Atrial fibrillation ablation

Specialty of Cardiothoracic surgery

What is atrial fibrillation ablation?

Atrial fibrillation ablation is a procedure used to treat atrial fibrillation - a type of abnormal heart rhythm also known arrhythmia. It works by scarring the inside of the heart, by burning or freezing parts of the heart tissue, to help alter or break up electrical signals that cause irregular heartbeats.

There are a group of cells in the heart that start the signal which initiates a heartbeat. In people who have atrial fibrillation these cells are overridden by other cells that are faulty and work too fast, causing the upper chambers of the heart to fibrillate (quiver). This creates a disorganisation of contractions in the heart and means that blood may not be pumped around the body efficiently.

Why is it done?

Some people experience shortness of breath and palpitations. In addition, atrial fibrillation can increase the risk of stroke.

Some people take medicine to control the symptoms, whilst for others the medication is ineffective so an ablation is needed to control it.

If your atrial fibrillation attacks are short (less than 7 days long), then it’s likely that an ablation will help in the long-term. If it’s very persistent, then ablation is less likely to work in the long-term. If you have no other heart problems, then this procedure might be a good option for you.

How is the procedure performed?

The procedure is normally performed in a hospital and you’ll be given a sedative to help you relax. The procedure may be performed under general anaesthetic.  A doctor will insert a needle into your vein and place a tube through the needle. After this, catheters are thread through the tube and guided to various places within your heart. These catheters have electrodes at the tips which send electrical impulses to your heart. Either heat or cold is applied via these catheters to the desired area to destroy cells and cause scarring.

The whole procedure can take up to 6 hours. Dye can be used to help the doctor see the blood vessels better. Sometimes, ablation can cause discomfort and slight pain. The procedure would be stopped if the pain is severe or it is too uncomfortable.

How do you prepare for it?

Your doctor will offer advice to you about how to prepare for it. Usually, you are asked to stop eating and drinking the night before the procedure.

You will be advised what medications should be stopped on the day of the procedure. If you are not on a blood thinning tablet normally, you may be asked to take it for a few weeks before and after the procedure.

If you have any other heart conditions or an implanted heart device such as a pacemaker, your doctor will need to advise you on any precautions to take before.

After-care

After the procedure you will need to rest a few hours and your heartbeat and blood pressure will be monitored. You may be able to go home the same day but will likely need a few days of rest before resuming normal activities.

After receiving this treatment, your symptoms should subside and you’ll start feeling better. However, your irregular heartbeat can return years later. This is more common in elderly people.

You’ll likely return to see the doctor after three months to check if the symptoms have reappeared. If they have, you should be able to control the symptoms with medication. If you need another procedure, then it’s advised that you wait until you’ve completely healed before having another one.

You doctor could also suggest that you have a pacemaker fitted if your symptoms keep returning.