This page is courtesy of Florida Electrophysiology Associates; The leader in the Southeast United States in complex catheter ablation procedures
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Dr. Fishel holding an ablation catheter. Dr. Fishel specializes in catheter ablations of all cardiac arrhythmias and for over the past 10 years has been the leading physician in the entire state of Florida in the number of catheter ablation procedures performed (Medicare Medpar data as of last update for 2009). He is considered one of the leading physicians in the United States in ablations for atrial fibrillation and is a worldwide training site for other electrophysiologists wishing to perform this procedure.
"SVT" stands for supraventricular tachycardia. SVT is a rhythm disorder which involves the upper chambers of the heart ("supraventricular" means above the ventricles or lower chambers). SVT is extremely common and unlike other types of heart disease affects people of all ages. Babies can be born with SVT (and even have it in the womb). SVT can also develop later in life and in many people first becomes evident in the late teens or twenties.
When someone has SVT, their heart rhythm goes out of control and suddenly starts racing. heart rates greater than 220 beats per minute are not unusual during an attack. An SVT attack can in many patients occur without warning and strike at any time. During these attacks the patient becomes short of breath, weak, lightheaded and can have chest pain. Passing out spells can also occur. During an SVT attack, once the heart starts racing patients can occasionally terminate the attack by engaging in certain maneuvers which resets the heart. These include bearing down, holding one's breath or splashing cold water in the face. In many patients however nothing can be done to stop the episode short of calling 911 and going to the emergency room. In the ER, doctors can terminate the abnormal rhythm with intravenous medications and even at times will use an electrical shock from the paddles.
SVT is the result of an abnormal region of electrical conduction in one of the two upper chambers of the heart. This extra nerve causes the normal electrical impulses in the heart to travel in a vicious circle between the normal electrical system and the extra nerve. The heart essentially shorts out during an episode of SVT. Episodes can be very debilitating and permanently alter the life of the affected patient.
An illustration of an "accessory" pathway or extra nerve in the heart
There are several different types of SVT. The technical names of some of the more common types include;
No matter the type, patients basically have two options for treating recurrent SVT. One is lifelong medical therapy. Numerous drugs are available to treat SVT, many which are relatively safe to take for long periods of time. Unfortunately, all drugs have side effects and ultimately about 50% of patients treated with medical therapy will need to stop the medication either due to side effects or due to failure of the drug to control SVT. Medical therapy also is a long term proposition; once the medications are stopped SVT invariably returns.
An alternative option is catheter ablation. During an SVT ablation, catheter are inserted into the veins in the groin and run into the heart. The electrical system of the heart is mapped with these catheters. Once the abnormal extra nerve is identified, the steerable ablation catheter is positions on top of the abnormal electrical pathway. Radiofrequency energy is than delivered cauterizing the nerve and eliminating the heart's ability to enter the abnormal rhythm. The patient's heart is than tested to be certain that after the ablation, SVT can no longer be brought on. The tubes are than removed and usually later that day the patient is discharged home.
Patients who undergo successful ablation for SVT are permanently cured of their heart rhythm problem. Medications for this problem are no longer needed and patients can usually resume their usual activities 1-2 days following the ablation. The success rate for SVT ablations at Florida Electrophysiology Associates exceeds 90% of all patients operated on.
This procedure is generally safe and in most patients is performed on an out-patient basis. As with all invasive procedures however, it's not entirely risk free. Complications occur in under 1% of patients but can include the need for a permanent pacemaker in a very small percentage of patients (<1 in 400) and other rare complications such as bleeding, stroke or adverse reaction to medications. The typical ablation is performed with mild sedation and local anesthesia to the groin site. Typically, an ablation takes under 90 minutes but in some cases can be finished in 30 minutes or last up to three hours.
Patients who successfully undergo catheter ablation are generally very very happy patients. Most of these individuals were troubled by recurrent SVT for years prior to the ablation and had their lifestyles permanently changed as a result of having to live with the treat of SVT. After SVT ablation, these patients often describe a new sense of energy and freedom.
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