Ablation therapy in atrial fibrillationBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6428 (Published 29 November 2019) Cite this as: BMJ 2019;367:l6428
- Alysha Bhatti, academic foundation doctor1,
- Pippa Oakeshott, professor of general practice2,
- Mehul Dhinoja, consultant cardiologist and electrophysiologist3,
- Julia Grapsa, consultant cardiologist4
- 1St George’s University Hospitals NHS Trust, Tooting, London SW17 0QT, UK
- 2Population Health Research Institute, St George’s University of London, Tooting, London SW17 0RE, UK
- 3Arrhythmia Service, Department of Cardiology, St Bartholomew’s Hospital, London EC1A 7BE, UK
- 4Department of Cardiology, Royal London Hospital, London E1 1FR, UK
- Correspondence to: A Bhatti
What you need to know
Ablation is a management option for those experiencing symptoms of atrial fibrillation who have not responded to, or wish to avoid, anti-arrhythmic medication, or for whom such medication is contraindicated
Ablation has been shown to improve quality of life but has not yet been shown to reduce stroke risk or mortality. Long term anticoagulation is still indicated after ablation, according to the pre-ablation stroke risk
The success rate in returning to sinus rhythm is around 80% at three years, but up to a third of patients need more than one procedure to achieve this
Atrial fibrillation has a prevalence of 1% in the general population and 6% in those aged over 60 years. It increases the risk of stroke fivefold and doubles the risk of death.1 Although it is often asymptomatic, symptoms may include palpitations, breathlessness, dizziness, and exercise intolerance and lead to a reduced quality of life.2
Atrial fibrillation can be managed with pharmacotherapy, but ablation therapy (catheter ablation) is an option for symptomatic patients who wish to avoid or cannot tolerate medication. Once a cardiologist has assessed that the patient is a suitable candidate for the procedure, patients may have further questions to put to their general practitioner or other care provider. To aid these discussions, this practice pointer outlines what ablation therapy entails, the potential risks, the likelihood of success, and postoperative advice.
When is ablation therapy offered to patients with atrial fibrillation?
The number of catheter ablation procedures carried out for atrial fibrillation has risen, with over 6000 procedures being performed annually in the UK (approximately 100/million population).3 The National Institute for Health and Care Excellence (NICE) recommends the use of percutaneous radiofrequency ablation for those whose atrial fibrillation is causing symptoms and who have not responded to, or wish to avoid, anti-arrhythmic medication or in whom such medication is contraindicated.4
What is the evidence for ablation therapy?