our heart are responsible for creating electrical signals that travel along a set pathway to the heart’s upper and lower chambers helping it to beat in a normal sequence. Abnormal cells or tissues in the heart may create disorderly electrical impulses leading to rapid and irregular heartbeats known as arrhythmias. These disorganized electrical signals hinder the heart’s activity in pumping blood effectively and cause symptoms such as fainting, shortness of breath, fatigue, weakness and heavy pounding of heart.
Though most people respond well to medicines to control fast and irregular heartbeats, it may not work for everyone and even cause side effects in some people. In such cases, the cardiologist may suggest you catheter ablation. Catheter ablation is most often used in the treatment of supraventricular tachycardia (SVT), atrial flutter and atrial fibrillation.
- Your doctor may instruct you not to eat or drink anything for at least six to eight hours before the procedure.
- Inform your doctor about the medicines you are taking at least a day before the procedure.
- Remember to leave your jewelry at home and arrange someone to drive you home after the procedure.
Usually, a catheter ablation procedure is carried out in an electrophysiology or catheter laboratory by specialist doctors supported by a team of nurses and technicians.
- An intravenous line (IV) is inserted into a vein in your arm to inject an anesthesia in your body to prevent pain. If you are nervous, your doctor may also give a sedative to help you relax.
- Then, the nurse will clean and shave the area where the catheter is to be inserted. This is usually the groin area. Also, local anesthesia is given to numb the needle puncture area.
- The doctor will puncture your skin with a needle and reach a vein or artery in your groin. First, a sheath, a small tube sized like a small straw, is inserted into the blood vessel.
- Then, the doctor will gently guide a catheter (long thin tube) into the blood vessel through the sheath. Your doctor will use the video screen to position the catheter correctly. Though you may feel some pressure, you won’t feel any pain.
- Then, the doctor inserts electrode catheters (long, thin tubes with wires) through the sheath and inserts these tubes into your heart. To activate and locate the abnormal tissue in the heart, the doctor will send a small electrical impulse through the electrode catheter while other catheters record the heart’s electric signals to locate the affected site.
- Finally, once the exact location of the abnormal tissue is located, the doctor will send a mild and painless radiofrequency energy to the abnormal cells. This allows the doctor to destroy the culprit cells in a very small area of the heart without damaging other tissues. Once the abnormal tissues are destroyed the unstable impulses causing rapid and irregular heartbeats also stop.
- After the procedure, you’ll be taken to a recovery room where you have to lie flat until the sheath is removed.
- After the sheath is removed, a nurse will put pressure on the puncture site to stop the bleeding.
- You will be asked to keep your leg straight for six to eight hours after the sheath is removed. Meanwhile, your heartbeat and vital signs will be carefully monitored.
- You must inform the doctor or nurse if you experience any chest pain or swelling, bleeding and pain at the site where the puncture is made.
- Your doctor may prescribe aspirin for 2-4 weeks to avoid clots at the ablation site.
A pacemaker is a small battery-operated device that helps restore the heart’s regular rhythm. The device is divided into two parts that include a generator and set of wires. The generator is battery-powered and it produces the electrical impulses required for the heart to beat.
- A pacemaker is placed under your skin through a small incision and connected to the heart through tiny wires.
- The pacemaker imitates the heart’s natural pacemaker and sends impulses to the heart at regular intervals through the wires.
- Some pacemakers can also be worn externally (without surgery) for short intervals of time.
You are generally recommended a pacemaker to make your heart beat more uniformly in case your heart rate is too slow, too fast or too irregular.
You’ll need to undergo several tests before receiving a pacemaker to ensure that your condition warrants a pacemaker or it is the right choice for you. The following tests are performed by your cardiologist/ electrophysiologist:
- Echocardiogram – A process that uses sound waves to measure the thickness and size of your heart muscle.
- Electrocardiogram – A test that measures your heart’s electrical signals by placing sensors on the skin.
- Holter Monitoring – A device that tracks your heart rhythm for 24 hours.
- Stress Testing – A procedure that monitors your heart rate while you exercise.
Once the doctor decides that a pacemaker is right for you, he will give you the following instructions to prepare:
- The night before your surgery you should not drink or eat anything after midnight.
- Instructions on the medicines you need to stop and the ones you need to take.
- Your doctor may also advise you to shampoo and shower well before the procedure. That is done to avoid infections after the surgery.
Once you are ready for the procedure, you will be given a local anesthesia to numb the site of incision and perhaps a sedative to relax you. However, you’ll be awake during the procedure. The process takes usually 1 to 2 hours.
- Your surgeon will make a small incision close to your shoulder and guide a small wire into a major vein near the collarbone. From there the surgeon will push the wire through the vein to the heart.
- The entire process is guided by an X-ray machine. Once the wire reaches the heart, the surgeon will attach an electrode to the right ventricle in the heart while the other end is attached to a pulse generator.
- The pulse generator contains the battery and circuits and will be implanted under your skin, close to the collarbone. In case the surgeon thinks that you require a biventricular pacemaker, he will attach another lead (wire) to the right atrium in your heart.
- Finally, after the procedure, the incision is closed with stitches.
- After the implant procedure, you can go home in the evening or stay overnight for better monitoring.
- Your doctor should ensure that your pacemaker is programmed according to your heart’s needs.
- Remember your pacemaker can also be reprogrammed if the results are not as expected.
- You will be advised to avoid rigorous exercises and heavy lifting. Your doctor may prescribe medications to provide pain relief or other discomforts. The amazing thing about your pacemaker is that your doctor can analyze it without you having to visit your doctor.
- Just hook your pacemaker to your phone using a special equipment and it will allow your surgeon to receive information about the status of the pacemaker. This follow-up consultation is done once every few months.