Atrial Fibrillation: When Should You Consider Ablation? A

Atrial Fibrillation: When Should You Consider Ablation? A

Atrial Fibrillation: When Should You Consider Ablation? A Program for Patients & Caregivers Prepared by Luigi Di Biase, MD, PhD, FACC; Alan Wimmer, MD, FACC Last reviewed: September 2017 Todays Program

What is an ablation? When should you consider ablation? Who is a good candidate? Factors to consider What to expect after ablation Lifestyle changes Ongoing care What is an Ablation?

Minimally invasive procedure Find the areas of the heart causing abnormal impulses (AF) and destroy those areas Essentially stops the electrical impulses from coming through Special machine uses different energy sources Radiofrequency (burn)

Cryoablation (freeze) Areas that are typically ablated in an AF ablation Who is a Good Candidate? Not all patients are good candidates for an ablation. A careful review of past medical history and AF

symptoms are considered. Antiarrhythmic medications are tried before considering AF ablation. There are reasons for catheter ablation for some AF patients who dont have symptoms. Factors to Consider How often do you have AF? What are the symptoms: fatigue, shortness of

breath, palpitations How old are you? Do you have any of the following: Diabetes High blood pressure Heart Failure Other major medical issues Factors to Consider

It is important to consider patient preference and values. Some patients are reluctant to consider a major procedure or surgery and prefer treatment with medications. In these patients, trying antiarrhythmic agents, including amiodarone, might be preferred to catheter ablation. Factors to Consider

Some patients prefer a treatment that depends less on medications. Some patients might have only rare episodes of AF for many years or could have AF that is responsive to welltolerated AAD therapy. Decision to perform AF ablation should be made after a patient, together with family members and care team, considers the risks, benefits, and alternatives to the procedure.

Factors to Consider Primary benefit from catheter ablation of AF is improved qualify of life Stops palpitations, fatigue Allows you to do what you want without being exhausted from AF Main factor to consider for catheter ablation should be the presence of AF symptoms.

Special Subgroups Patients with hypertrophic dilated cardiomyopathy Young patients (<45 years of age)

High-level athletes Patients with tachy-brady syndrome. After AF Ablation Studies reported a low stroke risk in patients who stopped oral blood thinners after successful AF ablation Data from the German Ablation Registry showed a high stroke risk after ablation in patients at high risk for stroke

Symptomatic and asymptomatic AF can happen again after AF ablation procedures, and AF is observed in at least 50% of patients in 5 years Absence of symptomatic AF after ablation does not necessarily indicate an absence of asymptomatic AF or a low risk of stroke What to Expect Long-Term Taking blood thinners is recommended for at least two

months post-catheter ablation of AF. Routine tests (holter, electrocardiograms (ECGs), event monitors) are done frequently after ablation to monitor for asymptomatic AF. Continuing blood thinners after having an ablation should be based on the patients stroke risk, not on the perceived results of the ablation procedure. Make Lifestyle Changes

Lifestyle changes may help prevent AF: -Weight loss -Treatment of sleep apnea -Regular moderate-intensity exercise -Treatment of other medical conditions such as high blood pressure, diabetes, coronary artery disease and heart failure

-Limiting alcohol intake Questions to Ask For a full list of Questions to Ask Your Doctor, visit: CardioSmart.org/AFib Resources for Support and Information Q&A Session

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