A cautionary note on AF ablation in 2015

It’s time to write an update on AF ablation. Things have changed. The major change is that I am doing many fewer ablations for AF. The reason is we have a better understanding of the disease, or should I say, condition? In the last 2-3 years, good science has changed the way specialists see AF. The old-thinking had AF in its own silo. Your ECG showed AF so you had the disease AF. And if you had a disease, we had a fix–say drugs or ablation. My partners would say, “John, we are sending you this patient with AF; please fix him.” And by fix, they meant drugs or ablation. Like a blockage–make it go away. That’s not how AF treatment works. I’m surprised it took this long to figure that out. The new thinking is that AF (often) occurs as a symptom or sign of something else. Before I expand on that something else, let’s set out that there exists a small (but very vocal) minority of patients with AF that have no underlying disease or cause. This type of AF, the focal kind coming from an isolated source, usually within or around the pulmonary veins, was the type of AF first described by Dr. Michel Haïssaguerre and colleagues in the NEJM in 1998. If this was the only AF we ablated; AF ablation would be as curative as it is in supraventricular tachycardia. It is not. Most AF in developed countries is not a focal or primary problem with the heart. Most AF has a root cause outside the heart. “Things” outside the heart that lead ...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs