Atrial Fibrillation Ablation

AF ablation is a relatively new procedure that was first introduced in 1998. Since then, AF ablation has become a common treatment for AF, and has been performed on hundreds of thousands of patients worldwide. In the early days of AF ablation, the procedure was considered to be experimental and was reserved for patients with severe AF that was not responding to other treatments. Over time, however, the development of novel ablation technologies and strategies refined the way we perform AF ablation and as a result outcomes improved. AF ablation has become now a more mainstream treatment option for AF, and is now considered a standard of care for a lot of patients suffering with AF.
Fig 57 AF ablation
Atrial fibrillation is often triggered by a burst of electrical signals originating from the pulmonary veins (the veins that bring the blood from the lungs to the left atrium) and maintained by an enlarged left atrium that can sustain AF. Pulmonary vein isolation (PVI) is considered the cornerstone procedure to treat AF. The goal of PVI is to disrupt the abnormal electrical signals that trigger AF by ablating or destroying the tissue around the mouths of pulmonary veins and isolating them electrically from the rest of the heart. In advanced cases of AF, isolating the pulmonary veins may not be enough to control AF and extra ablation lines need to be performed inside the left atrium to make it less susceptible to maintain AF. Your electrophysiologist will decide on what strategy will be best to treat your AF.
During an Atrial Fibrillation Ablation procedure, catheters are guided through a vein in the leg to the right atrium and then to the left atrium using a specialised needle and tube. The catheters are used then to deliver energy to the tissue around the pulmonary veins, either by heating the tissue (radiofrequency ablation), or freezing it (cryoablation), or by delivering a strong electrical current (pulsed field ablation). This creates a scar that blocks the abnormal electrical signals originating in the veins and were causing the AF. Extra lines of ablation are then added if needed inside the atrium.
The procedure typically takes 2-3 hours to complete, but can take longer in complex cases. After the procedure, patients will typically need to stay in the hospital for a short period of time for observation, but can usually go home the following day. Patients will usually need to avoid strenuous activity or carrying heavy weights for few days after the procedure before returning to normal daily activities.
PVI is considered to be a safe and effective treatment for AF, and has a success rate of up to 80-85% in some cases (compared to 40% with medications). The success rate of Atrial Fibrillation Ablation depends on several factors, including:

The type and severity of the patient's AF

Patients with paroxysmal (intermittent) AF have higher success rates than those with persistent AF. In general, the longer you are in AF, the lower the success rate of AF ablation.

The patient's age and overall health

younger patients with fewer comorbidities tend to have better outcomes than older patients or those with multiple health conditions.

The size of the left atrium

The smaller the left atrium the higher the success rate of AF ablation

The experience and skill of the operator

AF ablation is a complex procedure that requires specialized training and experience to perform. Studies have shown that success rates tend to be higher when the procedure is performed by experienced operators.

The patient's adherence to post-procedure care

Following AF ablation, patients are typically prescribed medications and advised to make lifestyle changes to reduce the risk of AF recurrence. Adherence to these recommendations can impact the success of the procedure.

If there is a recurrence of AF, the ablation procedure may need to be repeated. The Achilles heel of Atrial Fibrillation Ablation is the ability of the heart to repair and heal the area that was ablated in the weeks or months after ablation. Even if a small area is repaired, electrical impulses can now flow again from the veins and cause AF. During a repeat ablation procedure, your electrophysiologist will target the areas that were repaired and ablate them again, or add more ablation lesions as needed.
Like all medical procedures, AF ablation does carry some risks, such as bleeding, stroke, damage to the heart or surrounding organs. However, in experienced hands, the risks are often very small (<1%).
In summary, Atrial Fibrillation Ablation has become an essential part of the management of AF particularly in younger patients and patients who can’t tolerate or don’t want to take medications. It is important for patients to discuss their individual risks and benefits with their electrophysiologist prior to undergoing the procedure to decide on the best strategy.