| < back to Medication Therapy for IST Invasive (non-medication) Therapy Non-drug treatment is very much last resort and is not reversible, the complications associated with these invasive treatments are not insignificant. The treatments include Sinus Node Modification, Sinus Node Ablation or Complete AV Node Ablation. Alongside the warnings about complications and possible recurrence of IST after Ablation - lets not forget why we consider having these procedures - to make us feel better! To give us our lives back! The Sinus Node Ablation / Modification does work in some patients! With such powerful reasons/motives for having the procedures it is especially important to be aware of all details. Ablation Treatment An Ablation is performed as part of the EP Study - see tests. An EP study is a type of cardiac catheterisation where the heart's electrical system is studied from inside the heart. During this test, one or more catheters (thin flexible tubes) are inserted into a vein in your groin or sometimes in other places (under collar bone or neck). X-rays are used to gently guide the catheters into the right positions in the heart. The catheters sense the electrical activity in the heart and can also be programmed to stimulate different areas of your heart to try to 'induce' or kick-start any abnormal rhythms you may be having. The areas of the heart generating abnormal heart rhythms can be located. The EPS is performed by a team of one or more electrophysiologists, specialised cardiac technicians, radiographers and cardiology nurses. Once the area responsible for generating the abnormal rhythm is found then ablation can often be performed, often with good success rates, and low complication rates. RF (radiofrequency) ablation for the arrhythmia called AVNRT has a >95% success rate. Procedures for IST however have higher complication rates and lower sucess rates (you can ask your electrophysiologist for more detail on this). It is very important to remember that in IST these procedures are usually reserved for patients with severe symptoms and disability due to their symptoms, or rarely, the person with heart muscle that may have been damaged by a prolonged rapid heart rate. These procedures are NOT reversible and your Electrophysiologist must carefully explain any procedure and any potential risks and complications with you before you consider or agree to any procedure. Sinus Node Modification Selective ablation of the Sinus Node (i.e. the electrophysiologist will not try to destroy the entire function of the sinus node, but leaves a portion intact). Certain parts of the sinus node produce faster heart rates than others. This allows the electrophysiologist to ablate (destoy) the parts producing the fastest rates (usually at the top, central part of the sinus node), leaving the other parts of the node intact; which, in theory, should mean the patient won't need a pacemaker; (this is called a Sinus Node Modification). Sinus Node Ablation If the Sinus Node Modification procedure does not work or is not considered suitable then a Complete Sinus Node Ablation may be performed. In this procedure, the Electrophysiologist will attempt to completely destroy the function of the Sinus Node and to then implant a permanent pacemaker to take over the function of the Sinus Node. Complete AV Node Ablation If the Sinus Node Modification and / or Complete Sinus Node Ablation does not work then a Complete AV (atrio-ventricular) Node Ablation may be performed. The AV Node is the junction where signals from the atria (the upper heart chambers) are passed to the ventricles (the lower heart chambers). In this procedure, the Electrophysiologist will attempt to completely destroy the function of the AV Node, thus severing the electrical connection between the upper and lower chambers. This is called Complete Heart Block or 3rd Degree Heart Block. A permanent pacemaker is then implanted to pace the ventricles (i.e. stimulate the lower chambers to beat, and then cause a contraction). After this procedure you will be dependent on your pacemaker to live. Potential Complications There are some general complications associated with EP Studies and Ablation, these include : MAJOR RISKS: heart block (with need for a Permanent Pacemaker); cardiac arrest, heavy bleeding, damage to the heart wall (causing a condition called a cardiac tamponade - this is life-threatening) The risk of death during an EP study is very very small. MINOR RISKS : minor bleeding where the catheter is inserted, heart rhythm disturbances and changes in blood pressure; (please discuss this in detail with your cardiologist / electrophysiologist). Complications specific to (or more common with) IST ablations include : Need for a Permanent Pacemaker (due to destruction of the Sinus Node); Phrenic nerve paralysis (paralysis of the nerve that controls the diaphragm, muscle of breathing); SVC (superior vena cava) syndrome (obstruction of the main vein to the top part of the heart). More detailed information on Ablation treatments for IST > |
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| The content of this page was last modified at 02:46 GMT Wednesday 20th July 200 |
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