An Actual Ablation Procedure

JamesKnellerMD

Here is a rather technical and detailed video of what an ablation procedure looks like in real life. Not just a graphical representation.

This is an ablation for paroxysmal AFib (which is intermittent AFib before it becomes persistent). Hence they are just ablating (blocking the electrical impulses) around the pulmonary veins.

WARNING: this is very graphical and may be disturbing to some. Also it may be somewhat technical.

However, if you really want to get an idea of what an ablation ‘looks like’, and how safe and controlled they are, then this might be of interest to you.

Atrial fibrillation (AFIB) is the most common sustained cardiac arrhythmia encountered in clinical practice. The burden of AFIB as well as awareness of this condition has increased dramatically in recent years. AFIB can be effectively treated with a procedure known as catheter ablation. This procedure is usually performed under general anesthesia – meaning the first thing the patient knows is that the procedure is over! Patients usually spend one night over night in hospital and go home on the day following the procedure.

While the patient is asleep, catheters are advanced through the large veins to the heart, arriving in the right atrium (RA). The majority of AFIB arises from the left atrium (LA). To access the LA, transseptal puncture must be performed, so catheter can be advanced across the very thin wall separating the RA from LA. Within the LA, the priority is then to perform pulmonary vein isolation (PVI). The PVs can produces bursts of abnormal electrical activity, inducing episodes of AFIB. Catheter ablation is therefore performed around each of the four PVs, to achieve electrical isolation from the remainder of the LA. Durable PVI is the backbone of all ablation procedures for AFIB.

When the pattern of AFIB is paroxysmal (short episodes of AFIB that come and go), only PVI is performed. When the pattern of AFIB becomes persistent (episodes Lasting weeks to months), additional ablation targets may be addressed in addition to PVI. Tremendous progress in catheter technology and the evolution of electroanatomic mapping systems have made AFIB ablations far more safe and successful. In this video, we are using the CARTO mapping systems and catheters from Biosense Webster.