Ablation is a recognised, safe and effective method of treatment for most recurrent cardiac arrhythmias. It is a recognised alternative to long-term pharmacological treatment and it is generally more effective. In many types of arrhythmia, ablation is curative, while in some other types, it provides a considerable symptom reduction. The effectiveness of ablation is mainly determined by the type of arrhythmia being treated. Some patients may require a repeat procedure in the future.
During the ablation procedure, areas of the heart that cause arrhythmia are destroyed or isolated from healthy heart tissue. This is achieved with a special steerable electrode which is inserted by the doctor into the heart through a catheter placed in the patient’s blood vessel (most commonly, the femoral vein or femoral artery) or, less commonly, the pericardial sac if the source of the arrhythmia is located on the outer surface of the heart. Ablation is preceded by a precise search for the sources of arrhythmia at sites where abnormal electrical waves arise and from which they spread.
At Medicover Hospital, we carry out heart ablation both as commercial procedures and procedures paid for by the National Health Fund (NFZ).
We treat all types of recurrent cardiac arrhythmias, including:
- Paroxysmal and persistent atrial fibrillation
- Atrial flutter
- Supraventricular tachycardias (atrioventricular nodal re-entrant tachycardia [AVNRT], atrioventricular re-entrant tachycardia [AVRT], recurrent atrial tachycardia [AT])
- Ventricular tachycardias (post-MI ventricular tachycardia and other ventricular tachycardias, such as those associated with cardiomyopathies, developing after surgery for valvular heart disease, idiopathic). We also provide interventional treatment for recurrent ventricular tachycardias (the so-called electrical storms) to patients with implantable cardioverter–defibrillators.
- Ventricular arrhythmias in patients without structural heart disease (extrasystoles from the ventricular outflow tracts and from other locations)
- Pre-excitation syndromes (Wolff–Parkinson–White syndrome, Mahaim syndrome etc.)
During the procedure, the doctor navigates the electrode into the site that causes the arrhythmia. This is achieved based on ECG signals recorded from other diagnostic electrodes, indications of a special navigation system (CARTO 3, En Site Precision) and X-ray images. Ablation is carried out using a radiofrequency (RF) current whose flow through the ablation electrode heats up and coagulates the tissues that are in contact with the electrode tip. It is also possible to carry out cryoablation, which involves freezing the tissue that is in contact with the cryoablation electrode.
Patient eligibility for the procedure is checked during an appointment with one of Medicover Hospital’s cardiac surgeons. Although no additional tests are required before the consultation, it is always a good idea to bring to the consultation: a resting ECG, an ECG or Holter ECG tracing that captures the patient's arrhythmia, a recent echocardiogram report, and all the other medical records (test reports, hospital discharge summaries). A pre-anaesthesia consultation, if necessary, takes place after patient admission to the Ward.
The procedure is most commonly carried out under local anaesthesia delivered to the area of the skin around the femoral vessel puncture site through which the electrodes are inserted, and under intravenous conscious sedation. Certain complex procedures are carried out under general anaesthesia with the anaesthetist present. The duration of hospital stay is between 1 and 3 days. The patient resumes daily activities after several hours of remaining in the lying position. The blood vessel punctures heal within 1–2 days. Resuming activities that involve heavy lifting (mainly isometric exertion, such as lifting weights) is possible within 4–6 weeks in cases of simple ablation and within 2–3 months in cases of difficult ablation of complex arrhythmias.
What does the ablation procedure look like?
After arrival at the treatment room, the patient is connected to a number of devices that monitor their vital signs (ECG, pulse oximeter, multiple blood pressure measurements using a blood pressure cuff). The duration of the procedure varies (between about 1 and 8 hours, 2 hours on average). During the procedure, the patient is required to lie still on their back. Sedatives and painkillers given into the vein are used to reduce the associated discomfort. Both groin regions (and sometimes the neck) are disinfected and covered with sterile drapes. The doctor then numbs these regions with an anaesthetic injection and inserts into blood vessels special tubes called vascular sheaths. Usually 2 or 3 vascular sheaths are inserted via the femoral veins and sometimes also via the femoral artery. Occasionally, vascular access is gained via the internal jugular vein or subclavian vein. Then, through those sheaths, flexible steerable electrical wires, the so-called electrodes, are advanced into specific sites in the heart. The electrodes are then hooked up to a computer, which allows to assess the electrical function of the heart and precisely locate the sites where the patient's arrhythmia originates. The sources of arrhythmia can be located in various parts of the heart. If the sources of arrhythmia are located in the left atrium or left ventricle, it may be necessary go gain access to those sites by creating a small opening in the septum that separates the atria using a long needle covered by a sheath, which is inserted through the femoral vein. During the so-called electrophysiology study (EP study), which precedes ablation, the heart is artificially stimulated to beat faster, which is often perceived by patients as palpitations or rapid heart rate. Various drugs are often administered during the procedure to check their effect on heart function. Sometimes it is necessary to administer radiographic contrast to visualise the heart structures. After the necessary tests have been carried out, ablation is performed by applying radiofrequency current. The number of applications may vary. Because these are sometimes painful, the patient is given painkillers into a vein. In some cases, electrical cardioversion (interruption of an arrhythmia by means of a defibrillator) is necessary, which means that a brief general anaesthesia will be required.
How to prepare for the ablation procedure?
The patient must not eat or drink for 6 hours before the procedure. However, if the patient takes any regular medication, they can—after consulting their doctor—take it with a little water. During the pre-procedural period, the attending physician may change the way patient takes their anticoagulant and antiarrhythmic medications. Approximately 12 hours before the procedure, both groin regions should be thoroughly shaved, as the vascular sheaths will be inserted in these areas, followed by the electrodes. The patient should have a bath or shower before the procedure.
We encourage you to read the informational and educational material “Akcja Ablacja” (akcjaablacja.pl), prepared, for instance, in Medicover Hospital with the participation of our experts. You will find there some practical information on various aspects related to substrate ablation for atrial fibrillation.
Why choose the Cardiology Department at Medicover Hospital:
- We are one of the most dynamical and experienced electrophysiology centres in Poland performing substrate ablations for cardiac arrhythmias. We carry out several hundreds of such procedures per year.
- We treat all types of cardiac arrhythmias regardless of the type.
- Our doctors have many years of experience in performing electrophysiology procedures, which they have gained at leading institutions in Poland and abroad.
- We perform radiofrequency (RF) ablations and cryoablations (point and balloon cryoablations), and use state-of-the-art intracardiac navigation systems: CARTO 3 and EnSite Precision.
- We have a 10-bed Cardiac Intensive Care Unit (each bed with full monitoring) for patients who have undergone invasive cardiac procedures and require intensive care.
- We have permanent facilities in the Intensive Care Department and Cardiac Surgery Ward, which enables us to treat the most severe cases and provide a complete range of treatments in the event of complications.
At Medicover Hospital, substrate ablation for cardiac arrhythmias are carried out by experienced specialists:
Ablation workshops at Medicover Hospital
From 2017 to 2021, we organised the International Ablation Workshop together with the Institute of Cardiology in Warsaw. It is the largest educational and scientific event of its kind in our country, attended by the following state consultants in addition to practising doctors from Poland and abroad: national and regional consultants in cardiology, international experts and numerous professors. The ablation procedures performed during the Workshop are broadcast live to the conference room. Workshop participants have the opportunity to participate interactively in procedures and interact with the electrophysiology team on a real time basis. The workshop also includes lectures on the latest developments in electrophysiology.
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