Catheter ablation

Pulmonary veins are the most common ectopic site that triggers paroxysmal AF. Catheter ablation uses radiofrequency ablation or cryothermy balloon catheters to create lesions that encircle the pulmonary vein, producing a non-conducting scar. As a result, aberrant electrical activity cannot spread to the atrium.5,6 Catheter ablation is a first-line alternative to AAD to prevent recurrent AF and to improve symptoms in some patients with symptomatic paroxysmal AF based on patient preference and the balance of risks and benefits.5

Catheter ablation is generally more effective in patients with paroxysmal AF than in those with more advanced disease, which is usually associated with significant structural heart disease.6 A single catheter ablation shows a long-term success rate of 54% and 42% in paroxysmal and non-paroxysmal AF respectively.33 Some patients with paroxysmal AF require repeated catheter ablations.6

Complications of catheter ablation

Catheter ablation is associated with complications, some of which may be life-threatening, including periprocedural death (less than 0.2% of catheter ablations), oesophageal perforation or fistula (less than 0.5%) and periprocedural stroke, TIA or air embolism (less than 1%). Other possible complications include cardiac tamponade (1–2%), pulmonary vein stenosis (less than 1%), persistent phrenic nerve palsy (1–2%), vascular complications (2–4%) and asymptomatic cerebral embolism (5–20%). The clinical significance of asymptomatic cerebral embolism is unknown.5

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