Towards More Successful Ablation: American College of Cardiology 2018
By Debra Gordon and Mellanie True Hills
Radiofrequency catheter ablation (RFA) is a safe, two- to four-hour outpatient procedure in which the doctor threads a long, thin tube through your groin into the area of your heart responsible for the abnormal rhythms of AF. The doctor then sends a pulse of radiofrequency energy, like that used to heat items in the microwave, to destroy that abnormal bit of tissue.
It is typically used for people whose irregular heartbeats can’t be controlled by medication alone.
However, choosing the right patient for the procedure is important for its long-term success. For instance, elderly patients and those with hypertension and/or permanent AF—in which the rhythm is always out of sync—are more likely to experience AF recurrences after RFA.
Jeroen J. Bax, MD, of the Leiden University Medical Center in The Netherlands, identified several “clues” that can help doctors determine patients who are most likely to have a good outcome with RFA. One is the size of the left atrial appendage (LAA), the part of the heart where the blood clots form. For instance, in one study patients with large LAA had more AF recurrences than those with small LAAs, although a third of those with small LAs still had a recurrence.
Another thing to look for is fibrosis, or scarring in the LAA. The higher the amount of fibrosis, the less successful the procedure. He also stressed the importance of using real-time 3D echocardiography and MRI to assess the patient’s heart, as well using imaging during the ablation procedure. Bottom line, he said, “we need anatomic and functional imaging.”
We also need to perform ablation more often and sooner, said speaker Nassir F. Marrouche, MD, of the University of Utah in Salt Lake City. Of course, that should come after an in-depth discussion with the patient, also called shared decision making.
Dr. Marrouche stressed the importance of performing ablation on qualifying patients as early as possible because the longer the AF continues,, the greater the structural and chemical remodeling of the heart—including the development of fibrosis, which makes ablation less successful. There is also new evidence of improved quality of life in people who undergo ablation compared to those who treated with medication, as well as longer survival.1,2
1. Blomstrom-Lundqvist C, et al. Catheter Ablation compared with optimized Pharmacological Therapy for Atrial Fibrillation – CAPTAF. Paper presented at: ESC 20172017; Barcelona.
2. Bunch TJ, Crandall BG, Weiss JP, et al. Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22(8):839-845.