How can we suppress AF attacks? When do patients need to have catheter ablation?
Atrial fibrillation is a serious condition that should not be ignored as it can be life-threatening if left untreated. Unfortunately, atrial fibrillation cannot heal and will only worsen with time. It is therefore important to suppress and prevent the AF from happening. For most patients, they are given heart rhythm medications to stop AF. However, less than 30% of patients respond to such medication. For the remaining patients, a minimally invasive procedure called catheter ablation is much more successful in suppressing AF. The earlier catheter ablation is performed after your diagnosis of AF, the higher the success rates. For AF treated early, the success rates can be as high as 90%.
What is catheter ablation?
Catheter ablation. This is a minimally invasive procedure where a thin, flexible tube (catheter) is inserted into the heart through the veins. Once there, specific areas of the heart responsible for causing atrial fibrillation (AF) are targeted to stabilise the heart rhythm and prevent atrial fibrillation occurrence. Catheter ablation is the most effective treatment to prevent atrial fibrillation recurrence in the long term.
I have read about radiofrequency energy, cryoenergy and pulsed field ablation to treat atrial fibrillation? What are the differences?
Catheter ablation is the most common performed procedure for heart rhythm disorders globally. Each year, more than 300,000 patients worldwide undergo catheter ablation for atrial fibrillation. Traditionally, atrial fibrillation ablation has been performed using technologies that either heat (radiofrequency) or freeze (cryoenergy) the heart tissue. Whilst effective for treating atrial fibrillation, there is a small (<1%) risk of damaging structures around the heart. The search for safer energies to perform atrial fibrillation ablation led to the invention of pulsed field ablation (PFA).
PFA utilises high density, high-voltage electrical pulses to treat specific areas of the heart responsible for causing atrial fibrillation. PFA allows for more targeted treatment, at least 50-75% reduction in operating times and enhanced safety. PFA specifically targets cardiac tissue while sparing nearby structures like blood vessels, nerves, and connective tissue. Hence, the risk of collateral damage is eliminated.
Singapore was the first country in Asia to perform pulsed field ablation in 2022. Since the introduction of pulsed field ablation in September 2022, Asian Heart and Vascular Centre has performed more than 150 such ablations. Prior to this, Dr Jeremy Chow and Pipin Kojodjojo has performed more than 1,500 AF ablation using radiofrequency and cryoenergy.
What can you expect when one undergoes pulsed field ablation (PFA) for atrial fibrillation?
Pulsed field ablation is a minimally invasive procedure performed during sedation or general anaesthesia. You will not be awake during the procedure. Typically, a pulsed field ablation procedure can last between 30 to 60 minutes, depending on the complexity of individual patients.
Before the procedure
• Consultation – Before the ablation, we will explain the procedure, risks and alternative treatments, ensuring you’re comfortable and well-informed.
• Preparation – You’ll generally be advised to fast for at least 6 hours before the procedure. This precaution ensures your safety, as sedation or anaesthesia is employed. Patients are only admitted to hospital on the day of the procedure
During the procedure
• Comfort and safety – Patients will receive either sedation or general anaesthesia so that you are entirely comfortable and pain-free throughout.
• Safety scan – Once asleep, a scan will be performed to look out for any blood clots that could have formed in a patient with AF. This will ensure that the ablation can be carried out safely
- Catheter insertion – A catheter will be introduced in your veins using a fine needle and passed into the heart via the body’s main vein. A 3-D recreation of your heart will be created using sophisticated mapping technologies
• Ablation process – High voltage electrical pulses will be delivered to the problematic heart tissue using pulsed field technology to rectify atrial fibrillation.
After the procedure
• Initial monitoring – You’ll be observed closely in a recovery room after the ablation. Medical staff will monitor your vital signs and ensure there are no complications from the ablation
• Recovery – Most patients are able to walk around their room 6 hours after the ablation and be discharged the following morning. They can start jogging and light exercises 2-3 days after their ablation
• Follow-up – Regular appointments will be scheduled to ensure that the pulsed field ablation was successful and improve your general health. This is vital to minimise the risk of AF returning in the future
Is AF ablation safe?
AF ablation is a safe procedure. Asian Heart and Vascular Centre was invited to take part in a worldwide survey of 23 centres performing AF ablation regularly. Out of 33,879 ablation procedures, severe complications happened in only 8 of out 1,000 cases. The risk of death was 1 in 33,879 cases. (< 0.003%)
Is AF ablation suitable for all patients?
In short, no. AF ablation works best for patients with early-stage AF and whose heart has not excessively enlarged. Typically the earlier ablation is performed, the better the results. Unfortunately, some patients come to see us after many years of AF. For such patients, the success rates of AF ablation is lower and they may need to have more than 1 ablation procedure to achieve long term normal rhythm. Our team will discuss with you what the chances of success are and if you are not ideal for ablation, what our treatment options would be better