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Heart rhythm disorders occur when the electrical impulses that coordinate heartbeats don't work properly. This disruption may cause the heart to beat too fast, too slow, or erratically. Individuals who suffer from a heart rhythm disorder may be able to undergo a procedure known as ablation to help remedy the issue.
“With an ablation, we’re trying to find the areas that are leading to one of the heart rhythm disorders the patient might be experiencing,” states Dr. Michah Roberts, an Electrophysiologist and Cardiologist at Dignity Health Bakersfield.
During the ablation procedure a catheter is inserted in the leg and then navigated up to the heart. The catheter is essentially a tube filled with wires. At the end, there is a tiny electrode that runs along the surfaces of the heart.
“We can actually measure electricity within the heart itself, on the inner walls. We're able to send electricity or radio frequency energy through this mechanism. Or, we can use a cooling catheter where we're able to cause the areas we touch with the catheter to not be able to conduct electricity,” explains Dr. Roberts.
The types of heart rhythm disorders that can be remedied via ablation are typically the “fast” heart rhythms, including:
The success rate, and length of efficacy, really depends on the type of heart rhythm disorder. SVTs and AVNRTs tend to be very successful, with a success rate of 96 percent or better—where one ablation can cure a patient from ever experiencing it again.
“There are 21-year-olds who come into my office with fast heart rhythms and it’s landing them in the ER on multiple occasions. We can do one procedure and cure it so they never have to deal with it again for the rest of their life,” shares Dr. Roberts. “Earlier today I did a procedure on an 83-year-old who had an SVT she's been dealing with for decades, but she finally decided she would be willing to go through the procedure. I think she's going to do quite well. So, there are certain heart rhythm disorders where we
think of it as very curative, and because it's safe, it is generally the first line option for management.”
Other heart rhythm disorders require ablation to be part of a greater management strategy; particularly atrial fibrillation (AFib). Patients with this disorder may experience a reoccurrence at some point in the future, post-ablation. However, Dr. Roberts assures the data is getting better and better for AFib ablations.
“For somebody who is dealing with a set of episodes multiple times a week, they usually look at it and say, ‘You know, you're giving me 18 months of life without having to deal with this. I'm on board.’ What we do know is that the efficacy of this ablation deteriorates over time. At about five years, some 50 percent of people have had a recurrence of atrial fibrillation. But, even those people have had far less incidents or episodes of AFib. And even when they do have it, they tend to tolerate it better.”
Ultimately, the decision to pursue ablation as a treatment option is up to the patient and their physician—and how debilitating the heart rhythm disorder is impacting the patient’s life.
Should patients wish to consider alternative options to ablation, such as medication, Dr. Roberts wants them to be fully informed about the potential side effects these medications may produce.
“Oftentimes, we put patients on medications such as a beta blocker or calcium channel blocker. These are drugs that are very safe and can help suppress some of the arrhythmias. But, they can also come with some side effects such as fatigue or weight gain, and they can slow down your heart rate. And, a lot of times they don't work,” he cautions.
More aggressive medications tend to change how electrolytes move in and out of the cells of the heart. This can disrupt how electricity moves through the heart—which can be a good thing for heart rhythm disorders. But, it can also push patients closer to where they could potentially experience a riskier arrhythmia.
“Patients, don't get me wrong. If these drugs are working, if the patients tolerate them and we think it's safe, then great, we will use them. But, it's actually really nice that over the last 10 years we've been able to do a lot more ablations to address these disorders and not use some of the drugs that classically come with some pretty serious side effects or on long-term risks,” assures Dr. Roberts.