What is atrial fibrillation ablation?
Wilber Su, MD, is a cardiologist and cardiac electrophysiologist. He is on staff at Banner – University Medical Center Phoenix.
Question: What is atrial fibrillation ablation?
Answer: Atrial fibrillation ablation is a procedure performed by highly-trained cardiac electrophysiologists using various energy sources to destroy abnormal heart tissue that initiates or sustains the abnormal rhythm. Safer technology such as the cryoablation has emerged and is now becoming the standard of care in many centers.
Catheter ablation for the potential cure of atrial fibrillation has come a long way since a decade ago. It is now considered a standard of care in several national and international guidelines for care, including the Heart Rhythm Society (HRS), European Heart Rhythm Association (EHRA), and European Cardiac Arrhythmia Society (ECAS), who have consensus statement regarding catheter and surgical ablation for atrial fibrillation appropriate for standard of clinical practice in 2007.
Question: Is atrial fibrillation ablation right for me?
Answer: Atrial fibrillation ablation is typically not the first line of therapy. The patient should be symptomatic and intolerant to initial medical therapy. If there is cardiomyopathy related to Afib, there may be more benefit derived from ablative therapy.
Most non-randomized trials demonstrated a 60 percent or greater single procedural success rate in patients with paroxysmal AF. The single procedural success decreases down to 30 percent or less in those with persistent atrial fibrillation.
There are several strategies for catheter ablation of atrial fibrillation, but the common result is the elimination of pulmonary vein triggering potentials, and therefore blocking the important electrical signals from the pulmonary veins.
There are certainly risks associated with any ablation procedure, and current emphasis on the procedures are focused on the avoidance of complications—pulmonary vein stenosis, atrial esophageal fistula, and stroke. These complications have been minimized by the awareness of different ablation techniques, and by the ability to utilize different energy sources.
A commonly used energy source is radio frequency ablation (RFA), but some procedures have been associated with devastating complications such as pulmonary stenosis, atrial-esophageal fistula, and stroke.
Novel energy sources are increasing in popularity including cryoablation which freezes the abnormal heart tissue instead of heating it. This has proven to be safer in many regards.