In his 2015 AF Symposium presentation, Dr. Pierre Jais makes reference to the typical progression of a catheter ablation procedure. You may ask, what does he mean? What is the typical progression of an ablation?
Goals of Catheter Ablation for A-Fib
Just a reminder: the main goals of catheter ablation of A-Fib are to restore the heart to normal sinus rhythm and eliminate the symptoms of A-Fib. This also relieves the patient from the associated risks such as blood clot formation, stroke and increased risks of dementia and mortality.
[pullquote]The main goals of catheter ablation of A-Fib are to restore the heart to normal sinus rhythm and eliminate the symptoms of A-Fib.[/pullquote]
Progression of a typical ablation for Persistent A-Fib:
• First, the sources of the rogue A-Fib electrical signals are mapped using a computerized system.
• The tip of the catheter is then maneuvered to the various sources of the A-Fib signals (usually starting with the openings to the pulmonary veins). Using RF energy (or Cryo) a tiny burn or lesion is made at each location to disrupt (or ablate) the electrical pathway.
• As the series of lesions progress, more and more of the A-Fib signals stop. OR, A-Fib signals may transition into Atrial Flutter which is a more stable and less erratic heart rhythm.
• At this point it is not uncommon for some A-Fib signals to continue. So, one or more rounds of mapping and ablation may be required to stop any remaining sources of arrhythmic signals.
• Finally, the heart typically transitions to either a stable atrial tachycardia (a fast, but regular heartbeat) OR transitions into normal sinus rhythm (NSR).
[bctt tweet=”After an ablation, some patients may be in atrial tachycardia but they are NOT in A-Fib. This is still a good result!”]
After the Ablation
While many patients will be in normal sinus rhythm (hurray!), some patients will be in stable atrial tachycardia (a fast and regular heartbeat)—but here’s the important part— they are NOT in A-Fib. This is still a good result!
Why? If you’re in stable atrial tachycardia, with rhythm or rate control medication your heart will typically heal itself over the following three months—called the ‘blanking period’ (or up to a year) and on its own return to normal sinus rhythm (NSR). (That’s why you shouldn’t rush to decide if your ablation is a success until several months post-ablation.)
For more about catheter ablation see, The Evolving Terminology of Catheter Ablation
See also, Dr. Pierre Jais’ 2015 AF Symposium presentation “The Spectrum of Atrial Tachycardias Following Ablation of Drivers in Persistent AF.”
Jeff Patten’s A-Fib started briefly in 2000, then returned in 2010 when his father-in-law died. The emotional upset, high summer heat, stress and accumulated age, followed closely by a bout with appendicitis, put him back into A-Fib .
In 2012, came a successful CryoBalloon ablation. But Jeff’s post-ablation recovery on Pradaxa turned into “alimentary torture” and burning diarrhea. Later came a Right Atrium Catheter Ablation for PACs/PVCs. Learn how Jeff emerged in 2015 healthy and A-Fib free.