Are you battling common symptoms of atrial fibrillation, such as an irregular heartbeat, palpitations, or a rapid heart rate, and wondering if you are a candidate for catheter ablation?
Traditionally, catheter ablation has been recommended for afib patients with symptoms that do not respond to at least one antiarrhythmic drug or when a patient cannot tolerate medications. In the updated 2017 HRS Expert Consensus Statement, catheter ablation was recommended as a reasonable first-line treatment in patients with afib symptoms even before trying antiarrhythmic drugs.1 However, some insurance plans and healthcare providers may require patients to try medications first.
Catheter ablation is also recommended as a reasonable first-line treatment for high-level competitive athletes with afib and is recommended for some afib patients who have heart failure or a reduced ejection fraction. A patient’s desire to stop taking anticoagulants, such as Coumadin (warfarin) or one of the newer direct oral anticoagulants (DOACs), is not usually a factor in the clinical decision for whether a patient is a candidate for catheter ablation.
From a practical perspective, catheter ablation patients are generally under 80 years of age and have a left atrium of normal size. However, a dilated (enlarged) left atrium will not always exclude you as a candidate. Your doctor will also check how much blood fills your left atrium (atrial volume) during the cardiac cycle and whether your left ventricle is working normally. Having high left atrial volume or left ventricular dysfunction may not exclude you from having a catheter ablation. However, the probability of procedure success may be lower. Learn more about predictors of catheter ablation success.
It’s important to seek treatment sooner rather than later, particularly if you still have afib episodes while taking antiarrhythmic medication. That’s because atrial fibrillation is often a progressive disease. If afib is not treated, patients may transition from paroxysmal atrial fibrillation to persistent atrial fibrillation and eventually to longstanding persistent atrial fibrillation. The greater the severity of atrial fibrillation, the harder it is to stop.
At first, afib activity is focused in the pulmonary vein region, which is the starting point for afib for over 90% of patients with paroxysmal atrial fibrillation. For most people with paroxysmal afib, ablating the pulmonary vein region terminates the afib. However, more than one catheter ablation procedure may be needed.
If left untreated, afib can create new pathways to cycle or perpetuate in the heart. These new pathways or entry points are often in other areas of the heart, so atrial fibrillation activity is no longer focused in the pulmonary vein region. Over time, this also changes the structure of tissue in the heart (atrial remodeling). Catheter ablation has lower success rates when treating persistent and longstanding persistent atrial fibrillation because of atrial remodeling.1 To learn more about why persistent and longstanding persistent afib are harder to treat, see Can Catheter Ablation Successfully Treat Persistent Atrial Fibrillation.
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Evaluation and preparation for catheter ablation may include some of the following tests:
In the past, patients were often instructed to stop taking their anticoagulants shortly before catheter ablation. Today, catheter ablation is increasingly performed without stopping anticoagulation. If you are on anticoagulants, such as Coumadin (warfarin) or one of the DOACs, you may be instructed to continue taking your anticoagulant to reduce the risk of stroke or bleeding. This is referred to as uninterrupted anticoagulation.
If you are in afib at the time of the catheter ablation, you will likely have a transesophageal 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.
You won’t be allowed anything to eat or drink after midnight during the evening before your procedure.
To learn more about catheter ablation procedures, see What to Expect During Catheter Ablation.
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