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Atrial Fibrillation Ablation

 

Catheter ablation is a minimally invasive procedure with the goal of eliminating the cause of AF in a given patient. In expert hands, catheter ablation is an effective treatment for patients with most forms of AF but is most effective for the elimination of paroxysmal ie episodic AF. Ablation therapy requires a team approach and your choice of specialist and team is key to achieving the best outcome for you.

 

Should I have a catheter ablation procedure?


Catheter ablation is most often recommended for patients with symptomatic AF which has been inadequately controlled with the use of a medication. In certain circumstances, it is reasonable to recommend catheter ablation without having tried an anti-arrhythmic medication first. The decision to undergo an ablation procedure is not taken lightly as although AF cure rates of up to 80% can be achieved, this will require more than one procedure in up to half of patients and each procedure carries a significant complication rate of between 2 and 3%.

 

How is a catheter ablation procedure performed?


You will be admitted on the day of the procedure, fasted from 6 hours before the planned time of the procedure. If you are already taking warfarin, the procedure will be performed without stopping the warfarin. If you are not already taking an anticoagulant, one will be started after the procedure and continued for at least 3 months.

 

Under general anaesthetic, small purpose-built catheters are passed from the femoral vein in the groin up to the heart. Following an atrial transseptal puncture, the catheters are passed into the left atrium. Depending on the ablation technology being used, deliberate but limited scars are placed within the left atrium. The extent and location of the scars depends largely on the type of AF being treated. For paroxysmal AF, a pulmonary vein isolation procedure alone would be recommended in the majority of patients. Once complete, all of the equipment is removed from the heart and the small puncture wounds in the femoral vein sealed. The procedure typically takes between 2 and 3 hours and involves one night in hospital.

What are the potential risks and benefits of a catheter ablation procedure?


For the majority of patients with paroxysmal AF and an otherwise normal heart, an ablation procedure will likely result in a substantial improvement if not elimination of AF-related symptoms. In patients with persistent and longstanding persistent AF, a cure is more difficult to achieve and repeat procedures more likely. Nevertheless, in expert hands and with appropriate and realistic patient selection, cure rates in excess of 70% can be achieved. It is not realistic to expect to cure every AF patient with catheter ablation nor should it be recommended as the appropriate treatment for all without a full discussion of the risk-benefit balance.

 

Radiofrequency catheter ablation for AF carries a 2-3% risk of a complication. These include lower limb vascular injury (1.5%), cardiac puncture (0.5%), stroke (0.5%), pulmonary vein stenosis (0.3%), phrenic nerve injury (0.2%), atrio-oesophageal fistula (1/800), death (1/800).

 

Who will perform my catheter ablation?


Your catheter ablation procedure will be performed by the consultant you have seen in the clinic. Where necessary, our team of consultants will work together during your procedure to ensure that you receive the highest level of care we can offer.

 

What happens after the procedure?


Patients are usually discharged home the day after the procedure. You can expect to have some discomfort in the groin at the vascular access site for a few days after the procedure. You will be seen 3 months after the catheter ablation procedure but there will always be a consultant available to see you in the interim should the need arise. A 7 day period of heart rhythm monitoring will be performed at 3, 6 and 12 months after the procedure. Your anticoagulant medication will be continued for at least 3 months following your procedure. The decision to discontinue any of your medication will be discussed in detail with you and recommendations will be made according to published evidence and best practice guidelines. It is important to understand that catheter ablation has not been proven to eliminate AF-associated stroke risk.

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