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Alcohol septal ablation was first performed in 1994 by Ulrich Sigwart at the Royal Brompton Hospital in the United Kingdom. [2] Since that time, it has gained favor among physicians and patients due to its minimally invasive nature, thereby avoiding general anesthesia, lengthy inpatient recuperation and other complications associated with open-heart surgery (e.g. septal myectomy).
Catheter ablation of most arrhythmias has a high success rate. Success rates for WPW syndrome have been as high as 95% [2] For Supraventricular tachycardia (SVT), single procedure success is 91% to 96% (95% Confidence Interval) and multiple procedure success is 92% to 97% (95% Confidence Interval). [3]
When performed properly, an alcohol septal ablation induces a controlled heart attack, in which the portion of the interventricular septum that involves the left ventricular outflow tract is infarcted and will contract into a scar. There is debate over which people are best served by surgical myectomy, alcohol septal ablation, or medical therapy.
Radiofrequency ablation (RFA), also called fulguration, [1] is a medical procedure in which part of the electrical conduction system of the heart, tumor, sensory nerves or a dysfunctional tissue is ablated using the heat generated from medium frequency alternating current (in the range of 350–500 kHz).
Ordinarily, septal myectomies are performed only after attempts at treatment with medication fail. The choice between septal myectomy and alcohol ablation is a complex medical decision. [citation needed] Septal myectomy was established by Andrew G. Morrow in the 1960s. [3]
a stimulator to electrically excite the heart and control the heart rate; ablation equipment to destroy abnormal tissue; an electroanatomic mapping system that tracks and records the catheter position in 3D and associated electrical signals; ready access to cardiac medications such as adenosine, atropine, dopamine, and isoproterenol
However, with proper treatment, including cessation of alcohol consumption and management of heart failure symptoms, the prognosis can improve significantly. [10] Research has shown that the mortality rate for people with ACM is higher than that of the general population, with a five-year survival rate of around 50%. [10]
The risks and benefits are weighed up before this is performed. Catheter ablation of the slow pathway, if successfully carried out, can potentially cure AVNRT with success rates of >95%, balanced against a small risk of complications including damaging the AV node and subsequently requiring a pacemaker. [8]