Atrial Fibrillation Ablation

What is ablation for atrial fibrillation?

Ablation is a procedure to treat atrial fibrillation. It uses small burns or freezes to cause some scarring on the inside of the heart to help break up and or insulate the electrical signals that cause irregular heartbeats. This can help the heart maintain a normal heart rhythm.

The heart has 4 chambers. There are 2 upper chambers called atria and 2 lower chambers called ventricles. Normally, a special group of cells begin the signal to start your heartbeat. These cells are in the sinoatrial (SA) node in the upper right atrium of the heart. During atrial fibrillation (AFib), the signal to start the heartbeat doesn’t begin in the sinoatrial node the way it should. Instead, the signal begins somewhere else within the tissue of the atria.. This abnormal signalling most commonly occurs near the connection between the pulmonary veins and the left atrium. These veins are what bring blood back from the lungs to the left atrium. When in AFib the atria can’t contract normally to move blood to the ventricles. This causes the atria to quiver or “fibrillate.” The disorganized signal spreads to the ventricles, causing them to contract irregularly and sometimes more quickly than they normally would. The contraction of the atria and the ventricles is no longer coordinated, and ventricles may not be able to pump blood as effectively to the body.

For ablation, a doctor puts thin, hollow tubes (catheters) into a blood vessel in the groin (or both groins) and threads it up to the heart giving access to the inside of the heart. Once the catheter is inside the heart, software mapping systems are used to allow the doctor to study the electrical signals as they occur in the heart as well as navigate where to position the catheter. The doctor then uses the catheters to create organized scar in a small area of the heart by making small burns or small freezes. In the burning process, a type of energy called radiofrequency energy uses heat to scar the tissue. The freezing process involves a technique called cryoablation. Scar does not conduct electrical signals inside the heart. Thus, by creating scar with the ablation, it helps prevent the heart from conducting the abnormal electrical signals that cause AFib.

Sometimes doctors use a surgical approach instead. This is most common when you are already having heart surgery for another reason.

Why might I need ablation?

Some people have unpleasant symptoms from AFib, such as shortness of breath and palpitations. AFib also greatly increases the risk for stroke. Blood-thinning (anticoagulant) medicines used for preventing stroke have their own risks. People on certain blood-thinners need to have extra blood draws and monitoring. The main reason for ablation is to control symptoms. It is not intended to eliminate the need for blood-thinners to prevent stroke.

Many people with AFib take medicines to help control their heart rate or their heart rhythm. The medicines don't work well for some people. In such cases, your doctor may suggest ablation to correct the problem. In general, ablation also works better to keep your heart at a normal heart rhythm when compared with medicines.

Ablation may be more likely to work long-term if you have AFib that has lasted for no more than 7 days at a time. It may be less likely to work long-term if you have AFib that lasts longer and if you have had it for years. Ablation might be a good option for you if you have no other structural problems with your heart. It also might be a good option for you if you have symptoms from your AFib and don't want to take medicine for the rest of your life.

Currently, healthcare providers treat most people with medicine before considering ablation. But ablation can be considered a first-line alternative to heart rhythm medicine. Ask your doctor about the pros and cons of the procedure in your particular situation.

What are the risks of ablation?

You may have certain risks based on your health conditions. Discuss all your concerns with your healthcare provider before your ablation. Most people who have AFib ablation have a successful outcome. But there are some risks linked to the procedure. Although rare, there is the risk of death. Other risks include:

  • Bleeding, infection, and pain from the catheter insertion
  • Damage to the blood vessels from the catheter
  • Puncture to the heart
  • Damage to the heart. This damage might require a permanent pacemaker.
  • Blood clots, which might lead to a stroke
  • Narrowing of the pulmonary veins. These are the veins that carry blood from the lungs to the heart.
  • Radiation exposure
  • Damage to the esophagus
  • Damage to the nerves of the diaphragm or gut

You are more likely to have complications if you are older or if you have certain other health and heart conditions.

It is important to understand that the procedure likely will not permanently stop AFib. Sometimes AFib will come back shortly after the procedure or several months later. You might be more likely to have this problem if you are older, have other heart problems, or have had AFib for a long time. Having the ablation again can often improve the results of the first ablation procedure.

How do I get ready for an ablation?

Talk with your doctor about what you should do to prepare for your AFib ablation. Follow any directions you are given for not eating or drinking before your procedure. Follow your doctor’s instructions about what medicines to take before the procedure. Don’t stop taking any medicine unless your doctor tells you to do so.

Your doctor might order some tests before your procedure. These might include:

  • Electrocardiogram (ECG), to analyze the heart rhythm
  • Echocardiography (echo), to assess heart structure and function
  • Stress testing, to see how your heart responds to exercise
  • Blood tests. for example, to test thyroid levels
  • Cardiac CT or MRI, to further look at your heart anatomy

Let your doctor know if you are pregnant before having the procedure. Ablation uses radiation, which may be a risk to the fetus. If you are a woman of childbearing age, your doctor may want a pregnancy test to make sure you aren’t pregnant.

Someone will shave your skin above the area of operation (usually in your groin). About an hour before the operation, you will be given medicine to help you relax.

What happens during ablation?

Talk with your doctor about what to expect during your ablation. The procedure usually takes 2 to 4 hours. A cardiologist and a special team of nurses and technicians will do the ablation. During the procedure:

  • You may have numbing medicine (local anesthetic) put on your skin where the team will make a small cut (incision). This is usually in your groin.
  • You will likely get medicine (general anesthesia) so that you will sleep through the surgery.
  • Your doctor will make several small holes in a vessel in one or both groins. He or she will put a few tapered tubes called sheaths through this hole.
  • Your doctor will put a series of electrode catheters through the sheaths and into your blood vessel. Electrode catheters are long, thin, flexible tubes with electrodes at the tip. The team will then move the tubes to the correct place in your heart.
  • Next, the doctor will locate the abnormal tissue using special technology. This technology involves a mapping system. It may also have a GPS like feature to let the doctor to see where the catheter is inside the heart. He or she will send small electrical impulses through the catheter. Other catheters will record the heart’s signals to find the abnormal sites.
  • The doctor will place the catheter at the site where the abnormal cells are. He or she will then scar the abnormal area by freezing or burning. This might cause slight discomfort if you are awake
  • You will likely get blood-thinning medicine through an IV to help prevent clots from forming on the catheters while they are inside your heart. This helps lower the risk for stroke.
  • Once the ablation is completed, the team will remove the tubes. They will close your vessel with firm pressure.
  • The team will close and bandage the site where the doctor inserted the tubes.

What happens after ablation?

Talk with your doctor about what to expect after your ablation. In the hospital after the procedure:

  • You will spend several hours in a recovery room.
  • The team will monitor your vital signs, such as your heart rate and breathing.
  • You will need to lie flat for several hours after the procedure. You should not bend your legs. This will help prevent bleeding.
  • Most people spend the night in the hospital.
  • You may feel some chest tightness after the procedure.
  • Your doctor will review which medicines you need to take, including blood-thinners.

At home after the procedure:

  • Most people can return to normal activities within a few days after leaving the hospital.
  • Don't do heavy physical activity for a few days.
  • Don't drive for 48 hours after the procedure.
  • You may have a small bruise from the catheter insertion. If the insertion site starts to bleed, press down on it and call your doctor.

Call your doctor if your leg is numb or if your puncture site swells. Also call your doctor if you have fever, vision changes, confusion, chest pain, an irregular heartbeat, or shortness of breath.

After you leave the hospital, it is important to follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care. Be sure to keep all your follow-up appointments.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how you will get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much you will have to pay for the test or procedure

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