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Catheter Examination 

Catheter examination is a special electrophysiological cardiac procedure for patients with cardiac arrhythmias. A catheter exam can determine exactly which form an arrhythmia is present. Usually the treatment can be performed concurrently to the examination and diagnosis.

The aim of a catheter examination is to analyze within the heart the specific type and origin of a suspected arrhythmia, as well as treatment for arrhythmias that have already been detected. After administering a local anesthetic, a special catheter is inserted through the veins to the heart, the catheter then induces impulses from the heart, the response to which, in particular to the dispersion of the electrical stimulation, can then be measured.  Electrical signals are registered with a special catheter at various locations in the heart, while another catheter stimulates impulses (similar to a pacemaker), none of which are felt by the patient. If the impulses trigger an arrhythmia, this can be eliminated either with the same catheter system or by a medication. In rare cases when symptoms (discomfort) occur, a cardioversion/defibrillation may be required. The patient is not aware of this as it is performed under a short-term anesthesia/sedation.
For many arrhythmias, this method is sufficient. More complex arrhythmias are analyzed using a procedure known as 3D mapping. In this method, a three-dimensional image of the anatomical structures can be superimposed on information obtained by electrophysiological methods in order to map the spatial path of the stimulation within the heart. If a subsequent treatment is necessary, this sort of 3D data is an important prerequisite.  This reduces the exposure to X-rays as the introduction of the catheter and its manipulation is possible within the 3D data set. (the 3D mapping procedure). There are a number of indicators which make an electrophysiological procedure necessary. Usually a catheter examination is performed before each electrophysiological or rhythmological treatment.
 
    Fig: Medtronic   
For the correct positioning of a treatment catheter (ablation) a special lasso catheter, such as the one pictured above, is used . This catheter can very accurately determine the source of pathological signals from the heart. An ablation catheter is capable of examining specific areas. Shown here is a Lasso catheter, having located the disruptive impulses in the pulmonary veins and below it, a radio-frequency ablation catheter. The tip of this catheter sets (creates; applies) lesions in the heart that inhibit the transmission of any more irregular impulses.
 

How long does an catheter ablation take? 

There is no standard answer to this question. With simple arrhythmias such as an atrial flutter, diagnosis and the subsequent ablation treatment does not last long when performed by an experienced examiner. For complex arrhythmias such as special forms of the WPW syndrome (Wolf-Parker-White syndrome) diagnosis and treatment can take several hours to complete. In order that the treatment is not too unpleasant for the patient, a light sedative is used. For modern mapping methods or the latest generation of ablation (e.g. laser ablation for atrial fibrillation) the examination and treatment time may be significantly shortened. 
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