Catheter ablation eliminates arrhythmias by advancing catheters (Teflon-coated wires) to the heart, putting the catheter tip on the spot causing the arrhythmia, and cauterizing and eliminating it by heating the tip of the catheter. This procedure was developed during the 1980’s, and has been standard therapy for many arrhythmias since 1990. It is performed by electrophysiologists; cardiologists who specialize in management of heart rhythm disturbances. Even the earliest reports showed this procedure to be extremely successful when trying to eliminate common arrhythmias other than AF, with few complications (less than 1%); it revolutionized the management of many common arrhythmias.
AF is more complex than those arrhythmias, however, and catheter ablation of AF was not attempted until about 10 years after it was in widespread use for other, less complex arrhythmias, when our understanding of AF improved and advanced therapy such as catheter ablation became practical. Catheter ablation of AF can be successful but has not reached the extremely high success rates that are attained in ablation of many other common arrhythmias.
When used for ablation of AF, this procedure goes by several names, including the Pulmonary Vein Isolation Procedure, Catheter Maze, Pappone Technique, Wide Area Circumferential Ablation, and Catheter Ablation of AF. Catheters are maneuvered from the leg into the left atrium, and ablation of the connections between the Left Atrium and the Pulmonary Veins is performed. The nerves responsible for some AF are near these connections, and some of these are eliminated at the same time. Because the connections are quite extensive, AF ablation is much more extensive than a standard ablation procedure, often requiring more than 100 applications of the heated tip of the catheter; for those reasons the procedure can be long. The potential for complications is higher than standard ablations, due to the large amount of ablation that is required, and the proximity of the pulmonary veins, the esophagus, and other structures. Success is moderate, more than one procedure is required in many patients, recurrence is thought to be between 5% and 10% annually in those patients with successful outcomes, and complications have occurred. Nevertheless, catheter ablation for AF is successful in many cases, and has become an important part of the management of AF. A complete discussion of the merits of catheter ablation is beyond the scope of this website.