When was catheter ablation invented

In March , the first catheter ablation was performed to treat life-threatening arrhythmia in a human, as an alternative to heart surgery. Scheinman is a Professor of Medicine and holds the Walter H. Today, he still plays an active role at the university, where he directs the cardiac genetic arrhythmia program, which is devoted to discovering new genes related to heart rhythm disorders.

Suffering from comorbid conditions, the man was too sick to be a candidate for open-heart surgery. The procedure, which involved guiding an electrode catheter across the Bundle of His and then delivering a DC charge from a defibrillator, lasted approximately two hours and was a success.

In the US alone, approximately 20, ablations are performed each year, more than of them at UCSF, where it all began. AF, the most common cardiac arrhythmia, affects at least 2. Cardiac ablation earned its place as a mainstay treatment for AF in , when Michelle Haissaguerre, a cardiac electrophysiologist in Bordeaux, France, first described the use of catheter ablation for patients with the condition. This landmark finding led to the establishment of catheter ablation as a routine AF management strategy.

Although the success of cardiac ablation has been proven, the procedure is technically challenging, and the field is a hotbed of innovation. All are working to increase the safety and efficacy of catheter ablation procedures. Definitive treatment of symptomatic supraventricular tachycardia SVT due to atrioventricular re-entrant tachycardia AVRT , atrioventricular nodal re-entrant tachycardia AVNRT , unifocal atrial tachycardia or atrial flutter;. AF with lifestyle-impairing symptoms and failure of at least one antiarrhythmic agent; and.

However, for VT in the setting of structural heart disease, catheter ablation is generally reserved for failure of drug-therapy or as adjunctive therapy in the setting of frequent implantable cardioverter defibrillator ICD discharges.

These arrhythmias that are amenable to ablation are discussed in more detail below and in Table 1 :. This arrhythmia is due to an atrioventricular re-entrant circuit involving a connection other than the AV node, known as an accessory pathway. These congenital accessory pathways sometimes, but not always, give rise to arrhythmias and often present at a young age with rapid paroxysmal palpitations and an underlying narrow-complex tachycardia.

This risk is best assessed by performing an electrophysiology study and, if the risk warrants it, ablating the pathway even if the patient is asymptomatic. This should correlate to the location of the accessory pathway, and it is localized using a diagnostic catheter initially on the tricuspid or mitral valve annulus.

Following this, the precise location of the pathway is identified with the ablation catheter and radiofrequency ablation can begin. Electrophysiology studies usually follow this procedure to ensure complete ablation of the accessory pathway. This is the commonest cause of regular narrow complex tachycardia in patients with normal hearts. In these patients, the AV node is functionally divided into two longitudinal pathways, usually one slowly and one fast conducting, that form the re-entrant circuit.

In the majority of patients, during AVNRT, antegrade conduction occurs to the ventricle over the slow pathway and retrograde conduction occurs over the fast pathway. Ablation of this arrhythmia targets the slow pathway, which is found inferior to the His bundle, close to the mouth of the coronary sinus Figure 2.

Fluoroscopic images in the right anterior oblique right image and left anterior oblique left image projections showing diagnostic and radiofrequency ablation catheters commonly used for ablation of AVNRT. An ablation catheter Ablation is located at the anatomical location of slow pathway fibres. Focal atrial tachycardia results from the atrial cells with enhanced automaticity that generate impulses at a greater rate than the sinoatrial node.

In order to ablate this focus, the arrhythmia must be induced and localized to the site of earliest atrial activation. The most common form of atrial flutter involves a single re-entrant circuit with circus activation in the right atrium around the tricuspid valve annulus with an area of slow conduction located between the tricuspid valve annulus and the coronary sinus ostium Figure 3.

This was the first re-entrant arrhythmia to be fully characterized. B A fluoroscopic image of the catheters used for ablation of flutter. A diagnostic catheter is placed in the CS and a large multi-polar catheter in the right atrium, wrapping around the tricuspid annulus RA.

The diagnosis of atrial flutter is confirmed using pacing manoeuvres in the right atrium and coronary sinus and ablation is performed with a line of ablation between the inferior vena cava and the tricuspid valve to interrupt the circuit. Post-ablation, pacing manoeuvres can confirm that the substrate required for the circuit has been interrupted in both directions.

VT ablation for patients with structural heart disease therefore tends to be reserved for those patients in whom medical therapy has failed to adequately control the arrhythmia. This may be undertaken after only one drug has been tried, e. Also, it may be performed in patients with implantable cardioverter defibrillators who are getting repeated shocks form their device due to VT that cannot be controlled with medication.

Well tolerated VT, preferably of single morphology, is most amenable to radiofrequency ablation in this patient population. The re-entrant circuit is identified through a combination of pacing manoeuvres, and matching the resulting electrocardiogram ECG to the clinical VT picture.

Once the re-entrant pathway has been identified, radiofrequency ablation at the critical, slow-conducting component of the pathway will often render the VT non-inducible. It is also possible to perform ablation of haemodynamically unstable VT using other techniques but success rates may be slightly lower.

This arrhythmia occurs as a result of re-entry in the His—Purkinje system and can be ablated by targeting a very specific area of tissue in the left ventricular septum.

One of the difficulties with treating AF is in achieving adequate ventricular rate control. This results in little or no ventricular rhythm subsequently so a pacemaker is implanted.

This is a very effective treatment but it needs to be noted that atrial fibrillation will still occur, but the fast ventricular rates should not. Furthermore, this usually renders the patient completely dependent upon the pacemaker and therefore is not attractive as a treatment option in younger patients. The cure of AF is the ultimate goal of invasive electrophysiology—it is complicated primarily because of the multiple triggers involved in the generation of AF.

The first descriptions of successful catheter ablation using radiofrequency for AF were from Haissaguerre et al. A A cardiovascular magnetic resonance CMR scan of the left atrium showing the common anatomical setup of the pulmonary veins PVs with a superior and inferior vein on the left and right sides [left superior LS ; left inferior LI ; right superior RS ; right inferior RI ].

Anatomical variants, such as a single large common left-sided vein, are common, so imaging modalities such as computed tomography CT or CMR can be helpful before the ablation procedure. B Fluoroscopic images showing typical catheter positions for catheter ablation of AF.

A catheter is seen in the coronary sinus CS , in the PV and an ablation catheter Ablation in the left atrium. The PV catheter allows recording of electrical signals in the PV during ablation.

PV isolation is effective for a large percentage of paroxysmal AF patients but more persistent AF is now recognized to have triggers outside the PVs, possibly involving multiple circuits. Changing the atrial substrate in order to prevent sustained multiple re-entry circuits was the aim of the surgical Maze procedure. This can now be performed endocardially through compartmentalization of the left and right atria with linear ablations Figure 6.

Also, because of the extensive ablation required, there is a higher chance of recovery of tissue that will then allow AF to occur again so these patients often need repeat procedures.

In some patients with AF, PV isolation alone is not enough. Mapping system image showing a 3D representation of the left atrium in this case, a cardiovascular magnetic resonance scan has been used.

Electro-anatomical mapping systems are now commonly used for ablation of complex arrhythmias such as AF. These systems have the advantage of allowing the operator to record positions that the ablation catheter has been to and to minimize fluoroscopy dose with visualization of the ablation catheter and its movement in real time.

Current guidelines suggest referral for consideration of invasive intervention for rhythm control of atrial fibrillation in patients who have failed medical therapy, have lone AF, or have ECG evidence of another underlying electrophysiological disorder i. The occurrence of complications varies depending on the procedure being performed. Serious complications are rare for most ablation procedures death, myocardial infarction or stroke 0.

Other forms of thromboembolism, including systemic embolism, pulmonary embolism occur very rarely. Radiofrequency ablation procedures require fluoroscopy, and the amount of radiation exposure depends on the equipment and the technique used. For longer procedures, the use of non-fluoroscopy catheter location techniques, using either magnetic i.

CartoTM or electrical fields i. Ensite NavXTM for mapping of catheter position, has reduced fluoroscopy time and radiation dose to both patient and staff. The newest versions of the mapping systems have been designed with features that may permit better radiofrequency ablation lesion formation. Whether this will translate into higher success rates, particularly for AF ablation, remains to be seen. Other improvements revolve around creating more user-friendly platforms with advanced software for some of the components of the procedures.

Apart from new designs in handles, one of the major developments in recent years has been the ability to cool the catheter tip while ablating. This reduces dissipation of heat into the blood, enabling more efficient energy delivery to the tissue, potentially with lower power settings. These catheters use bipolar radiofrequency energy in addition to the standard unipolar energy , which means that the powers required are lower for equivalent lesion formation Figure 8.

Fluoroscopic image showing an ablation catheter Ablation that can both record electrical activity in the PV and ablate around the multiple poles simultaneously labelled with arrows. The long time required for these procedures can be physically demanding for operators.

Systems have been developed that allow the operator to manipulate the radiofrequency ablation catheter from a control panel that is remote from the patient usually in the control room. This not only offers the advantage of reducing radiation exposure to the operator and making it more comfortable for them by not wearing lead gowns, but also the catheter stability may be improved that may translate into better lesion formation and long term success.

Completely contained within a specialized ablation catheter, liquid nitrous oxide released into the tip rapidly cools adjacent tissue. Microwave creates thermal energy-like radiofrequency but unlike radiofrequency, the mechanism is dielectric. Activate Account. Create a New Account. Forgot Username or Password?

Types Our Approach to Ablation For many people with atrial fibrillation AFib and certain other abnormal heart rates known as arrhythmias, medications do not work to reduce their symptoms. Make an Appointment. Find a Clinic. Co-invented by our medical director, this procedure uses extreme cold to freeze arrhythmia-causing heart cells.

Leading expertise in FIRM ablation , a new technology for locating and treating the precise regions in your heart that cause arrhythmia. We were one of the first U. A national clinical trial is currently underway. Make An Appointment. What Is Cardiac Ablation? Conditions Treated. Types of Cardiac Ablation. Catheter ablation We offer minimally invasive procedures using catheters thin, flexible tubes inserted through blood vessels to access the heart. Atrioventricular AV node ablation Cryoablation Epicardial ablation.

Hybrid surgical-catheter ablation At Stanford, our arrhythmia team is one of the first to develop hybrid surgical-catheter ablation to treat persistent AFib.

Surgical ablation Our colleagues in heart surgery perform ablation using minimally invasive laparoscopy and open-heart surgical procedures. Previous Section Next Section. Our Clinics Cardiac Arrhythmia Service. Vascular and Endovascular Care. Our interdisciplinary team excels in designing innovative solutions to challenging vascular problems, whether it's medical or surgical management, aneurysms, or aortic dissections.

View All Locations ». Clinical Trials. MyHealth Login.