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How I approach AF ablation

AF ablation is a common procedure which is the most reliable way of returning the heart to normal rhythm for AF. I almost always perform this as a daycase (outpatient) procedure or staying just one night in hospital. The procedure is generally done under local anaesthetic with some sedation so the patient isn’t in any discomfort, but in certain situations we may elect to use a general anaesthetic.

Tubes are passed from the vein in at the top of the leg to the heart, a long thin needle is used to get from the right side of the heart to the left atrium through the very thin membrane separating the two atria (top chambers of the heart). X-rays and / or a specialized 3D navigation system is used to guide the procedure. Most of the time, the procedure only under one (if freezing is used) or two hours in total, though of course it can take a little longer if there are complexities during the case itself.

If AF continues at the end of the procedure we normally use a DC cardioversion to restore sinus rhythm (an electric shock to the heart), but in fact if this is needed it does not mean that the procedure has not been successful and most patients who have this maintain normal rhythm.

Patients are anticoagulated and remain on their blood-thinner (warfarin or NOAC) over the course of the procedure, and the decision whether or not this can be safely stopped is usually not related to the success of the procedure.

Either freezing (cryoablation) or burning (RF ablation) energy is used to prevent the triggers of AF arising from the pulmonary veins and causing fibrillation. In certain cases, particularly when fibrillation is there all the time (persistent AF) we also spend time tracking down other areas which may be driving the arrhythmia.