Electrophysiological Study and Ablation Method of Rhythm Disorders

Our heart has a system similar to the electricity grid of a city. In fact, the stimuli originating from the main center (sinus node) in the right atrium, after passing through an intermediate station (atrioventricular node) located between the atria and ventricles, with a short delay, are again spread to the ventricles by specialized conduction pathways. Thus, the electrical impulse produced in the main center is transmitted to all heart muscle cells and causes the heart to contract.

Disruptions may occur in this normal warning and conduction system of the heart for various reasons. Sometimes, additional congenital pathways can cause short circuits in conduction, causing rapid heartbeats, which we call tachycardia. In addition, sometimes stimuli outside the control of the heart’s main warning center mentioned above may arise from any part of the heart and cause rapid beats.

What is the electrophysiological diagnosis method?

With the help of the diagnosis method called electrophysiological study, the electrical signals received directly from the heart with the help of thin wires called catheters, which are passed through thin sheaths placed in the groin and / or neck through the veins, are evaluated by means of advanced computers, and deviations from normal are investigated. In patients with palpitations in the form of rapid beating most of the time, the causes of rapid beats, which are the cause of the patient’s complaint, are created with the stimuli given from these wires (2-4 pieces according to the purpose of the study and the type of rhythm disorder) placed in the heart with special methods. Thus, if the presence of short circuits is detected, the flutter is completely treated by giving point energy with radio waves. Or, if a focus that creates the flutter is detected, it is eliminated by giving radio wave energy. This is called catheter ablation therapy (BURN OR FREEZE). In this way, permanent treatment of most palpitations in the form of rapid heartbeat (tachycardia) has become possible today.

You may feel palpitations when test impulses are given from inside the heart during electrophysiological study. Or, you may feel a similar feeling when palpitations, your main complaint, are caused by the stimuli given to the heart. Sometimes it may be necessary to give an external electric shock to correct the rhythm in the form of rapid beat after stimulating it. Before giving the shock, you will not feel pain because most of the time you will be given drugs to put you to sleep.
Electrophysiological examinations for diagnostic purposes take 30-60 minutes. If a therapeutic intervention is required, this is a procedure that can take up to 1-4 hours.

These transactions are basically low-risk applications. However, as with any transaction, it can bring some problems. The probability of death is very low. Rarely, fluid may leak between the pericardium due to the perforation of the heart muscle during the procedure. Again, rarely, during therapeutic procedures (ablation), because the short circuit that causes palpitation is very close to the normal stimulation system of the heart, blocks may occur in the conduction system of the heart during radio wave energy administration. In such cases, permanent pacemaker implantation may be required.

Data obtained by electrophysiological study cannot be obtained by any other diagnostic method. It is often used when other diagnostic methods are insufficient.

What is catheter ablation, when and how is it applied?

Catheter ablation is a rhythm disorder treatment by giving radio waves. This method is applied in rhythm disorders that cannot be controlled with drugs or if patients do not want to take drugs for life. In some cases, the rhythm disturbance can be so significant that it can be life-threatening. In such cases, direct catheter ablation may be required. The procedure is basically performed under local anesthesia by numbing the needle entry points, and in some cases under general anesthesia. You may be given a sedative medication to make you feel comfortable during the procedure. To prevent bleeding after the procedures, you should lie down for a few hours without moving your legs.

What is the success rate of the catheter ablation method? 

The probability of success in the treatment of rhythm disorders in the form of rapid beating of the heart with catheter ablation varies between 70-95%, depending on the type of palpitation targeted for treatment and the location of the short circuit. Success is understood as the treatment of palpitations never to happen again. The probability of recurrence of palpitations after successful administration varies according to the type of arrhythmia. For example, this probability is between 5-8% in palpitations due to short circuits in the heart.

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