Atrial Fibrillation Video Series: Day Nine
Catheter Ablation: How It Works and Who It Helps
Up to now, we’ve mainly discussed medications and monitoring for AF. Now let’s talk about a more direct treatment option that you may have heard of or even been recommended: catheter ablation. In simple terms, catheter ablation is a minimally invasive procedure that aims to eliminate the source of the AF within the heart, rather than just managing it with medications. It’s an important option for many patients, especially if symptoms persist despite meds or if you prefer to try to fix the problem at its root.
How does ablation work? In atrial fibrillation, the erratic electrical signals often originate in the areas where the pulmonary veins connect to the left atrium (these veins bring blood from the lungs into the heart). In a catheter ablation, a specialized heart doctor called an electrophysiologist inserts thin, flexible wires called catheters into your heart (usually via a vein in the groin, under local anesthetic). Once the catheters reach the left atrium, the doctor uses either heat (radiofrequency energy) or extreme cold (cryoablation) at the tip of the catheter to create small scars around the openings of those pulmonary veins. This is called pulmonary vein isolation. The scars act like roadblocks, preventing rogue electrical signals from those veins from spreading into the rest of the atrium and causing AF.
The procedure typically takes a few hours. You’re usually sedated or under light general anesthesia (so you won’t feel pain during it). Many patients go home the same day or after one night in the hospital. It’s worth noting that after an ablation, it’s normal to still have some irregular heartbeats as the heart heals – we usually give it about 2-3 months (a “blanking period”) to see the full effect.
Who is ablation for? Catheter ablation is often recommended for people with symptomatic AF who haven’t had enough relief from medications or prefer not to stay on them long-term. It’s particularly effective for paroxysmal AF (episodes that come and go) – success rates in maintaining normal rhythm for at least a year or more after a single ablation can be quite good in this group (often quoted around 70-80% success for one procedure, potentially higher with multiple). For persistent AF, ablation can still help, but success rates are a bit lower and sometimes multiple procedures or additional strategies are needed. Ablation is usually not the first option for permanent AF, because once AF is long-established it’s harder to completely eradicate.
It’s important to have a discussion with an electrophysiologist to understand the risks and benefits in your specific case. Ablation is generally safe, but like any procedure, it carries some risks – these can include bleeding where the catheters go in, or rare but more serious complications like stroke, heart damage, or an injury to the esophagus due to the heat (these are uncommon in experienced hands, but they are why we carefully consider who really needs an ablation).
The big benefit of successful ablation is the potential to live free of AF (or with much less AF), which can greatly improve quality of life. Some patients are able to reduce or stop certain medications after a successful ablation (for example, coming off an antiarrhythmic drug). However, many patients will still need to continue blood thinners, because AF can recur silently and stroke risk might still be present.
In short, catheter ablation is like fixing faulty wiring in the heart. It doesn’t involve any large incisions – just needle punctures – and for the right patient, it can make a world of difference.
In the next email: We’ll explore another route: surgical AF ablation via keyhole (VATS) surgery. This is different from catheter ablation and can be a great option in certain scenarios. I’ll explain why a surgical approach might be used and how it works.
