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Is Cardiac Ablation Effective in Treating Atrial Fibrillation?

Understanding cardiac ablation

Cardiac ablation is a procedure used to treat abnormal heart rhythms, such as atrial fibrillation (AFib), by targeting and scarring the heart tissue responsible for the irregular rhythm, preventing further abnormal heart beats.

During cardiac ablation, a catheter is guided through a blood vessel to the heart (the doctors guide it into position using advanced x-ray technology) where it delivers targeted energy (such as bursts of heat or freezing cold) to specific areas to disrupt the abnormal electrical signals causing the irregular heartbeat. This disruption creates scar tissue, which can help restore a normal heart rhythm.

How long after an ablation will I know if it is successful?

Patients are understandably eager to know if the ablation has been successful in treating their AFib as soon as possible following the procedure, but don’t judge the success of your ablation too quickly. Be patient with your heart’s healing process, as the impact of ablation on AFib varies greatly between patients.

Immediately following an ablation, the tissues in the heart will be irritated, and it will take a while for them to recover. The areas of ablation will slowly form scar tissue which is part of the benefit of the ablation and this can take weeks to months. As a result of the time it takes for the heart to settle and heal properly, it can take approximately three to six months after an ablation to reach the full benefit of the procedure. This period is commonly referred to as the ‘blanking period’.

What is the ‘blanking period’ after an ablation?

A ‘Blanking Period’ is often talked about after a cardiac ablation and it refers to the first 3 months following ablation. It’s a period where the heart muscle is healing: initially, the internal muscle walls of the atria will be inflamed around the ablation sites, then the inflammation settles as scar tissue forms. During this time, it’s not uncommon for episodes of atrial fibrillation to occur – and it doesn’t mean that the ablation has failed – it just takes time for the tissues to recover and the heart rhythms to stabilise. This can particularly be the case for people who have more persistent AFib or had longer periods of AFib prior to the ablation.

Talk to your EP about any long episodes of AFib that are occurring in the 3 months after an ablation. Your EP may want to adjust your treatment plan while you are healing. Long lasting episodes of atrial fibrillation occurring in the first 3 months post ablation may require cardioversion.

Are there potential risks associated with having an ablation?

Ablations performed at well-regarded hospitals, with highly-trained EPs, nurses, and technicians, like the team at the AFib Institute, generally have low risks of complications.

You are more likely to have complications if you are older or if you have certain other medical and heart conditions. As with any medical procedure, your doctor will discuss the risks and benefits of cardiac ablation with you to understand if this procedure is right for you.

In recommending this procedure your doctor has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead.

Common risks and complications (more than 5%) include:

  • Minor bruising at the puncture site.

Uncommon and risks and complications (1- 5%) include:

  • Major bruising or swelling at the groin puncture site.
  • Bleeding, pain, infection at the catheter site
  • Skin injury from radiation

Extremely rare risks and complication (less than 1%) include:

  • Blood clots
  • Stroke
  • Damage to the heart

Blood Clots

The risk of blood clots is very rare. However, it is serious as blood clots can travel to the lungs or brain and cause a stroke. To reduce this risk, the EPs at the AFib Institute may perform a Transesophageal Echocardiogram (or TOE) before starting an ablation. This enables them to obtain a clear picture of the inside of the heart and ensure that there are no existing blood clots that have formed inside the heart before they start the procedure.

Will I need more than one ablation to manage my AFib?

For many patients, a single ablation can be sufficient to provide relative freedom from AFib or a reduction in symptoms, particularly when performed before the AFib rhythm becomes too persistent. But there is a risk that the procedure may not permanently eliminate atrial fibrillation. Sometimes atrial fibrillation will come back shortly after the procedure or several months later and sometimes after years of being back in normal rhythm. You might be more likely to have this problem if you are older, have other heart problems, or have a longer duration of atrial fibrillation.

In approximately one third of patients, it can take more than one ablation to create enough of a barrier to achieve electrical isolation of the pulmonary veins. This could be because after the tissues heals and scar tissues forms there may still some heart muscle cells that remain able to conduct. It could be that new circuits have established around or through gaps in the ablation area. You will have ongoing appointments with your EP over time so that they can monitor your progress and adjust your treatment strategy if needed.