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Heart Rhythm Disorders: Ablation as a Treatment Option
Praveen Rao, MD, An electrophysiologist explains the different types of ablations and ablation as a treatment option.
Featured Speaker:
Praveen Rao, MD
Dr. Rao is a cardiologist specializing in electrophysiology (heart rhythm disorders). On the medical staff of Baylor Scott & White Heart and Vascular Hospital - Dallas, Baylor University Medical Center in Dallas. Dr. Rao completed his fellowship in cardiac electrophysiology following the completion of his cardiology fellowship at Washington University at Barnes Jewish Hospital. Transcription:
Heart Rhythm Disorders: Ablation as a Treatment Option
Caitlin Whyte (Host): This is Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth. Today, we welcome Dr. Praveen Rao to the show, a Cardiac Electrophysiologist on the Medical Staff of Baylor Scott and White Heart and Vascular Hospital Dallas. So, Doctor, starting us off, what is cardiac ablation and when is indicated for heart rhythm patients?
Praveen Rao, MD (Guest): There are many different types of abnormal heart rhythms, both in the upper and the lower chambers of the heart. Cardiac ablation is a minimally invasive treatment that we do in a specialized lab setting, similar to someone having a stent placed in a similar sort of lab. We have specialized equipment that helps us to find and treat the abnormal part of the heart that's causing the arrhythmia. It is indicated when patients continue to have symptoms of their arrhythmia despite being on medications, or if they have side effects from their medications, or if they prefer a non-pharmacologic option to treat their condition and potentially cure it.
Host: So, what are the different types of ablation and are they used for different types of heart rhythm disorders?
Dr. Rao: There are two main types of ablation, at this point. The mainstay is something called radio frequency ablation, which is taking one of these catheters, which is a long, skinny plastic tube that has a metal tip on the end. It has some dials and controls that allows us to drive that catheter around someone's heart, to the area of interest. And it's connected to electricity on the back end. That electricity heats the metal tip of the catheter, that then cauterizes the abnormal location in the heart. That's the mainstay of treatment.
There is also, instead of heating a metal tip, we can freeze a metal tip of a catheter, and that's called cryoablation. And cryoablation can be done for patients with atrial fibrillation, or if we are working close to sensitive areas in the heart, then sometimes we choose cryoablation over radio frequency ablation. Far and away, the mainstay of the treatment is radio frequency ablation though.
Host: So, that leads me into my next question. How are ablations performed?
Dr. Rao: They're performed through access in the arteries and veins of the legs, and it's all done through a minimally invasive approach. We thread those catheters all the way up the arteries and veins of the legs up into the heart. And depending on the area of the heart that we are treating, there's different pathways we use to get there. Takes anywhere from about one to three hours on average, for some of these procedures. Some of the more complicated ones can take longer, but the vast majority of them are about one to three hours and patients are typically asleep under anesthesia for it.
Host: So, what are some of the benefits of a procedure like this?
Dr. Rao: These procedures can be curative for many patients and they won't need to take long-term medications to suppress their symptoms. Alternatively, for many patients, they continue to have symptoms despite trying a variety of different medications. And these symptoms can be things that are fairly mild with just mild palpitations to life-threatening conditions. And many patients are quite symptomatic. It's disruptive to their lifestyle and treatment of it in a non-pharmacologic way, could certainly potentially cure these conditions or deliver them long-term benefit where they don't need medications for a very long time. Many of the medications we use, unfortunately can have side effects. Some patients certainly do prefer the non-medication route.
Host: Now on the flip side of that, what are some of the risks associated?
Dr. Rao: Anytime we do procedures on someone's heart there's of course going to be some risks. Thankfully, because these are somewhat common procedures these days, we are able to minimize the risks by iteration. The risks are things you would expect with getting access to the arteries and veins; there could be bleeding troubles or damage to the blood vessels. The patient is under anesthesia. So, there's risks associated with being asleep for a couple of hours. That could be things like breathing troubles under anesthesia, concerns about heart attacks or strokes while under anesthesia, there could be damage to the heart or other parts of the surrounding structures during the procedure itself. These are all things we take into close consideration. And generally the risks are about 1% for most of the procedures. So, it's not zero, but it is low.
Host: Now why is cardiac ablation effective, especially in treating atrial fibrillation?
Dr. Rao: Atrial fibrillation is the most common abnormal rhythm in this country. And there's millions of patients that suffer with it. Particularly we've been learning more over the past several years, that the more we've tried to suppress it with medications, the more symptoms sometimes people get and certainly ablation because it treats this condition in a non-pharmacologic way; not only do the patients get spared from years of being on medication, but potentially they also have mortality benefits we are learning in certain subgroups. And those typically are patients who are younger or they have some weakness of their heart muscle. Those patients seem to do especially well with ablation over medications.
Host: So, you mentioned doctors have been learning more and more about this. So, have there been any recent advancements in ablation?
Dr. Rao: One of the exciting things of our field is that the advances from a technological perspective, very rapidly. Every year, there's new technology, both on the mapping side to help us locate the abnormal area faster and more precisely. And also on the ablation side, we're able to deliver our energy in a safer, yet more effective way. Between radio-frequency and cryoablation, the patients can get treated much more efficiently than they were even a few years ago. These procedures, what used to take several hours, five, six, seven hours, just 10 years ago, now we're taking one to two hours and that many patients are able to go home the same day. So, certainly those are advancements that were not possible even 10 years ago. And even on the frontier going forward, there's exciting new technology that is in research at this point, that could improve that even further.
Host: So, with all of these advancements, what is a typical recovery time like?
Dr. Rao: Patients typically spend a few hours of bed rest after a procedure here in the hospital, and there's a waiting area where the patients stay and then they're able to stay where the family members stay. And then they're able to join their family members in the post-procedure area, which is a few hours of bed rest. And then many patients go home the same day. If they're, if patients are coming from farther away or the procedures are a bit more complicated, then we choose to keep patients overnight, but they typically only spend one night in the hospital and then sort of early the next morning, they're able to go home. We do ask that they don't lift heavy things or exercise for about a week, just to be a little extra cautious so that they don't have any bleeding or bruising troubles from the puncture sites in their leg veins or arteries. But they're able to get back to their normal lifestyle quite quickly.
Host: Now, when it comes down to it, why should a patient choose to have cardiac ablation at Baylor Scott and White Heart and Vascular Hospital, Dallas?
Dr. Rao: Certainly these ablations can be done in a variety of different settings. We have the benefit of working in a large hospital-based facility, where we have the resources of many different specialties who can help in the event of any complications or certainly can help in terms of other aspects of a patient's care. We have a very busy heart transplant center here, so they're certainly able to provide good resources. Cardiac surgeons are always available on standby, which may ease worries for patients in terms of risks during any procedure, even though they're low, they're not going to be zero. And certainly having quick access to necessary resources is helpful. Also the hospital is able to have many different staff members able to be present both for a pre-procedure area, during an actual procedure and the recovery area that are specialized to just taking care of these patients. So, they're not, this is something that they get to do all day, every day. So, by volume, we're able to learn more about how best to take care of these patients and minimize risks.
Host: Well, thank you, Dr. Rao for joining us today. That's Dr. Praveen Rao, a Cardiac Electrophysiologist on the Medical Staff at Baylor Scott and White Heart and Vascular Hospital, Dallas. I'm your host, Caitlin Whyte.
Thanks for checking out this episode of Heart Speak. To find a specialist at Baylor Scott and White Heart and Vascular Hospital in Dallas or Fort Worth, please call 1-844-279-3627. That's 1-844-279-3627 or visit us online at baylorhearthospital.com. You can also download our app Baylor Heart Center for IOS users. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for more topics of interest to you. Thanks. And we'll talk again next time.
Baylor Scott and White Heart and Vascular Hospital, Dallas, joint ownership with physicians.
Heart Rhythm Disorders: Ablation as a Treatment Option
Caitlin Whyte (Host): This is Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth. Today, we welcome Dr. Praveen Rao to the show, a Cardiac Electrophysiologist on the Medical Staff of Baylor Scott and White Heart and Vascular Hospital Dallas. So, Doctor, starting us off, what is cardiac ablation and when is indicated for heart rhythm patients?
Praveen Rao, MD (Guest): There are many different types of abnormal heart rhythms, both in the upper and the lower chambers of the heart. Cardiac ablation is a minimally invasive treatment that we do in a specialized lab setting, similar to someone having a stent placed in a similar sort of lab. We have specialized equipment that helps us to find and treat the abnormal part of the heart that's causing the arrhythmia. It is indicated when patients continue to have symptoms of their arrhythmia despite being on medications, or if they have side effects from their medications, or if they prefer a non-pharmacologic option to treat their condition and potentially cure it.
Host: So, what are the different types of ablation and are they used for different types of heart rhythm disorders?
Dr. Rao: There are two main types of ablation, at this point. The mainstay is something called radio frequency ablation, which is taking one of these catheters, which is a long, skinny plastic tube that has a metal tip on the end. It has some dials and controls that allows us to drive that catheter around someone's heart, to the area of interest. And it's connected to electricity on the back end. That electricity heats the metal tip of the catheter, that then cauterizes the abnormal location in the heart. That's the mainstay of treatment.
There is also, instead of heating a metal tip, we can freeze a metal tip of a catheter, and that's called cryoablation. And cryoablation can be done for patients with atrial fibrillation, or if we are working close to sensitive areas in the heart, then sometimes we choose cryoablation over radio frequency ablation. Far and away, the mainstay of the treatment is radio frequency ablation though.
Host: So, that leads me into my next question. How are ablations performed?
Dr. Rao: They're performed through access in the arteries and veins of the legs, and it's all done through a minimally invasive approach. We thread those catheters all the way up the arteries and veins of the legs up into the heart. And depending on the area of the heart that we are treating, there's different pathways we use to get there. Takes anywhere from about one to three hours on average, for some of these procedures. Some of the more complicated ones can take longer, but the vast majority of them are about one to three hours and patients are typically asleep under anesthesia for it.
Host: So, what are some of the benefits of a procedure like this?
Dr. Rao: These procedures can be curative for many patients and they won't need to take long-term medications to suppress their symptoms. Alternatively, for many patients, they continue to have symptoms despite trying a variety of different medications. And these symptoms can be things that are fairly mild with just mild palpitations to life-threatening conditions. And many patients are quite symptomatic. It's disruptive to their lifestyle and treatment of it in a non-pharmacologic way, could certainly potentially cure these conditions or deliver them long-term benefit where they don't need medications for a very long time. Many of the medications we use, unfortunately can have side effects. Some patients certainly do prefer the non-medication route.
Host: Now on the flip side of that, what are some of the risks associated?
Dr. Rao: Anytime we do procedures on someone's heart there's of course going to be some risks. Thankfully, because these are somewhat common procedures these days, we are able to minimize the risks by iteration. The risks are things you would expect with getting access to the arteries and veins; there could be bleeding troubles or damage to the blood vessels. The patient is under anesthesia. So, there's risks associated with being asleep for a couple of hours. That could be things like breathing troubles under anesthesia, concerns about heart attacks or strokes while under anesthesia, there could be damage to the heart or other parts of the surrounding structures during the procedure itself. These are all things we take into close consideration. And generally the risks are about 1% for most of the procedures. So, it's not zero, but it is low.
Host: Now why is cardiac ablation effective, especially in treating atrial fibrillation?
Dr. Rao: Atrial fibrillation is the most common abnormal rhythm in this country. And there's millions of patients that suffer with it. Particularly we've been learning more over the past several years, that the more we've tried to suppress it with medications, the more symptoms sometimes people get and certainly ablation because it treats this condition in a non-pharmacologic way; not only do the patients get spared from years of being on medication, but potentially they also have mortality benefits we are learning in certain subgroups. And those typically are patients who are younger or they have some weakness of their heart muscle. Those patients seem to do especially well with ablation over medications.
Host: So, you mentioned doctors have been learning more and more about this. So, have there been any recent advancements in ablation?
Dr. Rao: One of the exciting things of our field is that the advances from a technological perspective, very rapidly. Every year, there's new technology, both on the mapping side to help us locate the abnormal area faster and more precisely. And also on the ablation side, we're able to deliver our energy in a safer, yet more effective way. Between radio-frequency and cryoablation, the patients can get treated much more efficiently than they were even a few years ago. These procedures, what used to take several hours, five, six, seven hours, just 10 years ago, now we're taking one to two hours and that many patients are able to go home the same day. So, certainly those are advancements that were not possible even 10 years ago. And even on the frontier going forward, there's exciting new technology that is in research at this point, that could improve that even further.
Host: So, with all of these advancements, what is a typical recovery time like?
Dr. Rao: Patients typically spend a few hours of bed rest after a procedure here in the hospital, and there's a waiting area where the patients stay and then they're able to stay where the family members stay. And then they're able to join their family members in the post-procedure area, which is a few hours of bed rest. And then many patients go home the same day. If they're, if patients are coming from farther away or the procedures are a bit more complicated, then we choose to keep patients overnight, but they typically only spend one night in the hospital and then sort of early the next morning, they're able to go home. We do ask that they don't lift heavy things or exercise for about a week, just to be a little extra cautious so that they don't have any bleeding or bruising troubles from the puncture sites in their leg veins or arteries. But they're able to get back to their normal lifestyle quite quickly.
Host: Now, when it comes down to it, why should a patient choose to have cardiac ablation at Baylor Scott and White Heart and Vascular Hospital, Dallas?
Dr. Rao: Certainly these ablations can be done in a variety of different settings. We have the benefit of working in a large hospital-based facility, where we have the resources of many different specialties who can help in the event of any complications or certainly can help in terms of other aspects of a patient's care. We have a very busy heart transplant center here, so they're certainly able to provide good resources. Cardiac surgeons are always available on standby, which may ease worries for patients in terms of risks during any procedure, even though they're low, they're not going to be zero. And certainly having quick access to necessary resources is helpful. Also the hospital is able to have many different staff members able to be present both for a pre-procedure area, during an actual procedure and the recovery area that are specialized to just taking care of these patients. So, they're not, this is something that they get to do all day, every day. So, by volume, we're able to learn more about how best to take care of these patients and minimize risks.
Host: Well, thank you, Dr. Rao for joining us today. That's Dr. Praveen Rao, a Cardiac Electrophysiologist on the Medical Staff at Baylor Scott and White Heart and Vascular Hospital, Dallas. I'm your host, Caitlin Whyte.
Thanks for checking out this episode of Heart Speak. To find a specialist at Baylor Scott and White Heart and Vascular Hospital in Dallas or Fort Worth, please call 1-844-279-3627. That's 1-844-279-3627 or visit us online at baylorhearthospital.com. You can also download our app Baylor Heart Center for IOS users. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for more topics of interest to you. Thanks. And we'll talk again next time.
Baylor Scott and White Heart and Vascular Hospital, Dallas, joint ownership with physicians.