Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  59

Understanding PTCA In PTCA, a guide catheter is threaded into the coronary artery by way of the femoral artery. Then, a balloon-tipped catheter is inserted through the occlusion and inflated to flatten the plaque until the vessel is opened.

Percutaneous Transluminal Coronary Angioplasty Percutaneous transluminal coronary angioplasty (PTCA), also called angioplasty, is a nonsurgical alternative to CABG. Performed in the cardiac catheterization laboratory under local anesthesia, it involves the use of a balloon-tipped catheter to dilate the blocked coronary artery. In most cases, the patients recuperate quickly, usually walking the same day and returning to work in 2 weeks. PTCA works best when lesions are readily accessible, noncalcified, less than 10 mm, concentric, discrete, and smoothly tapered. Possible complications include vessel closure and late atherosclerosis.

Wall of coronary artery Plaque Catheter in place; balloon deflated

Balloon inflated

Plaque flattened;

catheter removed Dashed lines indicate old plaque thickness

Catheter

Types of Ablation

Radiofrequency Ablation Radiofrequency ablation is used to treat arrhythmias in patients who do not respond to antiarrhythmic drugs or cardioversion. During the procedure, a special catheter is inserted in a vein and advanced to the heart. After the source of the arrhythmia is identified, radiofrequency energy destroys the abnormal electrical impulses or conduction pathway. The tissue that is destroyed can no longer conduct electrical impulses.

AV NODE ABLATION If a rapid arrhythmia originates above the AV node, the AV node may be destroyed to block impulses from reaching the ventricles.

PULMONARY VEIN ABLATION

If the pulmonary vein is the source of the arrhythmia, such as in AF, radiofrequency energy is used to destroy the tissue in the area of the atrium that connects to the pulmonary vein. The scar that forms blocks impulses from firing within the pulmonary vein, preventing arrhythmias. Pulmonary vein SA node Radio- frequency catheter

Sinoatrial (SA) node

Radio- frequency catheter

Right atrium

AV node

The radiofrequency ablation catheter is directed to the base of the pulmonary vein.

Radiofrequency energy is used to destroy the tissue where the atrium connects to the pulmonary vein.