AF Ablation: What Is It and Why Might Your Cardiologist Recommend It?

If you have been diagnosed with atrial fibrillation, or AF, you may have heard your cardiologist mention AF ablation as a possible treatment.

For many people, the word “ablation” sounds more intimidating than the procedure itself. So it helps to understand what it actually means, why it is performed and what your cardiologist is hoping to achieve.

First, what is atrial fibrillation?

Your heart normally beats to a regular electrical rhythm. With atrial fibrillation, the electrical signals in the upper chambers of the heart become disorganised, causing the heart to beat irregularly and often faster than normal.

Some people notice it immediately.

They may feel their heart racing or fluttering. Others experience breathlessness, tiredness, dizziness or a reduced ability to exercise. Some people have very few symptoms and AF is only discovered during a routine examination or heart test.

AF is important to manage because it is not only about an uncomfortable heartbeat. It can also increase the risk of complications, including stroke, which is why treatment looks at the bigger picture rather than simply trying to slow the heart down.

So, what exactly is AF ablation?

AF ablation is a minimally invasive procedure used to treat the abnormal electrical signals that contribute to atrial fibrillation.

Rather than opening the chest, an electrophysiologist guides thin tubes called catheters through a blood vessel, usually from the groin, and into the heart.

The electrical activity of the heart can then be mapped to identify the areas involved in triggering or maintaining the abnormal rhythm.

Ablation is then used to target these areas and interrupt the unwanted electrical signals.

Depending on the individual patient and the approach being used, this can involve technologies such as radiofrequency energy, freezing with Cryoballoon ablation, or newer techniques such as Pulse Field Ablation.

The aim is straightforward: to reduce the heart’s tendency to go into atrial fibrillation and help maintain a more normal rhythm.

Does everyone with AF need an ablation?

No.

There is no single treatment plan that is right for every person with atrial fibrillation.

Some patients may manage well with medication and treatment of underlying risk factors. Others continue to experience AF episodes, significant symptoms or difficulty tolerating medication.

In appropriate patients, catheter ablation may be considered as an early treatment option or after other rhythm control treatments have not provided the desired result. Modern international guidance recognises catheter ablation as an important treatment option for selected people with symptomatic and recurrent AF.

The decision depends on several factors, including:

• The type of AF you have
• How often it occurs
• How long your episodes last
• The severity of your symptoms
• Your age and general health
• Other heart conditions
• Previous treatments
• Your personal preferences and treatment goals

This is why two people with the same diagnosis of “AF” can have very different treatment plans.

What is AF ablation trying to achieve?

One of the biggest misconceptions about AF ablation is that having the procedure means atrial fibrillation can never return.

That is not necessarily the case.

The goal is generally to reduce AF episodes, improve rhythm control and reduce the symptoms AF is causing. Catheter ablation can significantly improve symptoms and quality of life in appropriately selected patients, but AF can recur and some people may require additional treatment or, occasionally, another procedure.

It is better to think of ablation as one part of managing AF rather than an isolated “fix”.

Treating the rhythm is only part of the picture

Good AF management also means looking at the things that may be contributing to the condition.

High blood pressure, sleep apnoea, excess weight, diabetes, alcohol intake and other cardiovascular conditions can all influence atrial fibrillation. Managing these factors remains important even if an ablation has been performed.

Stroke prevention also remains a separate consideration.

Depending on your individual stroke risk, your cardiologist may recommend anticoagulant medication. Having an apparently successful ablation does not automatically mean that blood thinning medication should be stopped. Medication changes should always be discussed with your treating cardiologist.

The most important question is whether ablation is right for you

If AF is interfering with your day to day life, causing significant symptoms or continuing despite treatment, it may be worth discussing whether AF ablation is appropriate for you.

At Nepean Heart Centre, patients with heart rhythm disorders can be assessed by a cardiac electrophysiologist, a cardiologist who specialises in the electrical system of the heart.

Dr Ihab El-Sokkari is a Cardiologist and Cardiac Electrophysiologist and Director of Cardiac Electrophysiology Services at Nepean Public and Private Hospitals. Nepean Heart Centre provides investigation and management of cardiac arrhythmias including atrial fibrillation and AF ablation.

If you have been diagnosed with atrial fibrillation and would like to better understand your treatment options, speak with your GP or contact Nepean Heart Centre to arrange an appointment.

This information is general in nature and does not replace personalised medical advice. Your cardiologist will recommend treatment based on your individual circumstances.