Abnormal heart rhythms (cardiac arrhythmias) are extremely common causes for people to seek medical advice. There are a large number of different types of arrhythmia ranging from harmless ‘extra beats’ (ectopics) to dangerous arrhythmias such as life-threatening ventricular tachycardias or complete heart-block. Recognizing and treating the different types of rhythm disturbance is a specialized branch of cardiology known as cardiac electrophysiology.
Many rhythm problems can be helped by drugs, but increasingly the best treatment is to cure the electrical fault by catheter ablation. This entails passing special wires through the blood vessels to the heart and exactly locating the point in the heart from which the abnormal electrical signal is coming. This point is then inactivated either by heating (radiofrequency ablation) or freezing (cryo-ablation).
One of the fastest growing indications for catheter ablation is to treat atrial fibrillation. I established the Atrial Fibrillation Ablation Program in Plymouth in 2004. We have a full range of ablation equipment in Plymouth including the St Jude Velocity and Biosense CARTO 3 mapping systems, Contact Force sensing ablation catheters, Arctic Front Advance Cryoablation balloons and Hybrid ablation approaches. Our results are continuously carefully audited and are in line with the best reported in worldwide surveys (Presentation – 46MB PowerPoint download). In a recent survey of my peers in the field of cardiac electrophysiology I was selected as one of the most recommended doctors in the UK.
From 2013 to 2020 I collaborated with Sir Malcolm Dalrymple-Hay Clinical Director of Cardiothoracic Surgery in Plymouth to start a 2 stage surgical and catheter ablation approach known as Hybrid Ablation which was designed for patients with the hardest to treat types of Atrial Fibrillation, most of whom have ‘Longstanding Persistent Atrial Fibrillation’. In February 2020 we published the results from the largest series of patients treated with this approach (European multicentre experience of staged hybrid atrial fibrillation ablation for the treatment of persistent and longstanding persistent atrial fibrillation). Thanks to recent developments in the field of catheter ablation and the results from randomised trials in the field, it is now possible to achieve the same approach through catheter ablation alone, avoiding the need for the more invasive surgical approach. I recently presented the lecture (see video clip below) on this approach ‘Left atrial posterior wall isolation’ at the UK Heart Rhythm Congress September 2020.
Ablation of a Persistent Left Atrial Tachycardia
Electrical wavefront circling around the left atrial chamber around the mitral valve opening resulting in a heart rate of 160 beats per minute.
Before…..
After…..
After radiofrequency ablation – a line of electrical block has been made with closely spaced RF points on the inside wall of the chamber. The circuit can no longer turn around the mitral valve opening and pacing from an electrode close to the base of the valve shows the electrical wavefront travelling from the base of the chamber and blocking on the line, then spreading around the back of the chamber and coming to a halt at the line of block. The next paced beat is then stimulated from the same electrode.
(All images taken from procedures by GH and the ablation team during 2022)