1. 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

2. Today’s 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

3. 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)

4. Areas that are typically ablated in an AF ablation

5. 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 don’t have symptoms.

6. 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

7. 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.

8. 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 well-tolerated 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.

9. 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.

10. Special Subgroups Patients with hypertrophic dilated cardiomyopathy
Young patients (<45 years of age)
High-level athletes
Patients with tachy-brady syndrome.

11. 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

12. 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 patient’s stroke risk, not on the perceived results of the ablation procedure.

13. 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

14. Questions to Ask
For a full list of “Questions to Ask Your Doctor,” visit: CardioSmart.org/AFib

15. Resources for Support and Information

16. Q&A Session