Non-pharmacological treatment of arrhythmia

Question 1

List the different non-pharmacological treatments that can be used to treat arrhythmias:

Answer 1

• catheter ablation
• ICD and pacemaker
• CRT
• electrical cardioversion
• Defibrillator

Question 2

Catheter ablation: def

Answer 2

• removal of tissue by electrical energy through a catheter

Question 3

Catheter ablation: radiofrequency energy

Answer 3

• cells are destroyed by heating > 50 degrees

Question 4

Catheter ablation: cryoablation

Answer 4

• liquid nitrous oxide is released into the tip, rapidly vaporizes and removes heat from the tissue in contact with the catheter, temperature falls to -30 -> reversible loss of cell function -> cooled to -60 irreversible

Question 5

Catheter ablation: indications

Answer 5

• AVNRT (97% success rate)
• AVRT
• A-flutter
• A-tachy
• PVC
• A-fib

Question 6

Catheter ablation: complications

Answer 6

• death, stroke, tamponade, AV node block, coronary spasm, x-ray exposure, pericarditis, recurrence of arrhythmia, cardiac perforation

Question 7

Catheter ablation: advantages

Answer 7

• reduces ICD shocks, high success, well defined lesion, no adverse hemodynamic effect, short recovery, repeatable, cost effective

Question 8

Ablation strategy of ventricular arrhythmias (VT)

Answer 8

• Exit - point of ablation -> de-channelization -> core ablation -> LP and LAVA ablation -> scar homogenization

Question 9

CRT: Cardiac resynchronization therapy:

Answer 9

Biventricular pacing. Device paces both the left and right ventricles simultaneously, improves EF. Can restore function: ex: in dilative cardiomyopathy, improves CO and symptoms

Question 10

Electrical cardioversion

Answer 10

• indications: sustained VT, treatment resistant SVT, A-fib, AFL