Coronary Angioplasty / Cardiac Ablation

Coronary angioplasty (percutaneous coronary intervention, PCI) and cardiac ablation are catheter-based, minimally invasive cardiac procedures performed in an electrophysiology or catheterisation laboratory. PCI is used to open atherosclerotic narrowings or occlusions in the coronary arteries that cause angina or myocardial infarction; the obstruction is dilated with a balloon and held open with a drug-eluting stent. NHS guidance describes PCI as a 30 minute to 2 hour procedure usually performed under local anaesthetic with same-day or next-day discharge. Cardiac ablation treats supraventricular and ventricular arrhythmias - most commonly atrial fibrillation, atrial flutter, supraventricular tachycardia and selected ventricular tachycardias - by destroying small areas of arrhythmogenic myocardium with radiofrequency heat, cryothermy or, more recently, pulsed-field electroporation. According to NHS sources, ablation for atrial fibrillation is typically performed under general anaesthesia, takes 2-4 hours, and patients usually do not need to stay overnight. Both procedures require femoral, radial or, for ablation, transseptal catheter access. Patients are typically discharged the same or following day and resume usual activity within 1-7 days. International patients commonly need 3-5 days in-country to allow access-site healing and one early follow-up. Approximately 80 percent of patients with paroxysmal atrial fibrillation gain symptomatic improvement after ablation, and PCI provides rapid relief of angina and is life-saving in primary PCI for STEMI. Sources: NHS, NHS England commissioning policy on AF ablation, NICE.