Atrial fibrillation is thought to arise from one or more of the pulmonary veins leading to an uncoordinated rapid contraction of the heart.
The objective of any form of Atrial Fibrillation ablation therapy is to electrically isolate the pulmonary veins from the rest of the heart in an attempt to prevent these haphazard stimuli.
This treatment involves the advancement of catheters into the heart via the groin vessels. These catheters are placed at the orifices of the pulmonary veins, and can detect abnormal electrical activity in these zones. Any detected abnormal activity can be destroyed with radiofrequency energy.
This treatment is only really effective in patients with Paroxysmal Atrial Fibrillation.
The immediate result can be very good. Recurrence occurs in as many as 30% of patients within one year and repeat therapies may be required.
Catheter ablation is not an effective therapy for permanent Atrial Fibrillation. When the rate of atrial fibrillation cannot be controlled with drugs a different strategy is sometimes used where the conduction system that connects the fast beating atrial chambers (AV node) can be disconnected from the big muscular ventricles.
The heart rate must be restored using a permanent pacemaker but the efficiency of the heart cannot be restored using this therapy. This is called AV node ablation, and is generally not recommended without first considering a surgical strategy for Atrial Fibrillation ablation.
Pulmonary vein isolation for the treatment of Atrial Fibrillation is a very effective therapy. In patients with Paroxysmal Atrial Fibrillation, Keyhole Atrial Fibrillation ablation can be performed. Clinicians are beginning to realize that when catheter based therapies fail to control Atrial Fibrillation in its early phase, surgical ablation should be offered.
In more advanced disease where Atrial Fibrillation can become permanent, a surgical therapies have been shown to be very effective in experienced hands and should be considered in suitable patients (contact).
Patients undergoing any form of heart surgery should be considered for concomitant surgical Atrial Fibrillation ablation.
Stand-alone surgery (i.e. Atrial Fibrillation ablation only) should be considered for symptomatic patients who prefer a surgical approach, have failed one or more attempts at catheter ablation, or are not candidates for catheter ablation.