Electrophysiological study and catheter ablation

Electrophysiological study and catheter ablation procedure

NORMAL CONDUCTION AND STIMULATION SYSTEM OF HEART MAY COMPROMISE DUE TO VARIOUS REASONS. SOMETIMES, CONGENITAL ACCESSORY PATHWAYS LEAD TO SHORT CIRCUITS, RESULTING IN ACCELERATED HEART RATE, ALSO KNOWN AS TACHYCARDIA.

Professor Fatih Duhan Bayran

The last two decades have witnessed significant developments in the diagnosis and management of arrhythmias, most people with an abnormal heart rhythm can lead a normal life if it is properly diagnosed. Diagnosing the type of the arrhythmias is the key to the treatment. Today, most of the advance heart centers use Electrophysiology studies (EPS) to test the electrical activity of your heart to find where an arrhythmia (abnormal heartbeat) is coming from. This can help doctors to decide whether patient needs medicine, a pacemaker, ICD, catheter ablation or surgery for arrhythmias. Cardiologist Professor Fatih Duhan Bayran M.D. explains heart’s electrical system and how to find and fix the problems of the rate or rhythm of the heartbeat with advanced methods.

What is the heart’s electrical system?

Our heart has an electrical conduction system that is similar to power network of a city. In fact, the stimuli signaled from the main center (sinus node), which is located at right atrium, pass an intermediary station (atrioventricular node) between atria and ventricles following a short latent time and ultimately they spread to the ventricles again via specialized conduction

For patients with complaint of palpitation (in the form of accelerated heart rate), the underlying cause of the complaint, the accelerated beats, is determined by generating stimuli using wires, which are advanced into the cardiac chambers using special methods (number of wires may vary between 2 to 4 wires depending on the aim of the study and type of the rhythm disorder).

means. Therefore, the electrical stimulation generated in the main center is conducted to all cardiac muscle (myocardial) cells and the heart is contracted.

Why do the disruptions occur in the heart’s electrical system?

Normal conduction and stimulation system of heart may compromise due to various reasons. Sometimes, congenital accessory pathways lead to short circuits, resulting in accelerated heart rate, also known as tachycardia. Moreover, extra-nodal stimulations can be emitted, which implies any signal arising out of any region of heart, excluding above specified main stimulation center, and thus, heart rate increases.

What is electrophysiological diagnosis method?

This diagnostic method, called electrophysiological study, investigates deviations by recording electrical signals directly on heart and by evaluating them after a catheter, also referred as electrode, is inserted through fine sheaths, which are inserted into the vessel located at inguinal and/or cervical region, to cardiac chamber(s). Thus, it is possible to understand whether main stimulation center of the heart and conduction systems function well.

Thus, if short circuit(s) is/are determined, punctuate energy is delivered with radio-waves and palpitation is completely eliminated. Or, if only one focus is responsible for palpitation, radio-waves are delivered and it is eliminated. This procedure is referred as catheter ablation. This method enabled elimination of most palpitations (tachycardia) permanently.

How does the electrophysiological diagnosis method affect the patient and how long does it take?

You may feel palpitation when test stimulations are emitted to the intra-cardiac chambers during electrophysiological study. Or, you may have the same feeling when palpitation, the original complaint, is induced with electrical

stimuli. Sometimes, external electrical shock can be required to correct palpitation, after tachycardia, rhythm is stimulated. You will not feel pain since you will be administered a sedative/ anesthetic agent before the shock is applied. Diagnostic electrophysiological studies last 30-60 minutes. If it is a therapeutic study, the procedure will possibly last 1-4 hour(s).

Is there any risk of electrophysiological diagnosis method?

Those procedures are generally associated with low risk. However, it does not mean that it is totally free of problems. The risk of death is very low. Although rare, pericardial effusion (deposition of fluid between layers of pericardium) may develop secondary to the rupture of myocardium. Again, therapeutic procedure may rarely block normal conduction system of the heart, while radio-waves are delivered, since the short circuit, the underlying cause of the palpitation, is located close to the normal conduction system. In this case, permanent placement of pacemaker may be required. Bleeding, subcutaneous hematoma and resultant swelling and pain may develop at puncture site in 2-3% of all cases. However, those complications do not lead to significant problems and they spontaneously resolve.

Are there any alternatives of electrophysiological diagnosis method?

Any other diagnostic method may not provide us with data which is obtained with electroCATHETER ABLATION IS A TREATMENT FOR RHYTHM DISORDER PERFORMED BY DELIVERING RADIOWAVES. THIS METHOD IS USED FOR TREATMENT OF RHYTHM DISORDER, IF RHYTHM DISORDER CANNOT BE CONTROLLED WITH DRUGS OR IF THE PATIENT DOES NOT WANT TO TAKE DRUGS FOR A LIFETIME. IN SOME CASES, RHYTHM DISORDER MAY BE SEVERE ENOUGH TO THREATEN LIFE.

physiological study. It is usually preferred when other diagnostic methods are insufficient.

What is catheter ablation; when and how is it applied?

Catheter ablation is a treatment for rhythm disorder performed by delivering radio-waves. This method is used for treatment of rhythm disorder, if rhythm disorder cannot be controlled with drugs or if the patient does not want to take drugs for lifetime. In some cases, rhythm disorder may be severe enough to threaten life. In such cases, catheter ablation method can be baseline option. The procedure can be carried out under local anesthesia, although some cases require general anesthesia. You will be administered sedative agents in order to feel comfortable during the procedure. You should rest without moving your legs for several hours in order to avoid bleeding.

What is the success rate of catheter ablation method?

Success rate of treating rhythm disorders (in the form of accelerated heart rate) with catheter ablation may vary between 70 to 95 percent depending on type of palpitation and localization of short circuit. Success implies lack of recurrence. Rate of recurrence varies depending on the type of rhythm disorder, after palpitation is successfully treated. The rate is around 5-8% for palpitations which are secondary to short circuits in heart.

The secret enemy of women: Deep endometriosis

DEEP ENDOMETRIOSIS ACCOUNTS FOR 10-20% OF ALL ENDOMETRIOSIS CASES AND IT MAY LEAD TO SEVERE DAMAGE IN THE INVOLVED ORGANS ALONG WITH THE SEVERE PAIN; THEREFORE, IT MAY BE NECESSARY TO REMOVE A PART OF THOSE ORGANS SURGICALLY.

Professor Mete Güngör

Professor of Gynecology, Obstetrics and Gynecologic Oncology Mete Güngör warns that the women suffering from severe menstrual pain and painful intercourse should necessarily visit a doctor in order to prevent the damages that can be potentially caused by deep endometriosis.

Endometriosis implies growth of the endometrium – the interior lining of the uterine wall – anywhere other than the womb. It is divided into two groups; superficial and deep. The endometrial tissues growing on the peritoneum, the outer surface of the ovaries and the fallopian tubes are referred to as “superficial endometriosis”.

It may cause irreversible damage in organs!

The most significant sign of endometriosis is the severe pain that usually occurs during the period and sexual intercourse, it is felt in the abdomen or the groin and impairs the quality of life. The pain may be independent from the menstrual cycle, if it progresses into a chronic form in time. Deep endometriosis accounts for 10-20% of all endometriosis cases and it may lead to

“Deep endometriosis” is defined as endometriosis lesions that have penetrated into the peritoneum more than 5 mm, have also involved intestinal and bladder wall, formed painful nodules, invaded the nerves and led to adhesions, resulting in impaired anatomy of the organs in the region.

severe damage in the involved organs along with the severe pain; therefore, it may be necessary to remove a part of those organs surgically.

Colon: It may cause severe pain during defecation, constipation and gas complaints secondary to obstruction in colon. Urinary bladder and ureters: It may cause hematuria (blood in urine) and dysuria (painful voiding associated with feeling of burn). Moreover, it may lead to kidney failure by obstructing the ureters. Ovaries and fallopian tubes: When the ovaries and the fallopian tubes are involved, these organs become totally dysfunctional, resulting in infertility. Nerves: It may, sometimes, lead to extremely severe pain and dysfunction, when the nerves located in pelvic region are involved.

Surgery is a must in deep endometriosis

Emphasizing that treatment of the endometriosis varies depending on the severity of the disease, symptoms and future pregnancy plan of the patient, Professor of Gynecology, Obstetrics and Gynecologic Oncology Mete Güngör says “Endometriosis can be managed with medication treatment, surgery or both modalities. However, the patient should be operated on to

eliminate adhesions of organs, obstructions and damages, even if medication treatment may alleviate the pain in endometriosis”.

It may be as difficult as cancer surgery

Highlighting that the surgical management of deep endometriosis may, sometimes, be as challenging and complex as the cancer surgery, Professor Mete Güngör adds “Therefore, when surgical treatment is decided, it is very crucial that the surgery is performed with closed techniques by the surgeons, who are experienced in management of this condition, in order to protect the fertility and hormonal functions and reduce the possibility of recurrence”.

Laparoscopic or Robotic-assisted surgeries increase the success

Deep endometriosis may cause adhesions between pelvic organs, such as womb, ovaries, ENDOMETRIOSIS CAN BE MANAGED WITH MEDICATION TREATMENT, SURGERY OR BOTH MODALITIES.

colon, urinary bladder and ureters, and obstruction of the digestive and urinary tracts. In the surgery, it is necessary to ensure patency of these organs without any damage, remove the irreversibly obstructed segments of the digestive or urinary tract and to anastomose them end-to-end. Meanwhile, the nerves should not be injured in order to maintain functions of the organs and the ovaries should be protected; finally, it is necessary to restore this body part such that a potential future pregnancy can be achieved. Professor Mete Güngör specifies that these surgeries should, therefore, be performed with minimally invasive techniques, namely laparoscopic or robotic-assisted surgery, in order to see the anatomy more closely and clearly and adds that those techniques will increase success rates of the surgeries and offer major advantages, such as quicker recovery, milder pain, less bleeding and ability to resume daily life earlier.”