A cardiac ablation procedure is one of the recommended treatments for patients who suffer with atrial fibrillation or Afib. The procedure is performed when the normal heart function is damaged. Normally, the heart pumps blood to the entire body through normal electrical activity followed by heart muscle contraction. Unfortunately, one of the drawbacks of cardiac ablation is the need to perform the procedure multiple times.1
During episodes of Afib, the electrical activity of the upper heart chambers called atria is impaired. This abnormal heart function leads to symptoms and increases the risk of stroke. Cardiac ablation procedures are conducted in order to restore the normal conduction of the electrical activity of the atria and heart function. The goal of performing the procedure is that patients experience symptomatic relief as well as minimize their chance of stroke.1
The most common ablation technique consists of isolating the areas in the atria where abnormal electrical activity is diagnosed. Most often, abnormal electrical activity originates in the pulmonary veins or PVs. PVs are vessels that conduct blood into the left atrium from the lungs and are connected to the left atrial walls. When abnormal electrical activity occurs in the PVs, it happens in the left atrium too. The need to isolate the PVs from the rest of the left atrial wall is essential in maintaining normal atrial function.
Despite the fact that the ablation technique has progressed over the past 15 years, up to 40% of cases require a redo. Repeat ablation procedures are targeted at re-isolating the pulmonary veins. Some patients require up to 3 procedures until complete isolation is achieved.1
Many physicians and researchers now conclude that isolating PVs is not the only mechanism that may prevent Afib. The concept that rotational activity or rotors may sustain Afib has caught the attention of major institutions, physicians and even patients. While the focus has been on isolating PVs in the left atrium, rotors appear to have a role in sustaining Afib in the right atrium as well. Initial studies identified that almost 30% of the rotors can be located in the right atrium. During repeat ablation (redo cases), many physicians now combine rotor elimination with re-isolation of the PVs.2,3 This provides physicians with a completely new perspective on how and where to treat Afib during a cardiac ablation procedure.
- Medscape. 10 facts about catheter ablation of atrial fibrillation in 2012. Accessed November 4, 2015.
- Narayan SM, Krummen DE, Shivkumar K, et al. Treatment of Atrial Fibrillation by the Ablation of Localized Sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) Trial. J Am Coll Cardiol. 2012; 60(7):628-636.
- Miller JM, Kowal RC, Swarup V, et al. Initial Independent Outcomes from Focal Impulse and Rotor Modulation Ablation for Atrial Fibrillation: Multicenter FIRM Registry. J Cardiovasc Electrophysiolol. 2014. 2014;25(9): 921-929.