Trans-Catheter Ablation (Fluoroscopic Technique)
TRANS-CATHETER ABLATION (FLUOROSCOPIC TECHNIQUE)
Many rhythm disease are made by focal activation or re-entry circuits.
Fluoroscopic techniques use diagnostic catheters as anatomical and electrical reference and ablator as mapping/ablating tool.
Usually simple arrhythmias can easily cured by trained operators with a very little Xray exposure avoiding more complex mapping system reducing procedural time.
The main patholgies treated with fluoroscopic approach are:
Tipical Flutter (common and uncommon)
Focal Atrial Tachycardia
Focal Ventricular Tachycardia
Ablation is performed only after an examination of the electrical system of the heart (electrophysiological study – EPS) and treatment takes place in the same session.
Silicon catheters with a metal tip are positioned inside cariac chambers via femoral vein
(usually Right Atrium, His Bundle, Right Ventricular Apex and inside the main vein of he heart ,the Coronary Synus). These catheters are able to record electrical signals inside cardiac structures, by the observation of these signals the elecrophysiologist recognize the status of the conduction system of the heart. These catheters are able to erogate an electrical pulse, with the electrical stimulation of the heart we try to induce arrhythmias and to record them.
During the tachycardia the catheters show the exact activation sequence of the cardiac structures and make the precise diagnosys. If the arrhythmia originates in the left heart is necessary to take a femoral artery access or to perform a trans-septal puncture in order to locate the mapping/ablation catheter in that chambers.
Through this special catheter radio frequency is released heating the site of tachycardia iniziation or the critical site of the circuit sustainig the tachicardia producing small burns.
The patient can communicate the presence of any disturbance to the doctor who is performing the procedure, but it is very important to remain stationary to avoid catheter improper movements. After the ablation EP study is repeated and if no tachycardia can be induced and conduction system works physiologically the procedure terminates. The entire procedure take averagely 45-90 minutes.