What is catheter ablation of AF?
Catheter ablation eliminates arrhythmias by advancing catheters (Teflon-coated wires) to the heart, putting the catheter tip on the spot causing the arrhythmia, and cauterizing and eliminating it by heating the tip of the catheter. This procedure was developed during the 1980’s, and has been standard therapy for many arrhythmias since 1990. It is performed by electrophysiologists; cardiologists who specialize in management of heart rhythm disturbances. Even the earliest reports showed this procedure to be extremely successful (almost 100%), with few complications (less than 1%); it revolutionized the management of many common arrhythmias.
AF is more complex than those arrhythmias, however, and catheter ablation of AF was not attempted until nearly 10 years later, when our understanding of AF improved and advanced therapy such as catheter ablation became practical. Catheter ablation of AF can be successful but has not reached the extremely high success rates that are attained in ablation of many other common arrhythmias.
This procedure goes by several names, including the Pulmonary Vein Isolation Procedure, Catheter Maze, Pappone Technique, Wide Area Circumferential Ablation, and Catheter Ablation of AF. Catheters are maneuvered from the leg into the left atrium, and ablation of the connections between the Left Atrium and the Pulmonary Veins is performed. The nerves responsible for some AF are near these connections, and many are eliminated at the same time. Because the connections are quite extensive, AF ablation is much more extensive than a standard ablation procedure, and the procedure can be long. The potential for complications is higher than standard ablations, due to the large amount of ablation that is required, and the proximity of the pulmonary veins, the esophagus, and other structures. Nevertheless, catheter ablation for AF is successful in many cases, and has become an important part of the management of AF.
What is it like to have a catheter ablation of AF?
Catheters in the right groin for ablation
You would come to the hospital on the morning of your procedure, to be admitted to the Cardiac floor. From there, you would be taken to the Electrophysiology Laboratory, where these procedures are performed. They can be long, taking at least 3 hours, but sometimes quite a bit longer than that.
You would be asleep at the time; most patients don’t feel or remember much. Your right and left groin areas would be cleaned, sterile drapes would be put over you, and the doctor and his staff would insert sheaths (tubes) into the vein in the groin so that catheters (thin, flexible Teflon-coated wires) could be maneuvered into the heart. To get to the area causing the AF, a needle must be used to advance them from the right upper chamber to the left upper chamber (transseptal procedure). You will be given blood thinners by vein to reduce the risk of stroke during the procedure. The main part of the procedure involves your doctor finding and cauterizing the spots causing the AF.
Afterward, you will return to your room. The sheaths are usually still in place; they are removed when the blood thinners wear off several hours later. You will stay overnight, and go home the next day.
Some AF may persist for the next 4 to 6 weeks or so, while the healing process completes. You will be followed in clinic by the electrophysiologist and their staff following the procedure.
How successful is catheter ablation of AF?
The reported success rates of all curative procedures is highly dependent on how long and how well patients are followed. See the brief discussion of this issue on the Curative Procedures page.
Worldwide results of catheter ablation of AF in more than 8000 patients from 1995 to 2002 were published in February 2005 and can be reviewed here. 52% of patients had a complete success, and 76% were successful if those who required medications to maintain normal rhythm after ablation are included. About 25% of patients had required a second procedure, and there were complications in 6% of patients. These results probably underestimate current success of catheter ablation using current techniques, which have improved since 2002, when the study ended.