Atrial fibrillation ( AF) is an arrhythmia with a rising incidence in our country, being the most frequently diagnosed arrhythmia in Spain. It is estimated that there are one million patients with AF in Spain, with a prevalence exceeding 17% in those over 80 years of age. The main consequences of AF are, on the one hand, the symptoms resulting from the irregular heartbeat and tendency towards tachycardia (palpitations, shortness of breath, chest pain, etc.) and, on the other hand, an increased risk of thromboembolic events, primarily stroke. Therefore, many patients with AF will receive anticoagulant therapy and various 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 the symptoms of atrial fibrillation.
By Dr. Angel Miracle, UICAR specialist
If you have been recommended an ablation, at the Arrhythmia Unit of UICAR we assess your case and explain the procedure to you step by step.