Atrial fibrillation ablation is a treatment for an irregular and chaotic heartbeat called atrial fibrillation (A-fib). It uses heat or cold energy to create tiny scars in your heart to block the abnormal electrical signals and restore a normal heartbeat.
Atrial fibrillation ablation may be used if medications or other treatments don't work. Sometimes it's the first treatment for certain patients.
Atrial fibrillation ablation is most often done using thin, flexible tubes called catheters inserted through the veins or arteries to the heart. Less commonly, ablation is performed during cardiac surgery.
Why it's done
Normal heart rhythm versus atrial fibrillation
In a normal heart rhythm, an electrical signal travels from the heart's upper chambers (atria) to the heart's lower chambers (ventricles). In atrial fibrillation, electrical signals fire from multiple locations in the upper chambers — most often from the pulmonary veins. The atrioventricular (AV) node doesn't stop the extra signals from entering the ventricles. The result is a rapid and chaotic heartbeat.
Atrial fibrillation ablation is done to restore a normal heart rhythm. Your doctor may recommend this type of ablation if you have A-fib symptoms, including a fast, fluttering heartbeat, that hasn't improved with medication or other treatments.
Possible atrial fibrillation ablation risks include:
- Bleeding or infection at the site where the catheters were inserted
- Blood vessel damage
- Heart valve damage
- New or worsening arrhythmia
- Slow heart rate that could require a pacemaker to correct
- Blood clots in your legs or lungs (venous thromboembolism)
- Stroke or heart attack
- Narrowing of the veins that carry blood between your lungs and heart (pulmonary vein stenosis)
- Damage to your kidneys from dye used during the procedure
- Death in rare cases
Discuss the risks and benefits of atrial fibrillation ablation with your doctor to decide whether it's right for you.
How you prepare
Your doctor may order several tests to get more information about your heart condition before your atrial fibrillation ablation.
You'll need to stop eating and drinking the night before your procedure. Your doctor or nurse will tell you how or if you should continue any medications before atrial fibrillation ablation.
What you can expect
Atrial fibrillation ablation is done in the hospital is done in the hospital. A specialist will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax.
The amount of sedation needed for the procedure depends on your specific arrhythmia and other health conditions. You may be fully awake or lightly sedated, or you may be given general anesthesia (fully asleep).
Catheter insertion points for cardiac ablation
During cardiac ablation, catheters are passed through a vein in order to reach your heart. Catheters may be inserted in your groin, your shoulder or your neck.
One of the following ablation techniques is used to create small scars in your heart and block the abnormal heart rhythms:
- Heat (radiofrequency energy)
- Extreme cold (cryoablation)
You may feel some minor discomfort when the catheter is moved into your heart or when the dye is injected and when energy is being delivered. If you have severe pain or shortness of breath, let your doctor know.
The procedure usually takes three to six hours. Complicated procedures may take longer.
Following your procedure, you'll be moved to a recovery area to rest quietly to prevent bleeding from the site where the catheters were inserted into the blood vessels. Your heartbeat and blood pressure will be monitored continuously to check for complications.
Depending on your condition, you may be able to go home the same day as your procedure. If you go home the same day, plan to have someone drive you.
You may feel a little sore after your procedure, but the soreness shouldn't last more than a week. You'll usually be able to return to your normal activities within a few days after undergoing cardiac catheter ablation.
Most people see improvements in their quality of life after cardiac ablation. But there's a chance that your abnormal heartbeat may return. If this happens, the procedure may be repeated or you and your doctor might consider other treatments. The procedure hasn't been shown to reduce your risk of a stroke. You may need to take blood thinners to reduce your stroke risk.
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