Albations for atrial fibrillation are referred to by many different names but they are all the same thing. They are referred to as “catheter ablation,” “Pulmonary Vein Ablation,” or “Pulmonary Vein Isolation (PVI). An ablation works by disrupting the electrical signals that come from your Pulmonary Vein in your left atrium, which is where most of the afib trouble starts.
PVI therapy helps doctors disrupt, destroy, or isolate these signals so that afib just can’t occur. Here is one of the best videos on what the procedure is all about from the Cleveland Clinic:
For this procedure, a CT scan or an MRI scan will be done so that your heart can be mapped. This will help the doctors understand exactly where they need to go and what they need to do in order to successfully treat your afib.
As shown in the video, small incisions are made so that catheters (thin, flexible tubes) can be inserted. These incisions are typically made in the groin area.
The doctor and his team watch all of this in real time on a device called a fluoroscope, which is an X-ray machine that they use specifically for this purpose.
The doctor will then get the tube to your pulmonary vein opening and use an energy source to burn or isolate specific locations on your heart that are believed to be causing the afib. One of two energy sources will be used – radio frequency (RF) or extreme cold (CryoBalloon).
If you are in afib at the time of the procedure, it’s relatively easy for the doctor to locate where the erratic signals are coming from and ablate (remove) them. However, it becomes more challenging if you occasional afib (paroxysmal afib) and aren’t experiencing any episodes at the time of the procedure.
Doctors still have methods, however, to locate and isolate potential sources of the afib signals if you’re not in afib during the procedure. Those methods are called circumferential ablation, like what you see in the video above, and the other is segmental catheter ablation.source
Regardless of which method used, after the areas are ablated, the doctor will try to induce atrial fibrillation by using drugs. If other areas of erratic signals are found that weren’t initially isolated, they will be mapped and ablated. This will continue until afib can no longer be induced by the doctor.
The Success Rates of Catheter Ablation
Current pulmonary vein ablation techniques are achieving success rates of 70-85% in making paroxysmal atrial fibrillation patients “afib free.”source But the devil is in the details. Success is defined as restoring patients to normal sinus rhythm (NSR) without any medications for one year after the 3-month healing period after the ablation. If you have an ablation and in the 16th month you have an afib episode, your procedure will be counted as a success because you went the entire year after the 3-month healing period without an episode.
Success rates may be defined slightly different depending on what doctor or heart hospital you are dealing with. For example, my electrophysiologist (EP) here in the Twin Cities said his group defines success as going “closer to two years” without an episode, and they achieve a 70% success rate or better based on that criteria (which is actually really good).
Now here’s what’s also interesting, most of these “success rates” aren’t achieved with just one ablation. You heard that right. The much touted 70-85% success rate is usually only experienced after two or more ablations. This is what I was told by two respected electrophysiologists, and after reading many many stories from people who have had the procedure, that appears to be the case. “One and done,” as the saying goes among afib patients familiar with the procedure, is rarely achieved.
So while ablations are the absolute best chance for a “cure” with the fewest risks, it’s far from being a sure thing. Many patients are totally afib free now and have been for many years thanks to an ablation (or two or more), but it’s not a sure thing for everyone and many will require more than one ablation.
For the 15-30% that aren’t completely cured after one or more ablations, there is still some good news. Many may find their condition to be significantly improved after an ablation.source They may have fewer or less intense episodes. Medications to control afib that didn’t work before the procedure might work afterwards. However, some in this “unsuccessful group” may not experience any improvement at all.
Fortunately, there are significant advances in catheter ablation techniques with each passing year. Hopefully someday soon PVI’s will have a 90% success rate or greater after ONE procedure – or some other procedure will come to the forefront that will have equal success!