Atrial Fibrillation Ablation

Background

An atrial fibrillation (AF) ablation is an invasive procedure that is intended to treat AF. AF is the most common cardiac arrhythmia and is caused by disorganized and rapid electrical impulses in the atria of the heart. In an untreated patient, the ventricular rate also tends to be rapid and variable, between 120 and 160 beats/minute, but in some patients it may exceed 200 beats/minute. This is visualized on the 12-lead electrocardiogram (EKG) as a lack of discernable normal P waves, many small atrial waves preceding the QRS complex, and an irregularly irregular ventricular heart rate that varies due to the chaotic impulses from the atria. See Chapter 26: Electrocardiography for more details about EKG.

The word “ablation” comes from the Latin word ablatio , which means to take away. Ablation can be used in the medical lexicon for a procedure that causes the destruction of tissue via various techniques. In the case of AF ablation, the tissue that is targeted is located in the left atrium of the heart. This tissue predisposes patients to the arrhythmia.

How to Use It

An AF ablation may be considered for patients with AF in the following clinical scenarios ^, :

• 1.

  Symptomatic paroxysmal or persistent AF that is either refractory to treatment with an antiarrhythmic medication or the patient is intolerant of the medication due to side effects.

• 2.

  Recurrent episodes of symptomatic paroxysmal AF or symptomatic persistent AF before trying antiarrhythmic medication.

• 3.

  Symptomatic AF and heart failure with reduced ejection fraction.

An AF ablation should not be performed in any patient who cannot be treated with anticoagulation during and after the procedure. ^,