How is an Ablation done?
Catheter based Radio frequency ablation (RFA) for Atrial Fibrillation is a well established therapy now with over 7-8 years of world wide experience. Approximately 50,000 patients have benefited from it.
Catheter based ablation for A Fib is done from small needle punctures in veins that run in the groin (similar to a heart catheterization or angioplasty). There is NO SURGICAL INCISION involved. There are no chest tubes involved. Most patients can stand up and walk after 6 hours of bedrest.
A special type of Heart Specialist can perform this procedure. She/he is called an Electrophysiologist (or EP for short). An EP specialist is a cardiologist with additional training in Heart Rhythm Disorders, and is generally an expert on Ablation therapy, pacemakers, defibrillators etc. (However, since there are many different types of Arrythmias (other than A Fib), there are many different types of cardiac ablation procedures. Most Ablations are considered simple or straight forward such as Atrial flutter ablation, AV Node ablation etc, but Atrial Fib Ablation is considered Complex, and a special skill set is needed for it. Not all Electophysiologists are well trained to perform Atrial Fib ablation.)
The procedure is done in the hospital, in a special area known as an Electrophysiology Lab (or EP lab). General anesthesia is usually used for it. A special type of ultrasound called a Trans Esophageal Echo (or TEE) is usually done to make sure there are no blood clots in your heart. After the patient is under anesthesia, using needles and wires, plastic tubes are placed in the femoral veins (in the groin) and through these tubes, “catheters” or special insulated wires are placed under x ray guidance inside various chambers of the heart.
We have to go across from the right upper chamber to the left upper chamber of the heart, via a technique known as Transeptal catheterization. Once in the left atrium, a spiral catheter is used to identify the “bad cells” on an advanced 3- dimensional mapping system, and another catheter (the ablation catheter) is used to cauterize or burn off these cells. For Atrial fibrillation, generally more than 100-200 tiny areas in the upper chambers need to be cauterized. (See videos on the Images/Videos page)
The procedure takes about 2-3 hours to perform in the hands of an experienced operator. A Fib ablation generally requires overnight stay, although sometimes can take upto 2-3 days in the hospital, especially if blood thinner medicines like warfarin need to be regulated. However, most people can be up and about in about 6 hours.
The Risk of undergoing this procedure is generally 2-5%, depending on patient’s general health. If the patient is younger and does not have too many other medical conditions, the risk is generally lower. Common complications (within this 2-5%) are bleeding/hematoma from the groin, damage to any structures we are putting the catheters through, including veins/arteries, heart or lungs, complications related to anesthesia etc. Serious complications like stroke, heart attack, death, esophageal fistula are much less common.
After going home, most patients will need about 1 week to recover fully, although this depends on the general condition of the patient. Also, IT IS VERY COMMON FOR PATIENTS TO EXPERIENCE SOME PALPITATIONS OR CHEST DISCOMFORT in the first few weeks after an Ablation, up to 3 months. Even some early recurrence of Atrial Fib is seen commonly in the 1st 3 months, as the heart is healing from the ablation. After 3 months, 70% of patients experience either complete absense of A fib or a significant improvement in severity or frequency of symptoms.
Patients may need to undergo heart monitors at 3, 6 and 12 months, to look for any recurrent A Fib, before stopping medications.
Sometimes, more than one ablation (2 or 3) may be necessary to achieve optimal results. Generally, the longer you have had A Fib, especially if it is persistant (i.e. you are in A Fib all the time), then you have a greater chance of needing repeat procedures.