Heart rhythm disturbances, i.e. heart arrhythmia in general, can be manifested by attacks of palpitations, fainting, a feeling of interruptions in the heartbeat or other, less characteristic ailments. Sometimes it is a symptom of a serious heart disease and sometimes it is only a painful symptom which does not mean any danger.
Arrhythmia originating in the upper part of the heart, the atria, is usually less serious, but can cause serious discomfort. The most common are irregular rapid heartbeats, which corresponds to atrial fibrillation, and regular palpitations, or supraventricular tachycardias.
Arrhythmia originating in the lower part of the heart – ventricles, can also be a mild arrhythmia, but is often caused by a significant heart disease and then the prognosis may be poor. The most common are single ventricular extrasystoles, perceived as extra beats and interruptions in the heartbeat, but sometimes there are attacks of ventricular tachycardia, which can be life-threatening.
A cardiac arrhythmia must be treated if it causes serious discomfort and makes life difficult, or if it threatens with serious complications, or even with deterioration of health or loss of life. Treatment may include removal of arrhythmic factors, administration of antiarrhythmic drugs, or ablation. Additionally, sometimes you need to implant a pacemaker or defibrillator.
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Pharmacotherapy
Antiarrhythmic drugs have been used for several decades and have an established place in the treatment of arrhythmias. The main disadvantage of pharmacotherapy is the fact that drugs do not eliminate the cause of arrhythmia, but can only suppress it, more or less effectively. This means that if the cause of the arrhythmia has not resolved, the drug must be used permanently, because if it is discontinued, the arrhythmia will, of course, recur.
Other disadvantages of antiarrhythmic drugs are often limited, incomplete effectiveness and the occurrence of side effects. These side effects can be harmless but bothersome leading to discontinuation of the treatment, but they can also be serious, including increasing the risk of death. Clearly, antiarrhythmic drugs are not the ideal solution for treating arrhythmias.
Ablation
Ablation, that is, removing the part of the heart muscle where the arrhythmia arises, is a much better option for treating arrhythmia than drugs. This invasive procedure allows in many cases to cure arrhythmia permanently, eliminate symptoms, reduce the risk of complications and eliminate the need to use antiarrhythmic drugs.
This procedure has been used in cardiology since the early nineties of the last century and consists in inserting electrodes (catheters) through veins or arteries into the heart and destroying the arrhythmia source by burning or freezing. Depending on the type of arrhythmia, efficacy ranges from nearly 100% for typical supraventricular tachycardia to 60-70% for atrial fibrillation.
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Eligibility for ablation
Preparing for the ablation procedure is usually simple and involves following your doctor’s instructions for maintaining or discontinuing your current medications and doing additional tests.
For such a visit, in addition to the above tests, you must take all the existing documentation, because it often turns out that one of the studies from the past gives a lot of important information.
This is the case, for example, in the case of a simple ECG recording – it often happens that one of the longest recordings is invaluable, because it was then that an arrhythmia was “caught”, which cannot be seen in other tests. If we have modern mobile devices such as smartphones or smartwatches, it is worth using them to record the heart rhythm during ailments, because then it is easier to capture arrhythmia and record it on an ECG.
Only then, “armed”, should we go to a cardiological consultation. If we do not have this set of tests, first of all, the doctor may not have sufficient data to make a decision about ablation, and moreover, if we go on a private visit, we run into costs, because after the first visit we have to do some additional tests and go for another consultation.
Remember that it is not only the doctor who requires us to complete tests and provide detailed data from the medical history, but we also require many important things from the doctor. Firstly, it is to determine whether there are indications for ablation and explain to us what the procedure involves. Second, it has to tell us what the chances are for success and what the risk of complications is. Third, he should know which center to refer us to and should issue a referral to the hospital.
The ablation procedure in Poland is reimbursed by the National Health Fund and there is no reason why we should bear the costs associated with the procedure. The quality of the procedures performed varies between centers (this is also the case in Poland and other countries) and we should ask our consultant who he recommends.
Unfortunately, in Poland there is no objective register of the effectiveness and safety of the ablation procedures performed. Therefore, it is worth visiting the websites of individual centers to search for information on this subject and consult other doctors and patients.
Remember to write down all the questions you want to ask on a piece of paper before visiting a doctor, because in the stress of talking to a doctor, we can forget about something important.
More information about the therapy on the website: https://www.dbamoserce.com/
Hospital stay
Ablation usually does not require a long hospital stay, depending on the type of arrhythmia, heart disease and comorbidities, and the organization of work in the ablation center. In the case of easy ablations (for example, typical supraventricular tachycardias) it may even be a day stay, in the case of more complicated procedures, we will spend 1-2 nights in the hospital.
Before the procedure, we must be on an empty stomach, sometimes a bladder catheter will be inserted, and the groin will be shaved, because at this point the operator will puncture the vessels through which the electrodes will lead to the heart. What happens during the procedure depends on the type of ablation.
The vast majority of ablation procedures in Poland are performed without intubation and general anesthesia, because in fact it is not necessary in most cases. But there are countries where most ablation procedures are performed under general anesthesia. General anesthesia has the advantage that we do not feel any discomfort during the procedure, but it extends the time and costs of the procedure, and prevents the doctor performing the procedure from having contact with us, so he may not always notice disturbing signals.
On the other hand, most common ablation procedures take no more than 1.5 – 2 hours, the pain of heating or freezing in the heart is usually not very great and is well suppressed by painkillers and tonics. However, you need to be prepared to lie down almost motionless for the entire duration of the procedure.
After ablation, we usually have to lie for 4-6 hours without bending the leg on the side where the punctures were made (if the punctures were made on both sides, then of course you do not bend both legs). But we can gently roll sideways and bend the other leg.
When we can leave the bed, remember that standing upright after lying for so long and often after a long break in taking fluids may cause a sharp drop in pressure and fainting. Therefore, you should stand up gradually and do not stand still for too long.
Post-hospital period
If it was a simple ablation and there are no significant heart diseases, then after 2-3 days we come to full form. However, you need to be careful about puncture sites in the groin, whether there is a hematoma or a large bruise, and whether there are any new heart ailments.
However, after difficult procedures performed in people with significant heart disease, convalescence may take longer, even 7-10 days. At the discharge from the hospital, we will receive instructions on how to proceed, what medications to take and what check-ups to perform to check the effectiveness of the ablation.
Most cardiac arrhythmias are ablative. If we want to get rid of the problem, we should choose ablation, not drugs.
More information at: https://www.dbamoserce.com/.
Author: Prof. dr hab. n. med. Piotr Kułakowski
Department of Cardiology, CMKP, Grochowski Hospital, Warsaw
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