Radiofrequency ablation of the heart (RFA): technique, reviews and cost

The physical basis of the RFA method

The term "ablation" comes from Latin ablatio and denotes the process of evaporation of a substance from the surface of a solid body under the influence of radiation and a stream of hot gas.

Cardiac catheter ablation is the use of alternating current of radio frequency energy with a power of 300 to 750 kHz. Under its influence, certain parts of the heart are destroyed. The resource for it is a standard electrical generator that produces an unmodulated bipolar current of a set frequency. Energy acts between the active end of the catheter, supplied to the desired point of the myocardium, and the external adhesive electrode located on the left side of the chest or lower back. Destruction of tissue occurs by burning it. Thus, the necrotic area loses the ability to generate impulses.

Indications and contraindications

Radiofrequency catheter ablation is used in cases where the patient is unable or unwilling to take antiarrhythmic drugs for a long time, or drug therapy does not bring a positive effect. Indications - such violations of the heart rhythm:

• monomorphic ventricular tachycardia (persistent and episodic);
• atrial fibrillation and flutter with a high frequency of contractions;
• ventricular premature beats;
• sinoatrial and AV nodal reciprocal tachycardia;
• atrial ectopia;
• Wolff-Parkinson-White syndrome (WPW).

The method is as safe as possible, with a small number of absolute contraindications. These include:

• severe renal failure;
• electrolyte disturbances;
• blood clotting disorders;
• high blood pressure;
• significant narrowing of the mitral valve opening;
• hypersensitivity to contrast agent;
• acute infectious diseases and high body temperature;
• the first days of acute myocardial infarction;
• decompensation of heart failure.

Ablation is considered ineffective in case of arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy.

However, each condition is individual, and the doctor decides on the appropriateness, the balance of benefits and harms of the procedure, having carefully studied the anamnesis and the results of the patient's examination.

Procedure technique

Radiofrequency ablation of the heart provides for a mandatory electrophysiological study (EPI). It is done in the operating room of a specialized center or an equipped cardiac dispensary. The intervention does not require anesthesia, since the procedure is minimally invasive and does not foresee incisions or severe painful sensations. The patient is sedated, treated with the desired parts of the body. Then the femoral, subclavian or jugular vein is punctured through the skin. Sometimes the femoral or radial artery is used. A guidewire and catheter are inserted long enough to reach the desired heart chamber. After the electrode hits the right place and is connected to a special device, electrical discharges are given, which stimulate intracardiac signals. The computer evaluates and displays the heart's response to the stimulus. Thus, the doctor recognizes foci of ectopic excitement (those parts of the myocardium that trigger arrhythmia or tachycardia). During EPI, the patient experiences an unpleasant tingling sensation, palpitations, fading or somersaults. Don't worry, though, as this is a response to stimulation.

When the problem focus is found, the actual radiofrequency ablation is done. The affected area is exposed to a stream of high-frequency energy. Then EFI is re-done in order to assess the effectiveness of treatment. If the result is positive, the operation is completed, the patient is transferred to the ward for further observation.

How the operation goes, see the video below.

Complications after execution

Like any intervention in the body, the postoperative period and long-term consequences are characterized by a number of complications. They are mainly caused by trauma to adjacent organs and tissues.

Let's consider some of them:

1. Thermal damage to the phrenic nerve, which is anatomically located near the superior vena cava and the right superior pulmonary vein. It is asymptomatic, but some people may experience shortness of breath, coughing.
2. Damage to the vagus nerve leads to a feeling of fullness in the stomach, bloating, possibly impaired gastrointestinal motility.
3. Damage to the esophagus, the formation of fistulas is manifested by pain when swallowing, fever, and inflammatory changes in the blood.
4. Violations of the integrity of blood vessels (hematomas, arteriovenous fistulas, pseudoaneurysms, bleeding).
5. Pericardial effusion and cardiac tamponade are life-threatening conditions (potential risk of any surgery).
6. Hypervolemia of the pulmonary circulation. In patients with heart failure and low myocardial contractility, hypervolemia is manifested by signs of stagnation: shortness of breath, unproductive cough, palpitations.
7. Pulmonary vein stenosis. The first signs appear after six months, which is confusing to doctors. Shortness of breath, cough, hemoptysis, frequent pneumonia are noted.
8. Thromboembolism due to the formation of intracardiac blood clots.
9. Death. Fatal outcome is extremely rare, but it is possible with a severe somatic condition of the patient.

Recovery after intervention

Rehabilitation after RFA of the heart begins immediately when the patient is transferred to the general ward. For the first six to eight hours, bed rest is shown; you cannot bend the leg where the artery was used to insert the electrode. A pressure bandage is applied to the puncture site. These measures are aimed at preventing the development of bruising in the thigh. Water and moderate intake of light food are allowed the next day after the procedure.

Sometimes there is a repeated breakdown of the rhythm, which should not be regarded as ineffectiveness of the operation. The heart needs to recover, the affected areas need to heal. In order to maintain the correct rhythm in the early postoperative period, antiarrhythmic drugs are prescribed. In the hospital, they start taking anticoagulants to prevent blood clots.

After discharge, rehabilitation continues at home. For the first couple of days, it is recommended to protect yourself from colds, do not play sports, and get more rest.

After three months, the result of RFA is assessed and further tactics are determined. The doctor cancels antiarrhythmics, anticoagulants (if indicated, therapy is extended to a year or more). In the future, there are no restrictions, the person returns to work and daily life.

Reviews of radiofrequency ablation

Reviews of cauterization of the heart with arrhythmias are mostly positive from both cardiologists and patients, which confirms the effectiveness of the method. However, remember: RFA is only suitable for certain pathologies of rhythm disturbances, and this is the key to the success of its implementation. Most of the procedures end with a positive result and significantly increase the duration and quality of the patient's life.

RFA operation cost

The cost of moxibustion in the treatment of cardiac arrhythmias depends on the institution in which it is done. If a patient goes to a specialized research institute, you can always get a check for a lower amount than in a private clinic. Depending on the conditions, only the cost of consumables and drugs is paid, or, having entered the queue under the state program, they wait and receive medical assistance free of charge.

Today, the price of the operation itself ranges from 20,000 to 900,000 rubles, depending on the city, clinic and exchange rate. The amount is added to the preoperative test package and hospital stay, if the institution is private.

Life after ablation

After ablation of the affected foci or the mouth of the pulmonary veins, it is recommended to adhere to the following principles:

1. A balanced diet with the elimination of trans fats, a decrease in consumption of saturated fatty acids. Most of the diet consists of fruits and vegetables, not meat products. Limit salt to a teaspoon per day.
2. Alcohol within reasonable limits. A complete rejection of alcoholic beverages is not required, 20 g of alcohol per day for men and 10 g for women is considered acceptable.
3. To give up smoking. Nicotine constricts blood vessels, which causes an increase in pressure, oxygen starvation of the myocardium and ischemia.
4. Caffeine acts like cigarette smoke.
5. Regular physical activity. Running, swimming, walking, cycling has a positive effect on the cardiovascular system. It is preferable to do an incline to cardio training, rather than power loads.
6. Control of blood pressure and related diseases.

If you follow a healthy lifestyle, the body is completely restored, the risk of repeated disruptions in the rhythm decreases, the prognosis for a speedy recovery and active longevity is improved.

Conclusions

Catheter ablation of the heart using radiofrequency energy is widely used in modern arrhythmology. The operation provides for high efficiency in the treatment of ventricular and atrial disorders, minimal mortality. The patient does not need long-term rehabilitation, after a few days his health returns to normal, he returns to his usual activities. The only disadvantage of the procedure is the high cost and inaccessibility for some patients.