Key takeaways:
Atrial fibrillation (AFib) ablation treats abnormal electrical signals in your heart using thin tubes (catheters) placed through blood vessels. It’s performed under sedation or anesthesia for safety and comfort.
After the procedure, it’ll take time to know how well the procedure worked. AFib episodes are common during the first few months.
Some people will need a second ablation if the first procedure doesn’t completely stop AFib.
Atrial fibrillation (AFib) affects nearly 1 in 20 Americans. It’s a heart rhythm problem where the upper chambers of the heart (the atria) beat in a fast and irregular way. Because AFib can impact both your health and quality of life, it’s important to treat it.
AFib can cause symptoms like palpitations, shortness of breath, and lightheadedness. It can also increase the risk of blood clots that can lead to stroke. AFib can be treated in several ways. Most people start with medications. But over the past 20 years, a procedure called catheter ablation has become a more common treatment for AFib.
What is a heart ablation for atrial fibrillation?
Ablation targets the electrical signals in your heart that cause the abnormal rhythm. There are two main types of ablation used to treat AFib:
AFib ablation
Atrioventricular (AV) node ablation
Both types of ablation are performed by an electrophysiologist (EP) in a hospital setting. An EP is a cardiologist with special training who treats rhythm disorders in the heart.
In this article, we focus on an AFib ablation. This type of ablation is meant to stop AFib from coming back.
AFib ablation procedure
The following details the steps of an AFib ablation:
You’ll first receive medications that’ll make you feel very relaxed or sleepy. Some people might even receive general anesthesia, which puts you fully asleep.
The cardiologist gently guides several catheters, which are thin and flexible tubes, into a blood vessel in your groin, arms, or neck.
Imaging equipment allows the cardiologist to guide the catheters into your heart. This imaging usually involves a small amount of radiation.
Using special tools, the cardiologist finds the areas of heart tissue that are causing the AFib.
The catheters then use heat or cold to create tiny scars in these areas. Afterward, the catheters are removed.
The procedure usually takes several hours. You may go home later the same day. But it’s common to spend the night in the hospital.
AV node ablation
The other type of ablation, called AV node ablation, works a little differently. It doesn’t stop AFib from happening. Instead, it blocks the abnormal electrical signals from traveling to the lower chambers of your heart. After an AV node ablation, a pacemaker is needed to keep your heart beating regularly.
AFib ablation vs. heart ablation surgery
There’s a third type of procedure called heart ablation surgery, which can also treat AFib.
AFib ablation isn’t surgery. It’s minimally invasive and doesn’t involve large cuts (incisions) in your body. Ablation surgery is less common and is done by a heart surgeon in an operating room. It’s most often done during open-heart surgery for another reason, like heart bypass or heart valve surgery. During the surgery, the surgeon treats the heart tissue directly to block abnormal signals. This is sometimes called a Cox-Maze procedure.
How well does an ablation for AFib work?
It takes time after an ablation to know how well it worked. During the first few weeks, the heart tissue is still healing. This healing process can sometimes trigger AFib. That’s why the first 1 to 3 months after the procedure is called the “blanking period.” If you have AFib during that time, it doesn’t always mean the ablation wasn’t successful.
What’s the risk of AFib returning after an ablation?
The technology for AFib ablation continues to improve. But overall, after the first few months, up to half of people will have more episodes of AFib after an ablation. Often, these episodes are less frequent than before. Those symptoms may be managed with medication.
Sometimes, another procedure is needed to fully treat returning AFib. Research shows that:
20-30% of people will need a second ablation
Up to 10% of people may get a third procedure
After three ablation procedures, it’s unlikely that another ablation will be successful.
When is a heart ablation needed for AFib?
An AFib ablation is often needed when medications for AFib aren’t effective. But in some cases, ablation may be the first choice for treatment. Some people choose ablation to avoid medication side effects. But keep in mind, it’s common to take heart rhythm medicines for the first few months after the procedure while your heart heals.
There are some situations where ablation is less likely to be effective. In these cases, medication is sometimes the better choice. These situations include:
Being over the age of 65
Persistent atrial fibrillation lasting more than 1 year
Congestive heart failure
An enlarged left atrium, which is one of the upper chambers of your heart
Severe lung disease
Severe mitral valve stenosis or regurgitation
Increased body weight is another condition that may make an ablation less effective. But weight loss and lifestyle changes, even after an ablation, can make a difference.
What are the risks of heart ablation?
AFib ablation is safe for most people. Minor problems can include bruising or bleeding where the catheter is inserted. These are common because blood thinners are often given during or after the procedure to prevent blood clots.
More serious complications happen less than 1% of the time and may include:
Temporary heart rhythm problems
Blood vessel injury
Stroke
Injury to your esophagus
Death (less than 1 in 1,000 people)
How long does it take to recover from a heart ablation?
Recovery after an AFib ablation is usually quick. Most people go home the same day or the next morning. You can usually return to light activities within a few days. It’s common to feel tired at first, and it may take 1 to 2 weeks to feel back to normal. The heart itself can take up to 3 months to fully heal.
Irregular heartbeats are common in the first few months after the procedure. That can include episodes of AFib. In this early phase, it doesn’t mean that the ablation didn’t work. But if you have any symptoms, it’s important to let your electrophysiologist know. That way they can check things out for you and keep you safe as your heart recovers.
Contact your care team if you have any of the following symptoms:
Bleeding, pain, or swelling at the catheter site in the first week after your procedure
Heart palpitations that last more than a few minutes
Dizziness or lightheadedness
Chest pain
Shortness of breath
Unusual fatigue
Any sign of stroke, including trouble speaking, facial dropping, weakness on one side of your body, or sudden confusion
Frequently asked questions
An AFib ablation usually takes several hours, but the exact time can vary. It depends on where the abnormal electrical signals are coming from and how many areas of your heart need to be treated. Some procedures may take about an hour, while others can take up to 4 hours or more. Because every heart is different, your cardiologist can’t know the exact length of the procedure ahead of time.
It’s common for some people to need a second ablation, and fewer people may need a third procedure. In certain situations, a fourth ablation is an option if symptoms continue. However, after a third procedure, the chance that additional ablations will work is usually low. At that point, your care team will often talk with you about other ways to manage AFib.
In the past, surgical ablation worked better than catheter-based ablation. But now, success rates are similar. Surgery has a longer recovery time and higher risks. About 20 % of people who get a surgical ablation experience a serious complication. This is why surgery is usually recommended only for people who already need heart surgery or who haven’t had success with catheter ablation.
An AFib ablation usually takes several hours, but the exact time can vary. It depends on where the abnormal electrical signals are coming from and how many areas of your heart need to be treated. Some procedures may take about an hour, while others can take up to 4 hours or more. Because every heart is different, your cardiologist can’t know the exact length of the procedure ahead of time.
It’s common for some people to need a second ablation, and fewer people may need a third procedure. In certain situations, a fourth ablation is an option if symptoms continue. However, after a third procedure, the chance that additional ablations will work is usually low. At that point, your care team will often talk with you about other ways to manage AFib.
In the past, surgical ablation worked better than catheter-based ablation. But now, success rates are similar. Surgery has a longer recovery time and higher risks. About 20 % of people who get a surgical ablation experience a serious complication. This is why surgery is usually recommended only for people who already need heart surgery or who haven’t had success with catheter ablation.
The bottom line
Ablation is a procedure that targets the electrical signals in your heart that cause AFib. In some cases — like older age or long-standing AFib — ablation may be less likely to work. But for many people, AFib ablation can reduce symptoms or even stop AFib from coming back. It’s not uncommon to need more than one procedure to eliminate AFib. So, don’t be discouraged if it doesn’t work the first time. AFib ablation is generally safe when done by experienced care teams.
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References
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