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Home > Wellness > Health Library > Catheter Ablation for Atrial Fibrillation
If medicine is not effective or not
atrial fibrillation, a nonsurgical procedure called
catheter ablation may be chosen. Catheter ablation for atrial fibrillation is
relatively new and is still being studied.
In this procedure
thin, flexible wires are inserted into a vein in the groin and threaded up
through the vein and 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
Ablation procedures either try to cure atrial fibrillation
(focal ablation, circumferential ablation, and pulmonary vein ablation) or try
to control your symptoms (nodal ablation).
circumferential catheter ablation are used to try to cure atrial fibrillation.
Focal ablation, also known as targeted ablation, is used to destroy the
specific areas in the heart that are firing off abnormal electrical impulses
and causing atrial fibrillation. Circumferential ablation is used to destroy
the tissue that lets atrial fibrillation continue. Sometimes, a doctor uses
both focal and circumferential ablation.
Pulmonary vein ablation
is also used to try to cure atrial fibrillation. 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
A pacemaker is usually not needed when catheter
ablation is done on the pulmonary vein or other targeted tissue.
slideshow of pulmonary vein or focal ablation to see how the heart's electrical
system works, how atrial fibrillation happens, and how pulmonary vein or focal
ablation is performed.
In some cases, catheter ablation may be
done by applying radiofrequency energy to the outside or inside surface of the
heart during open-heart surgery. This may be an option if you are already
having heart surgery for another reason, such as
coronary artery bypass or valve replacement
Nodal catheter ablation, also known as AV node ablation, can control
symptoms of atrial fibrillation when the cause cannot be stopped. You may need
AV node ablation if targeted or pulmonary vein ablation did not stop your
atrial fibrillation, or if these procedures will not help you. 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. So you will probably need to take
anticoagulation therapy such as warfarin.
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.
You will be given medicine to help you relax. A
local anesthetic will numb the site where the catheter
is inserted. The procedure is done in a hospital where you can be watched
Recovery from catheter ablation is
usually quick. You may be hospitalized for 1 to 2 days so that your doctor can
monitor your heart rate.
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 shown 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. See the:
After an ablation, you might take an antiarrhythmic medicine to help keep your heart in a normal rhythm.
You might feel a flutter in your heart after the
ablation procedure. The flutter usually goes away after your heart heals. If
your flutter does not go away, you may need a second ablation procedure.
Ablation might be done if you have symptoms of atrial fibrillation that won't go away, if your medicine
hasn't brought back a normal heartbeat, or if your medicine causes side effects that are hard to live with.
This treatment does
have some serious risks, but they are rare.
Many people decide to have ablation because they
hope to feel much better afterward, and that hope is worth the risks to them.
But the risks may not be worth it for people who have few symptoms or for those
who are less likely to be helped by ablation.
Catheter ablation is more successful in people who have atrial fibrillation that comes and goes (paroxysmal) than in people who have atrial fibrillation that is persistent or chronic (constant).
first procedure does not get rid of atrial fibrillation completely, catheter
ablation may need to be done a second time. Repeated catheter ablations have a
higher chance of being successful.
Catheter ablation is still
being studied to see how well it works and how safe it is in the long
Catheter ablation is thought to be safe. It has some
serious risks, but they are rare. They include:
You will have to decide whether the possible benefits of
ablation outweigh these risks. Your doctor can help you decide.
Certain people shouldn't have ablation
isn't a choice for some people, including those who:
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
Callahan TD IV, Natale A (2008). Catheter
ablation of atrial fibrillation. Medical Clinics of North America, 92(1): 179–201.
February 15, 2011
E. Gregory Thompson, MD - Internal Medicine & John M. Miller, MD, FACC - Cardiology, Electrophysiology
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