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Doctors & patients are saying about 'Beat Your A-Fib'...

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Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA

A Primer: What is the Typical Progression of an Ablation for A-Fib?

In his AF Symposium presentation, Dr. Pierre Jais, of the French Bordeaux group made a reference to the ‘typical progression of a catheter ablation procedure.‘ Readers may ask, what does he mean? What is the typical progression of an ablation procedure?

The Goals of Catheter Ablation for A-Fib: Let’s start by looking at the two main goals of a catheter ablation for A-Fib:

Restore the heart to normal sinus rhythm
Eliminate the symptoms of A-Fib

Additional benefits: Achieving these goals also relieves the patient from the associated risks such as blood clot formation, stroke and increased risks of dementia and mortality.

The EP Lab: Typical Ablation for Persistent A-Fib

We know that Atrial Fibrillation is not a ‘one-size fits all’ type of disease. Every operating electrophysiologist (EP) caters each catheter ablation to the specific patient’s needs. In this simplified example we are looking at the progression of a typical ablation for Persistent A-Fib:

Dr Ali Sovari in EP lab, Oxnard, CA at

Dr Ali Sovari in EP lab, Oxnard, CA

1. Mapping: First, the sources of the rogue A-Fib electrical signals are mapped using a computerized system.

2. Ablation/Isolation: 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.

3. Rogue signals terminate or transition: 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.

4. Re-Mapping/ablation: 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.

 5. NSR or Tachycardia: Finally, the heart typically transitions to either normal sinus rhythm (NSR) or a stable atrial tachycardia (a regular but fast heartbeat).

Outcomes After the Ablation

NSR: After their ablation, many patients will be in normal sinus rhythm (NSR). Hurray! Obviously, this is the best outcome.

Stable Atrial Tachycardia: A second good outcome is being in stable atrial tachycardia, i.e. a regular but fast heartbeat. It’s not NSR, but being in atrial tachycardia instead means the patient is NO LONGER in A-Fib.

Graphic: Cryoablation heat withdrawl at

Graphic: Cryoablation heat withdrawl

Why is stable atrial tachycardia still a good outcome? Typically, your heart will heal itself over the following months—called the ‘blanking period’ and, on its own, return to normal sinus rhythm (NSR). (That’s why you should wait for the 3+ months blanking period before you decide if your ablation is a success.)

Benefits from Failed Ablation? When the patient doesn’t return to NSR (or tachycardia), researchers who studied the follow-up data, found a few ‘side’ benefits to a ‘failed’ ablation. Some patients found their A-Fib symptoms were less intense or shorter in duration. Some patients found they could take certain medications that prior to their ablation had been ineffective.

Conclusion: So, either way, a catheter ablation offers benefits. You may still reap some substantial benefits from the previous “failed” ablation even if you need a second (or third) ablation.

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