Treatment Overview

If medicine is not effective or not tolerated for atrial fibrillation, a nonsurgical procedure called catheter ablation may be chosen. Catheter ablation for atrial fibrillation is relatively new and is still being studied.

In this procedure thin, flexible wires are inserted into a vein in the groin and threaded up through the vein and into the heart. There is an electrode at the tip of the wires. The electrode sends out radio waves that create heat. This heat destroys the heart tissue that causes atrial fibrillation or the heart tissue that keeps it happening. Another option is to use freezing cold to destroy the heart tissue.

Ablation procedures either try to cure atrial fibrillation (focal ablation, circumferential ablation, and pulmonary vein ablation) or try to control your symptoms (nodal ablation).

Ablation to cure atrial fibrillation

Focal and circumferential catheter ablation are used to try to cure atrial fibrillation. Focal ablation, also known as targeted ablation, is used to destroy the specific areas in the heart that are firing off abnormal electrical impulses and causing atrial fibrillation. Circumferential ablation is used to destroy the tissue that lets atrial fibrillation continue. Sometimes, a doctor uses both focal and circumferential ablation.

Pulmonary vein ablation is also used to try to cure atrial fibrillation. Sometimes, abnormal impulses come from inside a pulmonary vein and cause atrial fibrillation. (The pulmonary veins bring blood back from the lungs to the heart.) Catheter ablation in a pulmonary vein can block these impulses and keep atrial fibrillation from happening.

A pacemaker is usually not needed when catheter ablation is done on the pulmonary vein or other targeted tissue.

View a slideshow of pulmonary vein or focal ablation to see how the heart's electrical system works, how atrial fibrillation happens, and how pulmonary vein or focal ablation is performed.

In some cases, catheter ablation may be done by applying radiofrequency energy to the outside or inside surface of the heart during open-heart surgery. This may be an option if you are already having heart surgery for another reason, such as coronary artery bypass or valve replacement surgery.

Ablation to control symptoms of atrial fibrillation

Nodal catheter ablation, also known as AV node ablation, can control symptoms of atrial fibrillation when the cause cannot be stopped. You may need AV node ablation if targeted or pulmonary vein ablation did not stop your atrial fibrillation, or if these procedures will not help you. With AV node ablation, the entire atrioventricular (AV) node is destroyed. After the AV node is destroyed, it can no longer send impulses to the lower chambers of the heart (ventricles). This controls atrial fibrillation symptoms.

After AV node ablation, a permanent pacemaker is needed to regulate your heart rhythm. Nodal ablation can control your heart rate and reduce your symptoms, but it does not prevent or cure atrial fibrillation. So you will probably need to take anticoagulation therapy such as warfarin.

View a slideshow of AV node ablation to see how the heart's electrical system works, how atrial fibrillation happens, and how AV node ablation is performed.

You will be given medicine to help you relax. A local anesthetic will numb the site where the catheter is inserted. The procedure is done in a hospital where you can be watched carefully.