If you have been living with atrial fibrillation for a while, you may have reached the point where you are wondering what comes next.
Maybe medication is working reasonably well, but you still have episodes.
Maybe the episodes are becoming more frequent.
Maybe you are tired of the racing heartbeat, breathlessness or fatigue.
Or perhaps your cardiologist has mentioned an ablation and you are trying to decide whether taking that next step makes sense.
The answer is not the same for everyone.
AF can affect people very differently
One of the difficult things about atrial fibrillation is how different it can look from one person to another.
For one person, AF might mean an occasional flutter in the chest.
For someone else, an episode can leave them exhausted, short of breath and unable to exercise or go about their day normally.
Others have little or no obvious symptoms at all.
That is why the decision to consider an ablation cannot be based on the diagnosis alone.
Your cardiologist needs to understand your AF.
What is an AF ablation trying to do?
Atrial fibrillation is caused by disorganised electrical activity within the upper chambers of the heart.
During an AF ablation, a cardiac electrophysiologist uses catheters to access the heart and treat areas involved in generating or carrying these unwanted electrical signals.
The goal is to reduce episodes of atrial fibrillation, maintain a normal heart rhythm for longer and improve symptoms and quality of life.
It is a minimally invasive procedure, but it is still a medical procedure and the potential benefits and risks need to be considered carefully for each patient.
When might ablation be considered?
There is no simple checklist that automatically tells someone they “need” an AF ablation.
It may be considered when atrial fibrillation is causing significant symptoms, when episodes continue to recur, when medications are not controlling the rhythm adequately or when medications cause unwanted side effects.
For some appropriately selected people with symptomatic and recurrent AF, catheter ablation may also be considered as an earlier rhythm control treatment rather than waiting for multiple medications to fail.
Your cardiologist will consider things such as:
- Whether your AF comes and goes or is persistent
- How long you have had AF
- How frequently episodes occur
- How badly the episodes affect you
- Your heart function
- Other heart conditions
- Your age and general health
- Treatments you have already tried
- Your individual risks
- What matters most to you
This last point is important.
Modern AF management increasingly recognises that treatment should be patient centred and involve shared decision making. The “right” treatment is not simply the most aggressive treatment available. It is the treatment that makes sense for the individual patient.
What if my medication is working?
Then an ablation may not necessarily be the next step.
Medication remains an important part of AF treatment and some people achieve good symptom control without needing a procedure.
Other people find that medication does not provide sufficient control or creates side effects that affect their quality of life.
This is a conversation worth having with your cardiologist rather than assuming one option is automatically better than another.
What if my AF does not bother me very much?
Symptoms are only one part of atrial fibrillation management.
AF can increase the risk of stroke and may be associated with other cardiovascular problems, so even someone who feels relatively well still needs appropriate medical assessment and follow up.
Importantly, AF ablation and stroke prevention are not the same thing.
Even after an ablation, your doctor will assess whether you need anticoagulant medication based on your individual stroke risk. You should never stop blood thinning medication without discussing it with your treating doctor.
Is an ablation a cure for AF?
It is better not to think about AF ablation as a guaranteed cure.
For many appropriately selected patients, ablation can significantly reduce AF episodes and improve symptoms. But atrial fibrillation can recur, and some people require ongoing medication or another procedure.
The likelihood of success is also influenced by the type and duration of AF and other health factors.
This is why your electrophysiologist will discuss the expected benefits and potential risks in the context of your particular situation rather than quoting one result that applies to everybody.
Your overall health still matters
An ablation treats the electrical problem, but good AF care does not stop there.
High blood pressure, excess weight, obstructive sleep apnoea, diabetes, alcohol consumption and other cardiovascular risk factors can all contribute to atrial fibrillation. Addressing these factors is now considered a central part of AF management.
Sometimes the most effective AF strategy is not one single treatment.
It is a combination of rhythm management, stroke prevention and improving the underlying factors placing stress on the heart.
The conversation to have with your cardiologist
If you are considering an AF ablation, you do not need to arrive at your appointment having already made the decision.
Instead, consider asking:
What type of AF do I have?
What are the advantages of ablation in my situation?
What are the risks?
What are my alternatives?
What happens if I decide not to have an ablation now?
What is a realistic outcome for someone with my medical history?
Those questions turn the decision from “Should I have a procedure?” into something much more useful:
“What is the best way to manage my AF?”
At Nepean Heart Centre, Dr Ihab El-Sokkari is a Cardiologist and Cardiac Electrophysiologist with experience in the investigation and treatment of heart rhythm disorders, including atrial fibrillation. He performs electrophysiology and ablation procedures at Nepean Public and Private Hospitals.
If you are living with atrial fibrillation and would like to understand whether AF ablation may be appropriate for you, speak with your GP or contact Nepean Heart Centre to arrange an appointment.
This article provides general information only and is not intended to replace individual medical advice, diagnosis or treatment.
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