Name of the Procedure:

Intracardiac Catheter Ablation of Atrioventricular (AV) Node Function and Atrioventricular Conduction for Creation of Complete Heart Block, with or without Temporary Pacemaker Placement

Summary

Intracardiac catheter ablation of the AV node is a procedure that uses radiofrequency energy to destroy tissue in the heart's AV node, which can help manage certain abnormal heart rhythms. This can lead to a complete heart block, requiring the temporary or permanent insertion of a pacemaker to regulate the heart’s rhythm.

Purpose

This procedure is used to treat abnormal heart rhythms (arrhythmias) that do not respond well to medication. By targeting the AV node, the procedure aims to stop the irregular electrical signals causing the arrhythmias and restore a normal heart rhythm.

Indications

• Recurrent supraventricular tachycardia not responsive to medication
• Atrial fibrillation with rapid ventricular response unmanageable by other means
• Patients who require control of ventricular rates but cannot tolerate medications

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Certain medications may need to be adjusted or stopped, as directed by the healthcare provider.
• Pre-procedure diagnostic tests may include an electrocardiogram (ECG), echocardiogram, blood tests, and electrophysiological studies.

Procedure Description

1. Insertion: A thin catheter is inserted through a vein in the groin and guided to the heart.
2. Electrophysiological Mapping: The cardiologist maps the heart’s electrical pathways to locate the AV node.
3. Ablation: Radiofrequency energy is delivered through the catheter to destroy the AV node tissue.
4. Creation of Heart Block: This leads to a complete heart block.
5. Pacemaker Placement (if necessary): A temporary or permanent pacemaker is inserted to maintain a regular heart rhythm.

Tools used include catheters, radiofrequency ablation equipment, and pacemakers. General or local anesthesia is often used to ensure the patient’s comfort.

Duration

The procedure typically takes 2 to 4 hours.

Setting

It is performed in a hospital, usually in a specialized catheterization lab or electrophysiology lab.

Personnel

• Cardiologist specialized in electrophysiology
• Nurses and lab technicians
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Common risks: bleeding, infection, bruising at the catheter insertion site
• Rare risks: injury to blood vessels, heart perforation, stroke, and the need for a permanent pacemaker if a temporary one is insufficient

Benefits

• Effective control of abnormal heart rhythms
• Improvement in quality of life due to symptom relief
• Reduced risk of stroke associated with certain arrhythmias

Recovery

• Patients are typically monitored in the hospital for 1-2 days.
• Post-procedure instructions include avoiding heavy lifting and strenuous activity for a specified period.
• Follow-up appointments are necessary to monitor heart function and pacemaker activity if one is placed.

Alternatives

• Medications to control heart rhythm and rate
• Electrical cardioversion
• Other types of catheter ablation targeting different areas of the heart

Pros and cons of alternatives depend on individual patient conditions and treatment responses.

Patient Experience

During the procedure, patients may feel some pressure but should not feel significant pain due to anesthesia. Post-procedure, some soreness at the catheter insertion site is normal. Pain management, including medications as needed, can help ensure comfort. Regular follow-up ensures the success of the procedure and proper management of any placeholders, such as pacemakers.