Rewiring the Heart: Catheter Ablation for AFib

May 25, 2022

A heart shape on an electrocardiogram with a stethoscope

Atrial fibrillation, or AFib, is the most common heart rhythm disorder and affects more than 3 million adults in the U.S. It is caused by rapid and disorganized electrical impulses in the atria, or the two upper chambers of the heart. This causes the atria to no longer effectively force blood into the ventricles (lower chambers), potentially leading to poor blood flow, clot formation and decreased overall heart function.

People with symptomatic AFib may experience heart palpitations, shortness of breath, weakness, fatigue or other symptoms that can impact their daily lives. AFib is also progressive and can advance to persistent or permanent AFib over the course of just a few years.

A Potential Cure for AFib

Fortunately, people living with AFib have a variety of treatment options available to help control the irregular rhythms, improve heart function and increase quality of life. For many people, AFib can be managed with the use of medications such as blood thinners, heart rate control medications or antiarrhythmic drugs.

However, if medications do not work, cause side effects, or a patient does not want to be dependent on medication, there is a procedure called catheter ablation. This minimally invasive, percutaneous and relatively pain-free procedure can stabilize the heartbeat by electrically isolating the AFib triggers or disrupting the atrial substrate changes, allowing normalization of the heart rhythm.

“Ablation is a potentially curative approach for treating atrial fibrillation,” says University Hospitals cardiologist and Director of Clinical Electrophysiology Mauricio Arruda, MD. “Ablation can completely eliminate or significantly decrease episodes of AFib, decreasing the need for hospitalization, and decreasing the risk of death in the AFib population.”

High Rates of Success for Both Early-Stage and Advanced AFib

For patients in the early stages of AFib, with symptoms that come and go (known as paroxysmal AFib), catheter ablation has an 80 to 90 percent success rate. Even in patients with more advanced AFib, there is still about an 80 percent success rate when using adjunctive ablation strategies. If the first ablation is unsuccessful, most patients experience significant improvement with a second ablation procedure.

“There is more and more evidence that ablation can be performed as a first-line treatment for early stage AFib with excellent outcomes.” In addition, ablation may be the best option for patients with AFib and heart failure, Dr. Arruda says.

Catheter ablation has similar success rates to surgical procedures for AFib, such as Maze surgery. Maze, or surgical AFib ablation, is a more complex procedure than catheter ablation and is often performed in conjunction with open-heart surgery for a co-existing heart condition. Certain patients with very advanced AFib may benefit from a hybrid procedure utilizing a less invasive surgical approach followed by catheter ablation.

What Happens During an Ablation Procedure?

Ablation is usually performed under general anesthesia or conscious sedation (“twilight sleep”). During the procedure, several catheters (thin, flexible tubes) are inserted into blood vessels at the right groin.

University Hospitals AFib experts use the latest technology for mapping and ablation which basically eliminates radiation exposure from X-rays. The specialist performing the procedure will advance the catheters to the right and left atrium of the heart to visualize three-dimensional anatomy in a computer system to facilitate catheter navigation, map the heart’s rhythm and conduct the ablation.

The primary goal of AFib ablation is to electrically isolate the pulmonary veins (PVs), the vessels that carry oxygenated blood from the lungs to the heart. Most of the AFib triggers are localized in the PVs as they enter the heart, thus by isolating the PVs with ablation, normal rhythm may be restored.

There are two types of energy used for catheter ablation:

Radiofrequency: The most commonly used, ablates by heating the heart muscle.
Cryoablation: Ablates by freezing the heart muscle.

Recovery from Ablation Procedure

The entire catheter ablation procedure usually takes three to five hours, and most patients are discharged home within a few hours after the procedure.

Some patients may continue to experience episodes of AFib while healing after an ablation. It may take two to three months before AFib symptoms go away completely. During this time, patients will continue to follow up with their referring physician and with the electrophysiologist who performed the ablation.