Are You a Candidate for Catheter Ablation?

Are you battling common symptoms of atrial fibrillation, such as irregular heartbeat, heart palpitations, and rapid heart rate, and wondering if you are a candidate for catheter ablation?

There is guidance from the Task Force that created the HRS Consensus Statement into who is an appropriate candidate for catheter ablation. They generally agreed that catheter ablation should not be first line treatment for atrial fibrillation in most cases, but in some cases it may be appropriate. They recommended that catheter ablation is appropriate when a patient has afib symptoms that do not respond to at least one antiarrhythmic drug, or when a patient cannot tolerate medication, and for some afib patients with symptoms who also have heart failure or a reduced ejection fraction. They said, "A patient's desire to eliminate the need for longer-term anticoagulation by itself should not be considered an appropriate selection criterion." If a blood clot is found in the left atrium, then catheter ablation is not appropriate at that time.¹

From a practical perspective, catheter ablation patients are generally under 80 years of age and have a left atrium of normal size, though a dilated left atrium will not always exclude you as a candidate.

For most people with paroxysmal atrial fibrillation, targeting the pulmonary vein ostial region, the opening of the pulmonary veins, successfully terminates afib. For those with longstanding persistent afib, atrial remodeling may have shifted the afib away the pulmonary vein ostial region and thus there may be less chance of success from ablating in just that area.¹

Since most afib patients are in persistent atrial fibrillation,¹ and since afib is usually progressive, some paroxysmal afib patients opt for treatment before they become persistent and thus harder to cure.

Preparing for Catheter Ablation

Evaluation and preparation for catheter ablation may include some of the following tests:

• Electrocardiogram (ECG)
• Echocardiogram
• Transesophogeal echocardiogram (TEE)
• Computed tomography (CT)
• Holter monitor tests
• INR/Protime test (if on anticoagulants)
• Other blood tests or lab work

If you are on anticoagulants such as warfarin or Coumadin®, which is generally recommended, your INR must be an appropriate reading before catheter ablation. Starting a few days before the procedure, you will stop anticoagulants. You should discuss with your doctor whether to continue or stop your other medications.

If you are in afib at the time of the catheter ablation, you will likely have a transesophogeal echocardiogram (TEE) or computed tomography (CT) scan to determine if blood clots are present. If so, you will not be able to proceed to catheter ablation.

During the evening before your procedure you won't take any food or liquid after midnight

To learn more, see What to Expect During Catheter Ablation.

1 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up <http://www.hrsonline.org/News/Media/press-releases/CSAblation.cfm>, Heart Rhythm Society [Internet], Copyright, 2007.