Catheter Ablation for Arrythmias

The doctors at the Cedars-Sinai Heart Institute have extensive experience with catheter-based radiofrequency ablation, which is a procedure that uses heat energy to eliminate abnormal electrical pathways in the heart and restore normal heart rhythms. State-of-the-art technologies are being used to treat rhythm disorders at the Cedars-Sinai Heart Institute.

During an ablation procedure, a local anesthetic is used to numb the legs at the crease where the leg attaches to the pelvis. Small needles are placed into the veins of the right and left legs, and a series of small tubes are inserted into the veins. Wires are then passed through the tubes and guided to the heart using fluoroscopy (X-rays). The arrhythmia is induced and carefully mapped using different modalities of three-dimensional electroanatomic mapping systems.

Three-dimensional electroanatomic mapping system used for the diagnosis and treatment of cardiac arrhythmias.

Once the abnormal pathway or area causing the arrhythmia is found, electrical energy is applied to the pathway through the catheter to eliminate the arrhythmia.The procedure can be performed either as an inpatient or outpatient service.

Our team of heart rhythm specialists has many years of experience in treating complex rhythm disorders and using state-of-the-art technologies to treat arrhythmias. A multidisciplinary team approach assures that all aspects in the diagnosis, treatment and follow-up of our patients are taken care of.

Ablation for Atrial Fibrillation

Catheter-based ablation techniques can be used in the treatment of atrial fibrillation. Rapid electrical impulses begin in the upper chambers of the heart. The goal of ablation procedures is to isolate these areas of rapid impulses. Years of research have shown that the areas most responsible for these impulses are areas around the pulmonary veins that drain blood from the lungs into the heart. By isolating these regions with radiofrequency ablation, episodes of atrial fibrillation can be stopped or significantly decreased.

With extensive experience in the field, our heart rhythm doctors specialize in treating complex cases in which previous ablation procedures have failed. One of our heart rhythm specialists will perform a detailed evaluation before deciding the specific treatment strategy recommended for a specific case.

Ablation for Ventricular Tachycardia

Radiofrequency ablation may be used to destroy any small, abnormal area of the ventricles that an electrocardiogram (ECG) identifies as the site where an abnormal rhythm originates. When radiofrequency energy is delivered to the target, it can decrease the frequency of abnormal heart rhythms. This can be successful for patients with a history of heart attacks and scarred areas of the heart. This is also used with high success rates for patients with normal hearts who have these ventricular rhythm disturbances.

3-D electroanatomic mapping system used to diagnose and treat ventricular tachycardia.

Our team of specialists uses state-of-the-art technologies (pictured above) to treat complex, recurrent cases for which prior therapies have failed. After a careful evaluation, a decision is made about the therapeutic modality recommended for a given case.

Ablation for Supraventricular Tachycardia

Catheter ablation can be used to treat recurring episodes of supraventricular tachycardia. Catheter ablation focuses on burning abnormal electric impulses, and can eliminate episodes of supraventricular tachycardia and the need for further medication. This is a highly effective treatment for different forms of supraventricular tachycardia, including atrioventricular nodal re-entrant tachycardia, Wolff-Parkinson-White syndrome, atrioventricular re-entrant tachycardia, atrial tachycardia and atrial flutter. Our heart rhythm specialists have been involved in the development and study of treatment modalities for supraventricular tachycardia that are now used worldwide.

A tachycardia is a type of heart rhythm disorder in which the heart beats faster than normal (more than 100 beats per minute). "Supra" means "above," so a supraventricular tachycardia is an abnormally fast heartbeat that originates in the atria, which are the upper chambers of the heart.

Symptoms of Supraventricular Tachycardia

The rapid heart rate of supraventricular tachycardia usually starts and ends abruptly. It can last anywhere from a few minutes to several hours. It is usually felt as an uncomfortable palpitation of the heart, but can also include other symptoms, such as:

  • Chest pain
  • Lightheadedness
  • Shortness of breath
  • Weakness

Usually, the heart is otherwise normal.

Causes and Risk Factors of Supraventricular Tachycardia

Supraventricular tachycardia may be caused by an abnormality, such as having:

  • Abnormally rapid impulses generated in the atria. This uncommon condition is called paroxysmal atrial tachycardia
  • An abnormal electrical pathway between the upper chambers of the heart and the lower chambers, called an accessory pathway or bypass tract
  • Two electrical pathways in the atrioventricular node

Young people are more likely than older people to experience supraventricular tachycardia.

Treatment for Supraventricular Tachycardia

Several methods can be used to stop supraventricular tachycardia by stimulating the vagus nerve, which slows the heart rate. These are usually performed by a doctor or under a doctor's supervision, but people who frequently have this problem can learn to perform the methods themselves, including:

  • Plunging the face into a bowl of ice-cold water
  • Rubbing the neck just below the angle of the jaw to stimulate an area on the carotid artery
  • Straining as if having a difficult bowel movement

These methods are most effective when performed soon after the irregular heartbeat or arrhythmia starts.

Medical intervention to control arrhythmia is needed if:

  • The above methods are ineffective
  • The episode lasts more than 20 minutes
  • Symptoms are severe

A doctor can usually stop an episode by giving an injection of a drug. If the arrhythmia does not stop and symptoms are severe, electrical cardioversion may be necessary. This procedure uses an electrical current to reset the heart's rhythm and is performed under sedation.

Although drugs such as betablockers and digoxin are used to prevent arrhythmias and may be prescribed to help prevent future episodes, radiofrequency ablation is often performed to destroy the tissues where supraventricular tachycardia starts, as this is highly curative. The ablation procedure begins with a diagnostic electrophysiology study (figure below) to carefully map the origin of the arrhythmia, followed by treatment by delivery of radiofrequency energy in a precise area determined during the diagnostic study.

Electrophysiology study with intracardiac recordings performed to diagnose and treat supraventricular tachycardia.

Our team of heart rhythm specialists has extensive experience in treating and following patients with these conditions.

Selected ablation publications from our specialists:

Jackman WM, Wang X, et al. Catheter ablation of accessory atrioventricular pathways (Wolff–Parkinson–White Syndrome) by radiofrequency current. N Engl J Med. Jun 6, 1991;324(23):1605-11.

Shehata M, Liu T, Joshi N, Chugh SS,Wang X. Atrial tachycardia originating from the left coronary cusp near the aorto-mitral junction: anatomic considerations. Heart Rhythm. Jul 2010;7(7):987-91.

Liu X, Liu T, Shehata M, Nahapetian A, Amorn A, Chugh SS, Wang X. Spontaneously alternating forms of atrioventricular node re-entrant tachycardia. Pacing Clin Electrophysiol. May 2011;34(5):e43-6.Epub 2011

Liu E, Shehata M, Liu T, Amorn A, Cingolani E, Kannarkat V, Chugh SS, Wang X. Prevention of esophageal thermal injury during radiofrequency ablation for atrial fibrillation. J Interv Card Electrophysiol. Oct 2012;35(1):35-44

Liu E, Shehata M, Swerdlow C, Amorn A, Cingolani E, Kannarkat V, Chugh SS, Wang X. Approach to the difficult septalatrioventricular accessory pathway: the importance of regional anatomy. Circ Arrhythm Electrophysiol. Jun 1, 2012;5(3):e63-6.

To make an appointment with one of our heart rhythm specialists, please call (310) 248-6679.

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