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SVT and Flutter Ablation
Catheter ablation treats small areas of heart tissue that sustain certain fast rhythms, including SVT and atrial flutter. Interrupting the rhythm's electrical circuit can prevent further episodes of a racing heart.
A normal heartbeat begins with an electrical signal from the sinus node in the right upper chamber. The signal spreads across the upper chambers, then passes through the AV node to the lower pumping chambers and makes them contract.
In common forms of supraventricular tachycardia (SVT), a signal keeps travelling around an electrical loop. Each turn drives another heartbeat, so the heart suddenly races. Ablation targets a small part of that loop to stop the signal circulating.
In the common type called AVNRT, the loop uses two pathways close to the AV node. Ablation treats the slower pathway and aims to leave the normal connection to the lower chambers intact. In AVRT, the loop runs through an extra connection between the upper and lower chambers, and that connection is the target.
SVT can also start from a small area in an upper chamber that fires too fast and overrides the sinus node. This is called focal atrial tachycardia, and ablation treats that spot.
Typical atrial flutter circles the tricuspid valve in a larger loop in the right upper chamber. The signal has to pass through a narrow strip of tissue, and ablation puts a line of scar across it to interrupt the loop. Atypical flutter uses a different circuit, so it needs its own mapping and treatment plan.
In atrial fibrillation (AF), the electrical activity is disorganised and doesn't follow one circuit. Someone can have both rhythms, so treating flutter doesn't necessarily prevent AF.
Call triple zero (000) for severe, worsening or persistent chest pain, or chest discomfort with breathlessness, sweating, nausea or pain spreading to your arm, jaw or back.
Do not wait for a routine appointment or drive yourself to hospital.
The hospital gives instructions about fasting and medicines, including blood thinners and diabetes treatment. Follow the plan you're given, and don't stop a medicine because of general information about ablation.
A heart rhythm specialist, called an electrophysiologist, performs the procedure. Monitors check your heartbeat, and medicines are given through a small tube in a vein in your arm or hand. Local anaesthetic numbs the groin. Sedation makes you relaxed and drowsy; some procedures use a general anaesthetic so you're asleep.
The specialist passes thin tubes called catheters through a blood vessel, usually a groin vein, into the heart. X-rays or a computer mapping system guide their position. The chest isn't opened.
Electrodes on the catheters record electrical activity from inside the heart. They can also deliver small impulses to start the abnormal rhythm, so if you're awake, you may feel the familiar racing heartbeat. This electrophysiology study shows how the signals spread and which tissue starts the rhythm or forms part of its circuit, and the findings guide where to treat.
The ablation catheter's tip delivers heat, or sometimes freezing, to scar the selected tissue so it can no longer carry the unwanted signals. Further electrical testing checks whether the treatment has interrupted the circuit. Sometimes the rhythm can't be identified or the target can't be treated safely, and then ablation may not go ahead.
Pressure is applied to the entry site to stop bleeding. Ablation itself doesn't leave a device in the heart. You'll rest in bed while staff check your rhythm and groin. Some people go home that day; others stay overnight. Have someone take you home and follow the hospital's instructions about driving, lifting, work and exercise.
Ablation may be considered when episodes keep returning, interrupt daily life or cause troublesome symptoms despite medicines. It can also be an alternative to ongoing medicine that causes side effects. For some SVTs, it's an early treatment option.
An ECG records the heart's electrical activity. A recording made during an episode is particularly useful, and a monitor worn at home may capture ones that come and go. The recordings help distinguish an abnormal circuit from the normal rise in heart rate during exercise or illness.
After the rhythm has been assessed, people with brief, infrequent SVT episodes may choose to monitor the condition. Medicines can reduce episodes, while ablation aims to block the electrical route that allows them to recur.
For flutter, rate-control medicines limit how many rapid signals pass through the AV node to the lower chambers. This slows the pulse, although the upper chambers may remain in flutter. Electrical cardioversion uses a controlled shock under anaesthesia to restore normal rhythm. It ends the current episode but leaves the circuit in place, so flutter can return.
Flutter can increase the risk of a blood clot and stroke. Whether you need an anticoagulant, often called a blood thinner, depends on your stroke risk. A normal rhythm after ablation doesn't automatically mean it's safe to stop the blood thinner. Keep taking prescribed medicines unless the treating doctor gives different instructions.
Bruising and soreness around the groin are common. Less common complications include significant bleeding, blood vessel damage or fluid collecting around the heart. Stroke is a serious but uncommon risk.
Treatment near the AV node can damage the normal electrical connection to the lower chambers. A pacemaker may then be needed to keep the heart beating adequately. The risk depends on where the treatment is given, because these pathways lie close together.
Seek prompt medical advice for increasing groin pain or swelling, bleeding, fever or a racing heartbeat that persists. Call triple zero (000) for severe breathlessness, collapse, a drooping face, sudden arm weakness or trouble speaking.
Your GP or specialist can refer you to a Heartscope cardiologist to discuss a heart rhythm problem and whether a hospital referral for ablation is appropriate. Heartscope doesn't perform ablation at its clinics. The clinic can answer questions about the consultation.
Consultations are privately billed. If you're eligible, Medicare pays part of the consultation fee when you have a valid referral from your GP or specialist. The clinic will confirm the amount left to pay before the visit.
Hospital and procedure fees are separate from the consultation fee. The hospital or treating provider confirms those costs.
Heartscope cardiologists see patients at clinics in Melbourne and Queensland. If you have a referral, our team can confirm the location and appointment details.
View clinic locationsNo. Ablation is performed in hospital. Heartscope's cardiologists may be able to see patients with a valid referral from their GP or specialist, and can refer them for hospital treatment when appropriate.
Ablation can prevent further episodes of the rhythm treated, but that rhythm can return and another procedure may be needed. A different rhythm can also develop. At follow-up, your symptoms and, when needed, ECG or monitor recordings help work out which has happened.
Brief extra beats can occur after ablation without the original rhythm returning. Tell the treating doctor if palpitations persist or feel like your previous episodes. A recording made during symptoms helps tell extra beats apart from a sustained fast rhythm.
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