Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)
1. Heart Function: “Does this burning and scarring during the ablation procedure affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?”
Related question: “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.”
2. Radiation: “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I’m worried about radiation exposure.”
3. Condition of Heart: “What is an enlarged heart? Does it cause A-Fib? I was told I can’t have a catheter ablation because I have an enlarged heart. Why is that?”
Related question: “I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?”
Related question: “I have a defective Mitral Valve. Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?”
4. Age: “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?”
Related question: “I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?“
5. Blanking Period: “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”
Related question: “Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?”
6. O.R. Report: “I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?”
7. Procedure Length: “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?”
8. Clots/Blood Thinners: “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin, an NOAC or aspirin?”
Related question: “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. Afterwards shouldn’t there be even less need for a prescription anticoagulant rather than more?”
Related question: “During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?”
9. Exercise: “I’m having a PVA and I love to exercise. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?”
10. Non-PV Triggers: “Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib?
11. Heart Rate: “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”
12. The Bordeaux Group: “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?”
13. Cure? “I have Chronic Atrial Fibrillation. Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?”
Related question: “I’ve read that an ablation only treats A-Fib symptoms, that it isn’t a ‘cure’. If I take meds like flecainide which stop all A-Fib symptoms and have no significant side effects, isn’t that a ‘cure?’”
14. Tech Advances: “I’m getting by with my Atrial Fibrillation. With the recent improvements in Pulmonary Vein ablation techniques, should I wait until a better technique is developed?”
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.
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.
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).
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.”
“Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?”
It takes about three months to know if your ablation is a success. It takes that long for your heart to heal. For a period of time (which varies from patient to patient) your A-Fib may seem to get worse. Why?
Inflammation: This happens in some people because of the inflammation and trauma to the heart and body tissues caused by the catheter ablation burns and the poking around in your heart during the procedure. These can seem to exacerbate your A-Fib. (An ablation procedure doesn’t create new A-Fib producing areas in your heart, though it may stir up existing A-Fib areas temporarily.)
There is a tendency for ablated heart tissue to heal itself, re-grow the ablated area, reconnect, and start producing A-Fib signals again.
Gaps and Scar Tissue: Another reason you may still have A-Fib is because of gaps in the ablation lines. In the most common A-Fib ablation procedures used today, doctors try to create ablation lines around your pulmonary vein openings to isolate them from the rest of your heart. (A-Fib producing areas are usually found inside your pulmonary vein openings.) But it’s difficult making continuous, perfect ablation lines. Sometimes there are gaps in those lines which let A-Fib signals through. But as your heart heals, these gaps usually fill in gradually with scar tissue that reaches its thickest size at the end of three months.
Milestones: In general, if you’re in sinus rhythm after the third month, the chances are good you’ll stay in sinus rhythm. If you’re in sinus rhythm after the sixth month, the chances of a reoccurrence of A-Fib are even less.
Remember—it isn’t the end of the world if your ablation isn’t a total success. There is a tendency for ablated heart tissue to heal itself, re-grow the ablated area, reconnect, and start producing A-Fib signals again.
Second Ablation: Many people (as many as 15%-25%) have to go in for a ‘touch up’ ablation procedure (including myself). This second ablation is usually, though not always, easier than the first. Often all the doctor has to do is ablate any gaps that haven’t filled in or ablate where there has been re-growth/re-connection. This usually isn’t the doctor’s fault. Heart tissue is very tough and has a tendency to heal itself.
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