So your heart is beating irregularly. It jumps. It skips. You've been diagnosed with the medical condition called Atrial Fibrillation. The question is do you need an ablation.
First, if you may ask the question, "What is an ablation?"
An "ablation" is a cardiac procedure where specialized plastic tubes (called radiofrequency ablation catheters) are inserted into the heart's venous system through the right groin. The area where the Atrial Fibrillation is shown to originate is mapped out using a 3-dimensional location system.
Atrial Fibrillation is commonly triggered by extra heartbeats that originate in the muscles of the heart chamber called the left atrium. Frequently this location extends into the pulmonary veins that bring oxygenated blood into the heart from the lungs.
In patients whose Atrial Fibrillation is infrequent called "paroxysmal" up to 90% of all Paroxysmal Atrial Fibrillation originates in this location. Other locations where the Atrial Fibrillation can originate are in other areas of the left atrium or the right atrium.
The catheters are positioned in the appropriate position and radiofrequency energy is delivered through the tip of the catheter. The heart tissue's temperature rises and the area is effectively "burned."
The success rate of treating your Atrial Fibrillation with ablation is somewhere between 40-70%. By this I mean your ability to be off all mediations after receiving ablation. The ability to lesson symptoms by preventing recurrences or slowing the rate of Fibrillation is higher- 70% for many people.
Whether your Paroxysmal Atrial Fibrillation can be cured is very dependent on what is going on inside your body and heart. If you have a normal heart and no heart disease, your chances of having a cure from Paroxysmal Atrial Fibrillation using ablation is much better.
So if you don't have: high blood pressure, previous heart attack, leaky heart valves, lung disease that affects the heart, enlarge left atrium, or have had your heart rhythm problems for over a year- your chances of having a cure of your Atrial Fibrillation is much higher.
A more difficult form of Atrial Fibrillation to treat is called Chronic Atrial Fibrillation. In the Chronic form of Atrial Fibrillation where multiple sites of origination of Atrial Fibrillation is common. Because many sites need to be burned to cure this form of Atrial Fibrillation the success rate is not as good.
As was mentioned in previously (see earlier blog postings), two goals exist in the treatment of Atrial Fibrillation. One is to reduce the risk of stroke and the second is to reduce symptoms.
When trying to control symptoms your doctor has to decide if he/she is going to allow you to stay in Atrial Fibrillation while trying to control your fast heart rate or attempt to get you back into the normal rhythm.
Both of these methods generally require the use of medications. Medications, as most patients, know frequently have unwanted side effects. They may make you feel exhausted. They may cause nausea, diarrhea, light-headedness, or a number of other unpleasant feelings.
If it could be possible to stop Atrial Fibrillation without medications this would be desirable.
So, are you a good candidate for Ablation of your Atrial Fibrillation?
Good candidates have the following:
- Your heart normal? By this I mean that you don't have any enlargement of your heart chambers or weakening of your heart muscle.
- No valve problems. You shouldn't have leaky or narrowed valves.
- No heart attacks. People with prior heart damage due to blocked arteries have higher pressures in the heart and are more prone to Atrial Fibrillation
- A short duration of Atrial Fibrillation. If your Fibrillation has only been going on for a few months your chances of success are greater.
Can ablation be indicated if I don't fall into the above categories?
Sure, ablation can help reduce the number of episodes of Atrial Fibrillation. It can also be very helpful for people whose rate of Atrial Fibrillation is quite high and makes them pass out, get light-headed, or have shortness of breath. Ablation can help control the rate.
The American College of Cardiology has published guidelines of patients who should be referred for Ablation.
Radiofrequency Ablation is a reasonable treatment for patients who have symptom: fatigue, shortness of breath, palpitations who have failed drug treatment who do not have an enlarged left atrium. Elderly patients are at higher risk of developing complications.
One thing should be mentioned here. Radiofrequency ablation is not without possible complications, some very serious complications. Death is a possible complication. 1/1000 have died during this procedure due to rupture of the atrium and bleeding from the heart. The risk of death is highly dependent on the amount of experience of the doctor performing the procedure.
Another possible complication is narrowing of the pulmonary veins after the procedure. This is due to scarring from the burning. It occurs in 1-3%. This can cause a cough, shortness of breath with activity, and chest pain.
Other potential complications are:
- Stroke- 1-6%
- Injury to the phrenic nerve- <1%
- Coronary Artery blockage- <1%
I hope this has shed some light on the topic of Atrial Fibrillation ablation. For further information.
Dr. Kirk Laman