Atrial Fibrillation Ablation

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 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, the signal to start the heartbeat doesn’t begin in the sinoatrial node the way it should. Instead, the signal is sidetracked and begins somewhere else in the atria, triggering a small region at a time. 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 enough blood to the body.

For ablation, a doctor puts catheters (thin hollow tubes) into a blood vessel in the groin and threads it up to the heart giving access to the inside of the heart. The doctor then uses the catheters to scar 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. Scarring helps prevent the heart from conducting the abnormal electrical signals that cause atrial fibrillation.

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

Some people have unpleasant symptoms from atrial fibrillation, like shortness of breath and palpitations. Atrial fibrillation also greatly increases the risk of stroke. Anticoagulant medicines used for preventing stroke pose their own risks, and people on certain anticoagulation medicines require 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 for stroke prevention.

Many people with atrial fibrillation take medicines to help control their heart rate or their heart rhythm. Some people respond poorly to these medicines. In such cases, the doctor may suggest ablation to correct the problem.

Ablation may be more likely to work long-term if you have atrial fibrillation that has lasted for 7 days or less. It may be less likely to work long-term if you have more persistent atrial fibrillation. 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 atrial fibrillation.

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.

You may have specific risks based on your specific medical conditions. Be sure to discuss all your concerns with your healthcare provider before your ablation. Most people who have atrial fibrillation ablation have a successful outcome. There are some risks associated with the procedure, however. 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, which might require a permanent pacemaker
• Blood clots, which might lead to a stroke
• Narrowing of the pulmonary veins (veins that transport blood from the lungs to the heart)
• Radiation exposure

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

Another risk is that the procedure may not permanently eliminate atrial fibrillation. Sometimes atrial fibrillation 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 a longer duration of atrial fibrillation. Performing the ablation again can permanently eliminate atrial fibrillation in some of these people.

Talk with your doctor about what you should do to prepare for your atrial fibrillation ablation. Avoid eating or drinking anything before midnight of the day of 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 evaluate heart structure and function
• Stress testing, to see how the heart responds to exercise
• Blood tests (for example, to test thyroid levels)
• Cardiac catheterization or coronary angiography, to get more information about the coronary arteries
• Cardiac CT or MRI, to further evaluate 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.

Talk with your doctor about what to expect during your ablation. The procedure usually takes 3 to 6 hours. A cardiologist and a special team of nurses and technicians will do the ablation. During the procedure:

• You may have a local anesthetic (numbing medicine) applied to your skin where the team will make a small incision (usually in your groin).
• Or, you may receive a general anesthetic (numbing medicine) with a breathing tube inserted to make you sleep through the surgery.
• Your doctor will make several small holes in a vessel here. 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 advance the tubes to the correct place in your heart.
• Next, the doctor will locate the abnormal tissue using special technology. He or she will do this by sending a small electrical impulse 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.
• 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.

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.
• Avoid heavy physical activity for a few days.
• Avoid driving 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 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.

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
• The risks and benefits of the test or procedure
• When and where you are to have the test or procedure and who will do it
• When and how will you get the results
• How much will you have to pay for the test or procedure