Today catheter ablation of rapid irregular heartbeat (tachyarrhythmia) is already a standard procedure for treating many forms of tachyarrhythmia. It is in fact the only way of completely curing a patient with rapid heartbeats, as medication can only subdue them to a certain extend. The success rate of treating atrial flutter, atrio-ventricular nodal re-entrant tachycardia (AVNRT) or WPW syndrome is higher than 90%. Thus, catheter ablation is the first choice therapy for these kinds of rapid heartbeats, because conventional medication often also has serious side effects.
Atrial fibrillation is the most common type of cardiac arrhythmia. Unfortunately, at present catheter ablation of atrial fibrillation provides a better treatment option than medication, but still does not achieve success rates comparable to other cardiac arrhythmias.
Depending on the underlying tachycardia one has to distinguish:
2. AV nodal reentrant tachycardia(AVNRT)
3. Focal atrial tachycardia
4. „Typical" Atrial flutter (right atrium)
5. Ventricular tachycardia
WPW syndrome is a congenital “short-circuit” between the atria and the ventricles which means that the AV node is simply bypassed. Thus, the pathway between the atrium and the heart chambers is interrupted. The chances of curing this condition are, depending on where the pathway is situated, higher than 90%. Only 3 out of 100 patients develop another arrhythmia in the first months after the successful treatment of the accessory pathway.
AV nodal reentrant tachycardia (AVNRT)
This is the most common supraventricular tachycardia. There are two functionally different electrical pathways in the AV node which sometimes produce extra beats more than once a day even in perfectly healthy humans. However, these two pathways can also develop a tachycardia. In order to prevent further rapid heartbeats, one of the two AV pathways is interrupted for treatment.
Chances of success: altogether 90%, in 3 of 100 patients, arrhythmia can begin anew in the first few months after successful treatment.
Focal atrial tachycardia
There is an increased disposition to deliver stimuli in the atrium. It is also possible that there are circular stimuli, especially after surgery in the atrium (esp. near scarred tissue). The prospects of an ablation of atrial tachycardia are between 70% and 90%, depending on how often stimuli are applied.
"Typical" atrial flutter (right atrium)
Atrial flutter results from a rapid reentrant circular excitation in the right atrium. This circular stimulus runs around the valve ring (tricuspid valve annulus) and passes a constriction between the valve and the inferior caval vein (vena cava inferior). Ablation tries to isolate this “bottleneck”. The chances of success with typical atrial flutter are about 90%. In 5 to 10% of at first successfully treated patients, arrhythmia can occur again, but very often this is atrial fibrillation.
Right ventricular outflow tract tachycardia, a special form of tachycardia, has an almost 90% chance of success for being cured if there is no previously existing organic heart disease. With such a preexisting heart disease, as for example a heart attack, the chances decrease to 40 to 75%.
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