University College London Cardiologist Dr Oliver Segal explains that Catheter Ablation is now usually the preferred option for treating Atrial Fibrillation. The objective of this treatment is to achieve Pulmonary Vein Isolation in order to correctly insulate otherwise abnormal cardiac electrical activity. There are a number of methods to achieve this and Dr Segal says, "Different physicians favour different methods of pulmonary vein isolation and will have different experience using these methods. The key with any medical procedure is that the physician gets reproducible and reliable results with the methods they use with acceptable levels of complication rates."
Endoscopic or Open Heart for PVI
PVI can be performed using fine wires introduced from the top of the leg in a key-hole procedure or surgically, either by endoscope with instruments inserted through small holes in the chest or with open heart surgery by cutting the chest open to expose the heart.
Hybrid Heart Operations
There are also techniques in which surgery and key-hole techniques are combined (known as hybrid operations). Once the heart has been accessed, ablation is performed to destroy the tissue around the entrance to the pulmonary veins.
Type of Ablation Energy
There are different options for ablation energy too, these include:
- Radiofrequency energy (a bit like microwave energy) to cauterise tissue,
- Cryo-ablation (when the tissue is frozen to very low temperatures) and
- Laser (laser energy causes tissue heating just like radiofrequency energy).
Catheters are guided by the use of x-rays, 3-dimensional mapping systems (which create computerised 3D images of the left atrium and show the catheters moving in real-time inside them), direct vision (using an endoscope with the laser baloon catheter) and sometimes ultrasound (echo).
There are claims from the manufacturers of the different ablation technologies of superiority over others but it appears, thus far, overall success rates and complication rates are broadly similar.