Diagram of the difficulty and risks of radiofrequency ablation for arrhythmias

  Many patients are skeptical about radiofrequency ablation for the treatment of various tachycardias, either by exaggerating the risks or underestimating the difficulties. Because arrhythmias are abnormalities of the heart’s bioelectricity that are not visible to the naked eye, they are abstract in presentation and difficult to understand visually in words for patients. In order to facilitate the majority of patients to accurately understand the difficulty and risks of catheter ablation of the arrhythmia they are suffering from, we have created this schematic to give patients a better understanding of it. It is important to note that this mainly reflects the majority of representative cases of each type of tachyarrhythmia and excludes some rare cases.  As we can see from the figure, many patients with paroxysmal supraventricular tachycardia (generally referred to as supraventricular tachycardia) are worried about their ablation procedure, which is completely unwarranted. In fact, ablation of supraventricular tachycardia is the most basic introductory procedure for all physicians who perform catheter ablation, which is similar to appendectomy in general surgery and can be performed in general 3-A hospitals. The difference in level between doctors is mainly in the length of the procedure and the degree of patient pain. Highly qualified surgeons can also perform the surgery entirely through one femoral vein, so that instead of puncturing the neck, chest or both thighs, only one thigh root is needed, and no artery is punctured, with a quick postoperative recovery of 6 hours. In individual patients, the lesion (usually a bypass or slow pathway) may be close to a critical tissue called the bundle of Hitchcock, which is relatively susceptible to impaired atrioventricular conduction during ablation, requiring a pacemaker in severe cases. More difficult is the episcleral bypass, but it is extremely rare.  Ablation of atrial tachycardia and atrial flutter is slightly more difficult than conventional supraventricular tachycardia, and the success rate and time required for the procedure depends on the level of experience of the surgeon. More problematic is the ablation of specific scarring atrial tachycardias that occur in certain patients after complex congenital heart surgery, which is relatively difficult. The difficulty of ablation ventricular tachycardia varies widely for idiopathic (that is, patients whose heart ultrasound, CT, and other tests do not reveal organic heart disease). Ablation success rates are generally high for common sites, but may be more difficult for specific sites.  Ablation of atrial fibrillation is currently difficult, and the biggest challenge is that the lesions are extensive and recalcitrant, making it difficult to ablate completely. In general, the older the patient, the longer the history, the larger the left atrium, the longer the drinking period, and the combination of diabetes mellitus and dilated cardiomyopathy, the lower the success rate.  Instrumental ventricular tachycardia is the most difficult and risky procedure in catheter ablation, and overall only a very few individual physicians in top hospitals internationally are able to master it, and patients should be well informed before undergoing ablation.