La atrial fibrillation (DOES) It is an arrhythmia with an increasing incidence in our environment, being the most frequently diagnosed in Spain. It is estimated that in our country there are one million patients with AF, with a prevalence in those over 80 years of age that exceeds 17%. The main consequences of AF are on the one hand the symptoms derived from the irregularity of the heartbeat and tendency to tachycardia (palpitations, shortness of breath, chest pain...) and on the other hand an increased risk of presenting thromboembolic phenomena, mainly stroke. For this reason, many patients with AF will receive anticoagulant treatment and different antiarrhythmic treatments.
Among antiarrhythmic treatments we have two options, which can be used independently or in combination: antiarrhythmic drugs and ablation.
AF ablation is a treatment incorporated into clinical practice since the early 2000s, so there is extensive experience in its use. It has been shown to be the most effective treatment for preventing AF recurrences, although it is not an appropriate option for all patients. The chances of success of this treatment are close to 70% for patients with paroxysmal AF (relatively short, self-limited episodes) and 50% for patients with persistent AF (longer episodes or episodes that require medical intervention for termination). The patients most likely to benefit in the long term from AF ablation are those with a shorter history of the pathology and those who have not developed structural changes in their heart derived from the presence of the arrhythmia (left atrial dilation). The fundamental benefit expected from AF ablation is the improvement in quality of life derived from the control of symptoms, while it has not yet been possible to consistently demonstrate a reduction in thromboembolic complications or patient mortality (except in a selected group of patients with severe left ventricular dysfunction).
AF ablation consists of performing lesions around the pulmonary veins (pulmonary vein ablation) to block the conduction of the cardiac electrical impulse between them and the rest of the cardiac tissue. To do this, a catheter is introduced through a puncture in the femoral vein that will be advanced to the left atrium, which will be administered with different types of energy (cold or "cryoablation", heat or "radiofrequency" or non-thermal energy in the case of “pulsed field” ablation). The procedure is performed under sedation or general anesthesia and can be performed either on an outpatient basis or with an overnight stay in the hospital, after which the patient can return to their usual activities from the next day and even practice sports within a period of time. less than a week. After the procedure, patients are recommended to receive anticoagulant treatment for at least two months. The risks related to AF ablation are low (below 5%), with the occurrence of serious complications such as stroke or death being exceptional.
In conclusion, pulmonary vein ablation is an effective and safe procedure for controlling symptoms derived from atrial fibrillation.
By the doctor Angel Miracle specialist of the UICAR