33261 Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass

Name of the Procedure:

Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass
Common Name: Catheter Ablation Surgery
Medical Terms: Ventricular Tachycardia Ablation, Ablation Therapy with Bypass

Summary

Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass is a surgical procedure designed to treat abnormal heart rhythms originating in the ventricles. The surgery involves targeting and destroying small areas of heart tissue that are responsible for the irregular heartbeat, ensuring that the heart beats more regularly.

Purpose

Medical Condition: This procedure addresses ventricular arrhythmias, which are abnormal heart rhythms originating from the heart’s lower chambers (ventricles) and can be life-threatening if not managed.
Goals: The primary goal is to eliminate the source of abnormal electrical impulses, restore normal heart rhythm, and prevent complications such as sudden cardiac arrest or heart failure.

Indications

• Symptoms such as palpitations, dizziness, fainting, or shortness of breath related to ventricular arrhythmias.
• Patients with a history of heart attack or structural heart disease who are at high risk for ventricular tachycardia.
• Ineffectiveness of or intolerance to anti-arrhythmic medications.

Preparation

• Fasting: Patients may be required to fast for at least 6-8 hours before the procedure.
• Medications: Adjustments to existing medications, especially blood thinners. Patients may be advised to stop certain medications temporarily.
• Diagnostic Tests: Pre-procedure assessments including an electrocardiogram (ECG), echocardiogram, blood tests, and possibly a cardiac MRI or CT scan.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is completely unconscious and pain-free.
2. Incision: A small incision is made, typically in the groin area, to access a large blood vessel.
3. Catheter Insertion: A catheter is guided through the blood vessel to the heart.
4. Mapping: The heart's electrical activity is mapped to locate the arrhythmogenic focus.
5. Ablation: The arrhythmogenic focus is ablated (destroyed) using radiofrequency energy or cryotherapy.
6. Bypass: Cardiopulmonary bypass is initiated to support the heart and lungs during the procedure.
7. Completion: The catheter is removed, incisions are closed, and bypass support is gradually withdrawn.

Duration

The procedure typically takes between 4 to 6 hours.

Setting

The procedure is performed in a hospital setting, specifically in an electrophysiology lab or cardiac catheterization lab.

Personnel

• Surgeons: Cardiac surgeon or electrophysiologist.
• Nurses: Operating room nurses and circulating nurses.
• Anesthesiologists: Responsible for administering anesthesia and monitoring vital signs.
• Technicians: Specialized cardiovascular technicians and perfusionists to manage bypass equipment.

Risks and Complications

• Common Risks: Bleeding, infection, blood clots.
• Rare Risks: Stroke, heart attack, damage to blood vessels, arrhythmias induced by the procedure, complications related to anesthesia.
• Management: Immediate intervention by the surgical team for any complications.

Benefits

• Restoration of Normal Rhythm: Elimination of abnormal heart rhythms.
• Reduced Symptoms: Relief from symptoms such as palpitations and fainting.
• Prevention: Lower risk of sudden cardiac arrest and other complications.
• Timeline: Benefits are usually realized immediately but can sometimes take several months.

Recovery

• Post-Procedure Care: Patients are monitored in a hospital for a few days post-surgery.
• Instructions: Patients may need to avoid strenuous activities for several weeks and adhere to prescribed medications.
• Follow-Up: Regular follow-up appointments to monitor heart rhythm and overall recovery.

Alternatives

-Medications: Anti-arrhythmic drugs.

• Non-surgical: Catheter-based ablation without bypass.
• Devices: Implantable cardioverter-defibrillator (ICD).
• Pros and Cons:
  • Medications may have side effects and might not be effective.
  • Catheter ablation without bypass is less invasive but may not be suitable for complex cases.
  • ICDs prevent dangerous arrhythmias but do not cure underlying issues.

Patient Experience

• During Procedure: The patient will be under general anesthesia and will not feel or be aware of the procedure.
• Post-Procedure: Initial discomfort or soreness at the incision site, potential fatigue.
• Pain Management: Managed with prescribed pain medications and comfort measures to ensure a smooth recovery.