Radiofrequency Ablation in Hyderabad

How Does Radiofrequency Ablation Work?

The heart's rhythm is controlled by electrical impulses that travel along specific pathways through the heart muscle. In arrhythmias, abnormal electrical circuits, accessory pathways, or ectopic foci (rogue firing points) generate disorganized impulses that override the normal rhythm.

In radiofrequency ablation, thin flexible catheters are advanced through veins in the groin to the inside of the heart. These catheters have sensors at their tips that both record electrical signals and deliver energy. Electroanatomical mapping systems build a three-dimensional map of the heart's electrical activity, identifying the precise location of the abnormal tissue responsible for the arrhythmia.

Once the target is identified, radiofrequency energy (a form of heat energy at controlled temperatures of 50 to 60 degrees Celsius) is delivered through the catheter tip to create a small scar (2 to 5mm in diameter) in the abnormal tissue. This scar does not conduct electricity, permanently interrupting the arrhythmia circuit. The surrounding healthy heart muscle is unaffected.

Arrhythmias Treated by Radiofrequency Ablation

Atrial Fibrillation (AFib)

Pulmonary vein isolation (PVI) is the cornerstone of AFib ablation. The ablation catheter creates a ring of scar tissue around the pulmonary vein openings, isolating the electrical triggers that drive AFib from the rest of the atrium. Success rates for a single procedure in paroxysmal AFib are 70 to 80% at one year. Persistent AFib may require additional ablation beyond PVI.

Atrial Flutter

Typical atrial flutter is caused by a predictable re-entry circuit in the right atrium involving the cavotricuspid isthmus (CTI). CTI ablation achieves cure rates above 95% in a single procedure and is one of the most successful ablation procedures performed.

SVT (Supraventricular Tachycardia)

SVT encompasses AVNRT (AV nodal re-entry tachycardia, the most common type), AVRT (involving an accessory pathway), and atrial tachycardia. Ablation achieves cure rates of 95 to 98% for AVNRT and over 90% for most other SVT subtypes in a single session.

WPW Syndrome (Wolff-Parkinson-White)

An accessory electrical pathway connecting atria and ventricles causes SVT and, in some patients, risk of sudden cardiac arrest during AFib. Ablation of the accessory pathway is curative with success rates above 95%.

Ventricular Tachycardia (VT)

Ablation of VT circuits, usually arising from scar tissue after a heart attack or in cardiomyopathy, reduces VT burden and ICD shocks. VT ablation is technically the most demanding of all arrhythmia ablation procedures.

Premature Ventricular Contractions (PVC)

Frequent PVCs causing symptoms or reducing heart function can be ablated when a clear focal origin is identified on mapping. Success rates depend on PVC morphology and origin.

The Radiofrequency Ablation Procedure: Step by Step

Pre-procedure Assessment:

ECG, Holter monitoring, echocardiography, and blood tests. For AFib ablation, a CT or MRI of the left atrium and pulmonary veins is performed to map anatomy before the procedure. A transoesophageal echo (TOE) is performed on the day to rule out left atrial clot before transseptal puncture.

Anesthesia:

SVT and flutter ablations are typically performed under conscious sedation. AFib ablation is usually performed under general anesthesia or deep sedation due to the longer procedure duration and the need for the patient to remain completely still during pulmonary vein isolation.

Vascular Access:

Sheaths are inserted into the femoral veins in the groin (and occasionally the femoral artery for left-sided procedures). Three to four catheters are typically positioned in the heart simultaneously.

Transseptal Puncture (for left-sided procedures):

To access the left atrium for AFib ablation, a needle is used to cross the septum (the wall between the upper chambers) under ultrasound and X-ray guidance. This step requires technical precision.

Electrophysiology Study and Mapping:

Electrical recordings are taken from multiple points inside the heart. Three-dimensional mapping systems (such as CARTO or EnSite) build a real-time electroanatomical map of the arrhythmia circuit, guiding precise catheter positioning.

Arrhythmia Induction:

For SVT and flutter, the arrhythmia is deliberately induced with pacing techniques or medication to confirm the mechanism and locate the circuit. AFib ablation is performed anatomically based on the mapping system.

Radiofrequency Energy Delivery:

Energy is delivered at each target point for 30 to 60 seconds. Ablation is guided by temperature, impedance, and contact force feedback. Modern force-sensing catheters ensure consistent tissue contact and reduce risk of complications from excessive pressure.

Endpoint Confirmation:

For SVT and flutter, the arrhythmia should be non-inducible after ablation. For AFib, electrical silence within the pulmonary veins (exit and entrance block) confirms successful isolation. Further provocation testing ensures the arrhythmia cannot be reinduced.

Sheath Removal and Closure:

All sheaths are removed and groin compression or vascular closure devices used to achieve hemostasis. The patient rests flat for 3 to 6 hours.

SVT and flutter ablations typically take 90 to 150 minutes. AFib ablation procedures take 2 to 4 hours. You are monitored closely throughout and the team pauses to update you on progress at key steps.

Success Rates by Arrhythmia Type

Atrial Flutter (CTI ablation)

Over 95% cure rate in a single procedure.

SVT (AVNRT)

95 to 98% cure rate in a single procedure.

WPW Syndrome

Over 95% accessory pathway elimination.

Paroxysmal AFib (single procedure)

70 to 80% freedom from AFib at 1 year. Repeat procedure increases success to 85 to 90%.

Persistent AFib

60 to 70% success with PVI plus additional substrate modification. Often requires more than one procedure.

PVC ablation

75 to 85% success depending on PVC origin and operator experience.

Recovery After Radiofrequency Ablation

Hospital Stay

1 to 2 days for most procedures.

Groin Restriction

Avoid strenuous activity for 48 to 72 hours to allow the venous puncture sites to heal.

Return to Work

Office work: 3 to 5 days. Physical work: 1 to 2 weeks.

Driving

48 to 72 hours after the procedure for most arrhythmias.

Blanking Period (AFib)

The first 3 months after AFib ablation are considered the blanking period. AFib recurrence during this time does not mean the procedure has failed, as inflammation and healing can temporarily cause arrhythmia. Antiarrhythmic drugs are often continued for 3 months.

Anticoagulation (AFib)

Blood thinners are continued for at least 3 months after AFib ablation regardless of perceived success, and longer if stroke risk (CHA2DS2-VASc score) remains elevated.

Follow-up

Review at 3 months, 6 months, and 12 months. Holter monitoring to assess rhythm status.