Considering The Right Afib Patient for Ablation Treatment - St Michael's Hospital

Dr. Paul Dorian, MD, CM, MSc. Cardiologist, St Michael's Hospital, Toronto discusses the right atrial fibrillation patient for Ablation therapy treatment.

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Dr. Paul Dorian, MD, CM, MSc. Cardiologist, St Michael's Hospital, Toronto discusses the right atrial fibrillation patient for Ablation therapy treatment.
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Featuring Dr. Paul Dorian, MD, CM, MSc. Cardiologist

Duration: 4 minutes, 53 seconds

What about atrial fibrillation ablation? This is a commonly discussed procedure for patients with atrial fibrillation. Let’s first explain what ablation means, and then we’ll talk about if it’s right – for which patients it’s the right procedure.

So what is atrial fibrillation ablation? Ablation is a procedure we do by putting tubes inside the heart and delivering small amounts of electrical energy to burn away the potential short circuits that lead to atrial fibrillation. These short circuits are on the back wall of the left collecting chamber, called the left atrium.

What ablation will do is it will cause the small electrical burns in the back of a patient’s heart, and if done appropriately and successfully, which is about 70, 80% percent of the time in most patients, making these burns will prevent these electrical short circuits in the heart from forming and leading to the next attack of atrial fibrillation.

Which patients with atrial fibrillation can benefit the most from an ablation procedure? In general, the main reason to do an ablation procedure is for quality of life. We don’t recommend it specifically to prolong life, or to prevent dangerous things from happening.

Why? Because fortunately, dangerous things in atrial fibrillation are very rare. Dying from atrial fibrillation is very, very rare. Heart attacks are very, very rare. Stroke in atrial fibrillation can be prevented with a blood thinner. Doing an ablation will not prevent stroke, but we already have a great treatment for stroke: prevention, which is anticoagulants, or so-called blood thinners.

So the reason to recommend an ablation, and the reason for a patient to want to have an ablation, is to improve their quality of life. What do we mean by that? Many patients with atrial fibrillation can’t exercise when they have atrial fibrillation, because they have palpitations or shortness of breath. They’re bothered by the attacks. The attacks are very uncomfortable or unpleasant. They may be on medications which are ineffective; don’t stop the attacks of atrial fibrillation.

So commonly in patients with atrial fibrillation, this is more often the case in younger patients, who wish to exercise and be active and are maybe still working and not retired, and are out there in public or doing things in their everyday lives which require them to feel perfect, and when they have atrial fibrillation they just feel unwell.

By the way, the first thing we do for all the patients is to try to reassure them, to reduce their anxiety level, to help them understand their atrial fibrillation, although unpleasant, can usually be dealt with by a combination of medications and reassurance and tincture of time.

But many patients continue to feel unwell during attacks of atrial fibrillation. And they feel sufficiently unwell, that they understand that even though there’s a small risk they want to go ahead with the procedure. Those are the majority of patients where the procedure is reasonable and indicated.

Some patients aren’t sure how well they feel, or how ill they feel during atrial fibrillation, and that requires a conversation with their doctor. Am I going to feel better if I have an ablation procedure? Some patients are very little bothered by the atrial fibrillation. They’re bothered by the idea of having atrial fibrillation. The patient and the doctor are concerned because they have this condition.

But otherwise the patient’s feeling reasonably well, they can exercise, they’re active, they travel, they take their medications, and their quality of life – their everyday life, is not much affected by the atrial fibrillation. Those patients I generally would not recommend an ablation, even though the idea of having a condition is bothersome.

The reason we don’t recommend an ablation most of the time for these patients is they’re not going to feel any better. They might feel emotionally better, but they’re not going to feel physically any better. So this is a procedure with risks, which isn’t really going to benefit the patient, and in most kind of treatment is reassurance, advice and education.

If you have atrial fibrillation and you don’t feel well or you need more information, or you’re not completely satisfied with your treatment, speak to your family doctor, if needed ask to be sent to a cardiologist who has expertise in atrial fibrillation and get yourself as well informed as possible about this condition so that you better understand your own body and you can deal with the symptoms more effectively.

Presenter: Dr. Paul Dorian, Cardiologist, Toronto, ON

Local Practitioners: Cardiologist

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.