Catheter Ablation

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t breakneck speed, the cursor flits across the screen where little pink balls are turning red and something resembling a snake is prancing about. This is the computerized graphic view of a catheter during an intervention in the atrium of a patient's heart. A closer look reveals an outline that resembles a gray stone. "This", Charlotte Vivet explains, "is the 3D view of the inside of the heart." This 25-year-old engineer, a graduate of the École Polytechnique Fédérale de Lausanne (EPFL), has been working at Johnson & Johnson as a Clinical Support Specialist for well over a year. She is one of a team of 15 highly specialized staff in Switzerland who act as partners to doctors when they perform high-tech cardiac surgeries. This morning, she is working in tandem with Professor Etienne Delacrétaz at the Hirslanden, Clinique Cecil in Lausanne.

Behind Charlotte's screen, separated by a pane of glass, is the operating theater. On the table lies a young man, fast asleep. In front of him at waist level sits the doctor, whose quiet comments and instructions are relayed from the loudspeaker set up in front of Charlotte. Professor Etienne Delacrétaz is at work. This specialist in cardiology and electrophysiology is performing a catheter ablation of the patient's heart. This is a minimally invasive procedure that involves scarring of the heart tissue with the help of a catheter. It is an exceptionally efficient method of eliminating dangerous cardiac arrhythmias.

Fear As a Constant Companion

"Atrial fibrillation is the most frequent type of cardiac arrhythmia," Delacrétaz explains, "and it's a chronic condition that requires lifetime treatment with medications." There is no cure. Left untreated, it leads to disorders such as palpitations and shortness of breath; in extreme cases, it can even result in strokes and cardiac insufficiency. And the consequences for those affected can be dramatic – they may even become disabled. According to the Swiss Heart Foundation, about 100,000 people suffer from atrial fibrillation in this country – and the trend is upward.

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As well as putting life at risk, cardiac arrhythmias are extremely frightening for the sufferer. That was the case for 56-year-old Christian G, so he underwent catheter ablation performed by Professor Delacrétaz. This was after his heart suddenly started beating irregularly from one day to the next. "It happened while I was sitting in front of the TV after dinner – my heart suddenly started beating like crazy." Christian, a heating fitter, went to consult his cardiologist. "We tried to calm my heart down with medications, but that didn't really help," he explains. Although he is normally quite athletic, Christian felt listless, constantly tired and somewhat depressed due to his condition. He was afraid that he would have to give up his hobby of riding. "But the worst thing of all was the fear," he recalls. He knew that his father and uncle had suffered from high blood pressure, and both of them had died before their 60th birthdays. He too had been taking antihypertensive drugs for years.

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A catheter ablation is an intervention involving targeted scarring of the tissue that causes heart arrhythmias. It is performed via catheters that are introduced into the heart through the vein. Etienne Delacrétaz has been performing catheter ablations for over 20 years. Catheter ablation is not a surgery on the heart, he explains: it is a minimally invasive intervention that leaves no external traces behind. The doctor treating the patient must have very nimble fingers – "but most of all, he must understand the technical procedures and have plenty of practice." The doctor concentrates his attention on the large screen behind the operating table to see the exact location of the tip of the catheter as he steers it with his hand. Charlotte, his supporter, provides him with all the data he needs to guide him. She rotates the 3D images so the doctor can see the places that he has to scar. In the graphic view, they are marked by dots that becomes redder as the scarring becomes more intense. Of course, the heart must never be damaged as the procedure takes place.

Quickly Back to Work

After well over an hour, the operation is over as far as the patient is concerned. He is wheeled out of the operating theater. With latest-generation catheters, the procedure takes no more than one and a half hours. Delacrétaz recalls that it wasn't always like this: "It used to take up to four hours." About five percent of all heart patients are currently treated with cardiac catheter ablations. As well as elderly patients, they include children and young people – who are often competitive athletes. After the procedure, the patient has to take a few medicines that drastically reduce the risk of cardiac insufficiency or a stroke, which could lead to irreparable damage. 

There is a spectacular improvement in the patient's quality of life, accompanied by a reduction of the subsequent costs that would be incurred without the intervention. Long-term chances of a successful outcome decrease with age, so patients should not be older than 70. It is now six months since Christian G. had his catheter ablation. The surgery passed off without any complications whatsoever. Christian's entire face is radiant: "I hardly felt any pain – but I could already feel the positive consequences on the second day after the operation." He was even able to resume work immediately. The atrial fibrillation has disappeared and although his blood pressure is still slightly high, he has it under control thanks to medications. He feels fit and vigorous, and he is taking part in equestrian competitions once more. "It's as if I was young again," he says.