Catheter Ablation Procedure for Treating Atrial Fibrillation (A-Fib)

Since we are receiving many questions about catheter ablation from women with atrial fibrillation, we are dedicating this issue of Straight Talk to the topic.

Let’s first revisit atrial fibrillation…

Atrial fibrillation (AF or AFib) is caused by an electrical disturbance in the upper chambers of the heart, the atria. In people with this condition, the heart’s electrical signals originate in a disorganized and rapid pattern, which makes the heartbeat fast and irregular; in medicine, this is known as an arrhythmia. The atria no longer contract normally, and this can lead to the formation of small blood clots within the left atrium. AF increases your risk of stroke and heart failure.

To learn more about the symptoms, risk factors, diagnosis, treatment, and prevention of atrial fibrillation, visit: Atrial Fibrillation Puts You at Risk

Treatment for AF

The goal of treating AF is to reset the heart rate and rhythm to normal (sinus rhythm). Treatments include:

  • Anti-arrhythmic medications (rhythm control medication)
  • Cardioversion
  • Electrical cardioversion: An electrical shock is delivered to your heart through patches placed on your chest, under sedation. The shock stops your heart’s electrical activity momentarily; then in most cases, the heart beat resumes at its normal rhythm.
  • Cardioversion with drugs: Anti-arrhythmic medications can be used to help restore normal sinus rhythm.
  • AF catheter ablation (explained below)
  • Surgical maze procedure:  A doctor creates a pattern of scar tissue (the maze) in the upper chambers of the heart by applying heat (radiofrequency energy) or cold (cryoablation, a recent technique). Or, the doctor uses a scalpel to make several precise incisions; this method is more complex and takes longer.
  • Atrioventricular (AV) node ablation: Through a catheter (a small tube), the electrophysiologist applies heat to the pathway (called the AV node) connecting the upper chambers (atria) and the lower chambers (ventricles) of your heart. The heat destroys a small area of tissue, which prevents the atria from sending faulty electrical impulses to the ventricles.

What is catheter ablation for AF?

Catheter ablation is a minimally invasive, low-risk surgical option to treat patients with symptomatic, irregular heartbeat by destroying (ablating) the heart cells that are sending an irregular signal. Although it is not the primary choice of treatment for arrhythmia, it can be effective if medications or other interventions to control an irregular heart rhythm don’t work.

Who is a candidate for AF catheter ablation?

Candidates for AF catheter ablation include patients who have symptoms of AF that cannot be treated with medication, and patients who are in heart failure or have a reduced ejection fraction (the measurement of the percentage of blood leaving your heart when it contracts).

What should I expect during my procedure?

After an anesthesiologist applies local anesthesia, the electrophysiologist makes a small incision for the catheter to enter. The catheter is inserted through a blood vessel in the groin or neck and guided to the heart using an ultrasound until it reaches the place where the source of the heart’s irregular signals is located. The catheter is then used to create scars on the surface of the heart to block these irregular signals; these scars are created with heat (radiofrequency ablation) or cold (cryoablation).

In total, the procedure should last approximately 2-4 hours. After the procedure, you will be moved to a recovery area to rest for 4-6 hours to prevent bleeding from the catheter insertion site. You will be still monitored during this period. Depending on your condition, you may be able to go home the same day or the day after.

You may feel some soreness after the procedure that will go away within a week. Usually, patients return to normal activities within few days after the ablation.

Your doctor may prescribe blood thinners for a few months after the procedure to reduce your risk of a stroke. The scars on the heart take some time to form after the ablation, so the irregular heart beat may not instantly go away.

Recurrence of AF after ablation

Even after successful ablation, you may continue to need a continuous heart rhythm-monitoring device. Repeating the procedure is not uncommon as ablation is not a guaranteed cure for persistent AF. Catheter ablation is a common treatment option for persistent AF; however, despite medical advances and two decades of experience, long-term procedural success rates at curing persistent AF are about 50-60% at 18 months.

Until Next Time!

Stephanie Coulter, MD