Cardiac ablation (also known as catheter ablation or radiofrequency ablation) is a surgical procedure that uses radiofrequency energy to correct arrhythmias, which are problems with your heart’s rhythm. In a normal heart, cells create electrical signals that make the upper and lower chambers of your heart beat regularly. If you have atrial fibrillation (a heart arrythmia), abnormal cells affect the electrical signals and cause rapid or irregular heartbeats. Cardiologists treat ablation in hospitals 

What about atrial fibrillation ablation? This is a commonly discussed procedure for patients with atrial fibrillation. Let’s first explain what ablation means, and then we’ll talk about if it’s right – for which patients it’s the right procedure.

So what is atrial fibrillation ablation? Ablation is a procedure we do by putting tubes inside the heart and delivering small amounts of electrical energy to burn away the potential short circuits that lead to atrial fibrillation. These short circuits are on the back wall of the left collecting chamber, called the left atrium.

What ablation will do is it will cause the small electrical burns in the back of a patient’s heart, and if done appropriately and successfully, which is about 70, 80% percent of the time in most patients, making these burns will prevent these electrical short circuits in the heart from forming and leading to the next attack of atrial fibrillation.

Which patients with atrial fibrillation can benefit the most from an ablation procedure? In general, the main reason to do an ablation procedure is for quality of life. We don’t recommend it specifically to prolong life, or to prevent dangerous things from happening.

Why? Because fortunately, dangerous things in atrial fibrillation are very rare. Dying from atrial fibrillation is very, very rare. Heart attacks are very, very rare. Stroke in atrial fibrillation can be prevented with a blood thinner. Doing an ablation will not prevent stroke, but we already have a great treatment for stroke: prevention, which is anticoagulants, or so-called blood thinners.

So the reason to recommend an ablation, and the reason for a patient to want to have an ablation, is to improve their quality of life. What do we mean by that? Many patients with atrial fibrillation can’t exercise when they have atrial fibrillation, because they have palpitations or shortness of breath. They’re bothered by the attacks. The attacks are very uncomfortable or unpleasant. They may be on medications which are ineffective; don’t stop the attacks of atrial fibrillation.

So commonly in patients with atrial fibrillation, this is more often the case in younger patients, who wish to exercise and be active and are maybe still working and not retired, and are out there in public or doing things in their everyday lives which require them to feel perfect, and when they have atrial fibrillation they just feel unwell.

By the way, the first thing we do for all the patients is to try to reassure them, to reduce their anxiety level, to help them understand their atrial fibrillation, although unpleasant, can usually be dealt with by a combination of medications and reassurance and tincture of time.

But many patients continue to feel unwell during attacks of atrial fibrillation. And they feel sufficiently unwell, that they understand that even though there’s a small risk they want to go ahead with the procedure. Those are the majority of patients where the procedure is reasonable and indicated.

Some patients aren’t sure how well they feel, or how ill they feel during atrial fibrillation, and that requires a conversation with their doctor. Am I going to feel better if I have an ablation procedure? Some patients are very little bothered by the atrial fibrillation. They’re bothered by the idea of having atrial fibrillation. The patient and the doctor are concerned because they have this condition.

But otherwise the patient’s feeling reasonably well, they can exercise, they’re active, they travel, they take their medications, and their quality of life – their everyday life, is not much affected by the atrial fibrillation. Those patients I generally would not recommend an ablation, even though the idea of having a condition is bothersome.

The reason we don’t recommend an ablation most of the time for these patients is they’re not going to feel any better. They might feel emotionally better, but they’re not going to feel physically any better. So this is a procedure with risks, which isn’t really going to benefit the patient, and in most kind of treatment is reassurance, advice and education.   Often seeing a local family physician or a pharmacist in conjunction with a registered dietitian is a great option to take control of dehydration. In conjunction with healthy eating, exercise and  Smart Food Now

If you have atrial fibrillation and you don’t feel well or you need more information, or you’re not completely satisfied with your treatment, speak to your family doctor, if needed ask to be sent to a cardiologist who has expertise in atrial fibrillation and get yourself as well informed as possible about this condition so that you better understand your own body and you can deal with the symptoms more effectively.

Presenter: Dr. Paul Dorian, Cardiologist, Toronto, ON

Smart Food Now Local Practitioners: Cardiologist

As far as who a candidate for ablation is, not everyone with atrial fibrillation requires an ablation. Usually we recommend ablation for patients who are having a lot of symptoms from their atrial fibrillation. Symptoms from atrial fibrillation can include palpitations, shortness of breath, fatigue, and even in some cases, an inability to do any kind of physical activity. If you fall into this symptomatic category, then ablation may be a worthwhile therapy for you.

Drugs are an alternative to ablation. There are so-called antiarrhythmic drugs which can suppress the atrial fibrillation, and some patients find that these drugs work very well. Unfortunately drugs are often not a permanent solution, and will often fail at some point in time. And especially for patients who have failed antiarrhythmic drugs, ablation may be a very, very good option.

In addition to that, there are patients who will develop problems with their heart pumping function – we call this heart failure, or who may develop a weakness of their heart. Or, if the patient is particularly young and physically active and cannot tolerate drugs, then these are also other populations that could benefit greatly from atrial fibrillation ablation. Often seeing a local family physician or a pharmacist in conjunction with a registered dietitian is a great option to take control of atrial Fibrillation.   

If you have any more questions about your atrial fibrillation or whether you may be a potential candidate for ablation for your atrial fibrillation, feel free to contact your local health professional, your cardiologist, or have them refer you to the heart rhythm program here at Southlake Regional Health Centre, where we’ll be happy to do a consultation. Presenter: Dr. Atul Verma, Electrophysiologist, Newmarket, ON

Now Health Network  Local Practitioners: Electrophysiologist

Atrial fibrillation ablation is a procedure commonly discussed for patients with atrial fibrillation. The procedure involves putting tubes inside the heart and delivering small amounts of electrical energy to burn away the potential short circuits that lead to atrial fibrillation. 

These short circuits are on the back wall of the left collecting chamber called the left atrium. Ablation causes small electrical burns in the back of a patient's heart, which prevent these electrical short circuits in the heart from forming and leading to the next attack of atrial fibrillation.

The main reason to do an ablation procedure is for quality of life, rather than to prolong life or prevent dangerous things from happening. Dangerous things in atrial fibrillation, such as dying from atrial fibrillation or heart attacks, are rare. Stroke in atrial fibrillation can be prevented with blood thinners. Ablation does not prevent stroke, but it can improve the patient's quality of life. 

Patients who benefit the most from an ablation procedure are those who can't exercise when they have atrial fibrillation because of palpitations or shortness of breath. They may be on ineffective medications and have attacks of atrial fibrillation that are very uncomfortable or unpleasant. These patients are generally younger and wish to exercise, be active, and maintain their everyday lives without feeling unwell.

However, before recommending an ablation, doctors try to reassure patients and reduce their anxiety levels. They may also prescribe a combination of medications to help manage symptoms. Patients who continue to feel unwell during attacks of atrial fibrillation may want to proceed with the procedure, even though there is a small risk. Some patients may not be sure how well they feel during atrial fibrillation, and they need to have a conversation with their doctor about whether they would benefit from an ablation.

Patients who are little bothered by atrial fibrillation and whose everyday life is not much affected by the condition generally do not require ablation. The procedure has risks, and if the patient is not going to feel physically any better, then it is not recommended. Reassurance, advice, and education are the main forms of treatment for these patients. Dr. Paul Dorian, MD, CM, MSc., Cardiologist, talks about what lifestyle factors can impact the burden of atrial fibrillation.

If a patient has atrial fibrillation and does not feel well or is not satisfied with their treatment, they should speak to their family doctor and ask to be sent to a cardiologist who has expertise in atrial fibrillation. By becoming as well-informed as possible about their condition, patients can better understand their own bodies and deal with the symptoms more effectively.