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Radiofrequency Catheter Ablation
ℹ️ About Radiofrequency Ablation (RFA)
- Uses a catheter tip that delivers heat (~65°C) to myocardial tissue ⚡🔥.
- Thermal injury causes protein denaturation, coagulative necrosis, and local cell lysis ➝ destroys abnormal conduction pathways.
- Applied via femoral/jugular venous access; fluoroscopy and 3D mapping often used.
- Typical procedure duration: 2–4 hours ⏳.
- Curative in many supraventricular arrhythmias ➝ often preferable to long-term drug therapy.
🩺 Indications
- Accessory pathways (e.g. WPW) and AV re-entrant tachycardias.
- AV nodal re-entrant tachycardia (AVNRT).
- Atrial flutter and focal atrial tachycardia.
- Atrial fibrillation ➝ pulmonary vein isolation (PVI) 🌬️.
- Ventricular tachycardia (esp. scar-related VT post-MI).
- AV nodal ablation with pacemaker back-up (for refractory AF with rapid ventricular response).
⚠️ Complications
- Pericardial effusion ➝ cardiac tamponade 💧❤️.
- Oesophageal-atrial fistula (rare but catastrophic, esp. after AF ablation) 🥵.
- Complete heart block ➝ may require permanent pacing ⚡.
- Vascular access site complications (bleeding, haematoma, pseudoaneurysm).
- Pulmonary vein stenosis (specific to AF ablation).
- Stroke / systemic embolism 🧠.
💡 Teaching Pearl: RFA is most effective (>90% success) for re-entrant SVTs like AVNRT/WPW. In AF, success depends on careful pulmonary vein isolation, but repeat procedures are common. Always weigh procedural risk against benefit - particularly in older or frail patients.
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