Catheter Ablation for Atrial Fibrillation

Treatment Overview

Catheter ablation is a minimally invasive procedure to treat atrial fibrillation. It can relieve symptoms and improve quality of life.

During an ablation, the doctor destroys tiny areas in the heart that are firing off abnormal electrical impulses and causing atrial fibrillation.

You will be given medicine to help you relax. A local anesthetic will numb the site where the catheter is inserted. Sometimes, general anesthesia is used. The procedure is done in a hospital where you can be watched carefully.

Thin, flexible wires called catheters are inserted into a vein, typically in the groin or neck, and threaded up into the heart. There is an electrode at the tip of the wires. The electrode sends out radio waves that create heat. This heat destroys the heart tissue that causes atrial fibrillation or the heart tissue that keeps it happening. Another option is to use freezing cold to destroy the heart tissue.

Sometimes, abnormal impulses come from inside a pulmonary vein and cause atrial fibrillation. (The pulmonary veins bring blood back from the lungs to the heart.) Catheter ablation in a pulmonary vein can block these impulses and keep atrial fibrillation from happening.

View a slideshow of catheter ablation to see how the heart's electrical system works, how atrial fibrillation happens, and how ablation is done.

Click here to view a Decision Point.Atrial Fibrillation: Should I Have Catheter Ablation?

AV node ablation

AV node ablation is a slightly different type of ablation procedure for atrial fibrillation. AV node ablation can control symptoms of atrial fibrillation in some people. It might be right for you if medicine has not worked, catheter ablation did not stop your atrial fibrillation, or you cannot have catheter ablation. With AV node ablation, the entire atrioventricular (AV) node is destroyed. After the AV node is destroyed, it can no longer send impulses to the lower chambers of the heart (ventricles). This controls atrial fibrillation symptoms.

After AV node ablation, a permanent pacemaker is needed to regulate your heart rhythm. Nodal ablation can control your heart rate and reduce your symptoms, but it does not prevent or cure atrial fibrillation. AV node ablation helps about 9 out of 10 people.1 The procedure has a low risk of serious problems.2

View a slideshow of AV node ablation to see how the heart's electrical system works, how atrial fibrillation happens, and how AV node ablation is performed.

What To Expect After Treatment

Recovery from catheter ablation is usually quick. You may be hospitalized for 1 to 2 days so that your doctor can monitor your heart.

Many people think that having ablation means they'll be able to stop taking an anticoagulant (also called a blood thinner), such as warfarin, every day to prevent stroke. But that is only true if your risk of stroke is low. Studies haven't proved that ablation for atrial fibrillation lowers your risk of stroke. So you'll still need to take an anticoagulant if your risk of stroke remains high. Your doctor can tell you about your stroke risk.

Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?

After an ablation, you might take an antiarrhythmic medicine for a few months to help keep your heart in a normal rhythm.

Your doctor might ask you to take your pulse at home to see if it is irregular. You might also use an ambulatory EKG monitor (such as a Holter monitor) at home to check your heart rhythm.

You might feel symptoms, such as palpitations, after the ablation procedure. These symptoms might happen while your heart is healing. During your follow-up visits, tell your doctor if you have symptoms. If they do not go away after a few months, you may need a second ablation procedure.

Why It Is Done

Ablation might be done if you have symptoms that won't go away after you take an antiarrhythmic medicine to control your heart rhythm. Either your medicine did not bring back a normal heartbeat, or your medicine caused side effects that are hard to live with.3, 4

Catheter ablation does have some serious risks, but they are rare. Many people decide to have ablation because they hope to feel much better afterward. That hope is worth the risks to them. But the risks may not be worth it for people who have few symptoms or for people who are less likely to be helped by ablation.

How Well It Works

Catheter ablation can stop atrial fibrillation from happening and can relieve symptoms.

Catheter ablation works better in people who have atrial fibrillation that comes and goes (paroxysmal) than in people who have atrial fibrillation that is persistent (lasts longer than 7 days and doesn't go away on its own). Ablation might be less likely to work the longer a person has persistent atrial fibrillation.4

Other things that limit how well catheter ablation works include older age, other heart problems, obesity, and sleep apnea.4 Your doctor can help you decide if ablation is a good choice based on your health.

Catheter ablation is still being studied to see how well it works and how safe it is in the long term.

Paroxysmal atrial fibrillation
  • Research shows that ablation helps more than 70 to 80 out of 100 people.5 That means it does not help in about 20 to 30 out of 100 cases.
  • In a worldwide survey, ablation helped 84 out of every 100 people.6
Persistent atrial fibrillation
  • Research shows that ablation helps about 50 out of 100 people.4, 1 That means it doesn't work in about 50 out of 100 cases.
  • In a worldwide survey, ablation helped about 65 out of every 100 people.6
Repeated ablation procedures

If the first procedure doesn't get rid of atrial fibrillation completely, you may need to have it done a second time. Repeated ablations have a higher chance of success.

Research shows that a second ablation is needed in 20 to 40 people out of 100. This means that 60 to 80 out of 100 people don't need another ablation.4

Risks

Catheter ablation is considered safe. Most people do well afterward.

Your doctor can help you decide whether the possible benefits of ablation outweigh these risks:

Problems during the procedure

If problems happen during the procedure, your doctor is prepared to fix them right away. In studies and a worldwide survey, serious problems happened in about 4 out 100 people.7, 6 These problems include an accidental hole in the heart, the need for emergency surgery, and nerve damage in the chest.

Rare problems include cardiac tamponade and stroke. They happen in about 1 out of 100 people.5 This means that they do not happen in about 99 out of 100 people. Another serious problem affects the pulmonary vein and happens in about 1 to 6 people out of 100 people.5, 7 This means that it does not happen in about 94 to 99 people out of 100.

Death from the procedure is very rare. It happens to about 1 out of 1,000 people.5 This means that 999 out of 1,000 people don't die from the procedure.

Problems after the procedure

Problems after the procedure can be minor (such as mild pain) or serious (such as bleeding). Your doctor will check you closely after the procedure. He or she can fix most of these problems.

The most common problems are related to the catheter that was inserted in a vein. Most of these vein problems aren't serious. They include minor pain, bleeding, and bruising. Vein problems happen in 0 to 13 people out of 100.4 This means that they don't happen in 87 to 100 people out of 100. In a worldwide survey, serious vein problems happened in 1 out every 100 people.6

Serious problems aren't common. These problems include stroke and new heart rhythm problems. A rare problem is a life-threatening problem with the esophagus (atrio-esophageal fistula) that happens to about 1 out of 1,000 people.5 This means it doesn't happen to 999 out of 1,000 people.

What To Think About

Certain people shouldn't have ablation

Ablation isn't a choice for some people, including those who:

  • Aren't able to lie still or cooperate with the doctor who is doing the test.
  • Have a history of bleeding problems.
  • Have a blood clot in the left atrium of the heart.

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References

Citations

  1. Morady F, Zipes DP (2012). Atrial fibrillation: Clinical features, mechanisms, and management. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 825–844. Philadelphia: Saunders.
  2. Chatterjee NA, et al. (2012). Atrioventricular nodal ablation in atrial fibrillation: A meta-analysis and systematic review. Circulation: Arrhythmia and Electrophysiology: 5(1): 68–76.
  3. Fuster V, et al. (2011). 2011 ACCF/AHA/HRS focused update incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): e269–e367.
  4. Calkins H, et al. (2012). 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 9(4): 632–696.e21.
  5. Tedrow UB, et al. (2011). Electrophysiology and catheter-ablative techniques. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 1, pp. 1058–1070. New York: McGraw-Hill.
  6. Cappato R, et al. (2010). Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation: Arrhythmia and Electrophysiology, 3(1): 32–38.
  7. Agency for Healthcare Research and Quality (2009). Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation (AHRQ Publication No. 09-EDC015-EF). Rockville, MD: Agency for Healthcare Research and Quality.

Credits

By Healthwise Staff
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
John M. Miller, MD, FACC - Cardiology, Electrophysiology
Last Revised December 14, 2012

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