What is ablation?

Radiofrequency ablation is commonly known as radiofrequency ablation. There are many types of diseases that can be treated clinically, such as atrial flutter, atrioventricular reentrant tachycardia, premature beats, etc. Dissolution surgery is different from general treatment methods. For many patients, it is difficult to understand the professional technology. Understanding the treatment principles will help us use it better. So, what is ablative surgery? Let’s take a look below.

Introduction to the surgery

Cardiac radiofrequency ablation is an interventional technology that delivers an electrode catheter into a specific part of the heart cavity through a vein or artery, releasing radiofrequency current to cause local endocardial and subendocardial myocardial coagulative necrosis, thereby blocking the abnormal conduction bundle and origin point of rapid arrhythmia. The radiofrequency current introduced into the heart cavity via a catheter causes damage in the range of 1-3 mm and will not cause harm to the body. Radiofrequency ablation has become the most effective method for curing paroxysmal tachycardia. Basic equipment includes X-ray machine, radiofrequency ablation device and intracardiac electrophysiological examination equipment.

Indications for surgery

1. Atrioventricular reentrant tachycardia (preexcitation syndrome): There is a congenital "access pathway" between the atria and ventricles. Catheter radiofrequency will "cut off" the access pathway, and tachycardia or preexcitation waves will no longer exist.

2. Atrioventricular nodal reentrant tachycardia: The atrioventricular node forms a "dual pathway". Under appropriate conditions, the current runs rapidly in the reentrant loop formed by the two pathways, causing tachycardia. Catheter radiofrequency ablation of the slow pathway leaves only the fast pathway, and tachycardia no longer has the conditions for an attack.

3. Atrial flutter (AFC): Atrial flutter is a large loop in the atria, in which the electric current keeps circling. The atria beat at 250-350 beats/minute, and the ventricles generally beat at 150 beats/minute. Catheter radiofrequency can destroy the loop, causing bidirectional current block, thereby curing atrial flutter.

4. Atrial tachycardia (AT): AT is a condition in which there is an abnormally rapid "excitation point" in a certain part of the left or right atrium that releases electric current, or a small reentrant movement in the atrium; electrophysiological examination maps the ectopic "excitation point" or reentrant circuit, and ablation is performed to achieve a cure.

5. Ventricular premature contraction (premature beat): mainly used for frequent ventricular premature beats with obvious clinical symptoms from a single source; often caused by ventricular "excitation focus"; after mapping and ablation of the ectopic excitation focus, the ventricular premature beat can disappear.

6. Ventricular tachycardia (VT): including idiopathic, bundle branch reentrant and scar ventricular tachycardia. Idiopathic ventricular tachycardia is common in people with normal cardiac structure and function and no evidence of organic heart disease, but frequent attacks of tachycardia can cause tachycardia-induced cardiomyopathy; it occurs when an "excitement focus" in the right or left ventricular outflow tract and left ventricular septum rapidly discharges current, leading to tachycardia. By finding the "excited focus" through a catheter and delivering radiofrequency current for ablation, ventricular tachycardia can be cured. Bundle branch reentrant ventricular tachycardia and scar ventricular tachycardia are more common in patients with organic heart diseases such as dilated cardiomyopathy, coronary heart disease and congenital heart disease after surgery. Patients may experience fainting and convulsions during an attack and often require emergency rescue. Bundle branch reentrant ventricular tachycardia is a reentrant circuit ("circling") between the left and right conduction bundle branches of the heart and the left and right ventricles. The catheter electrode finds and delivers radiofrequency current to block the circuit. Scar ventricular tachycardia is caused by the reentrant circuit produced by the surviving myocardial cells between the fibrous scar tissue of the heart. By delivering radiofrequency current to block the circuit, the tachycardia can also be cured. Radiofrequency catheter ablation can cure ventricular tachycardia but cannot cure heart disease; when ablation is unsuccessful or the ventricular tachycardia attack is life-threatening, an implantable cardioverter defibrillator (ICD) should be implanted to prevent sudden death.

7. Atrial fibrillation (AF): AF is the most common persistent cardiac arrhythmia. Studies have found that AF is triggered by the release of rapid electrical impulses from the "myocardial sleeves" on the large veins connected to the atria. In addition, the persistence of AF is also related to the remodeling of the atria themselves. The use of catheter electrodes to ablate the circumferential pulmonary vein openings to create "electrical isolation" between the large veins and the atria, or combined with certain linear ablations within the atria, can achieve the goal of curing atrial fibrillation.