What is radiofrequency (RF) ablation?

From the Guidelines

Radiofrequency ablation is a recommended treatment for atrial fibrillation, with a success rate of approximately 80-90% in cases of paroxysmal AF and 80% in cases of persistent AF, as demonstrated by the accumulated experience involving nearly 4000 patients 1.

Overview of Radiofrequency Ablation

Radiofrequency ablation (RFA) is a minimally invasive medical procedure that uses heat generated from medium-frequency alternating current to destroy abnormal tissue. During the procedure, a thin needle electrode is inserted into the target tissue, and electrical current creates heat that destroys cells within a small, controlled area.

Indications for Radiofrequency Ablation

RFA is commonly used to treat various conditions including cardiac arrhythmias, such as atrial fibrillation. The procedure is typically performed under local anesthesia, sometimes with sedation, and often uses imaging guidance such as ultrasound, CT, or fluoroscopy to ensure precise placement.

Efficacy and Safety of Radiofrequency Ablation

The effectiveness of RFA varies by condition, but it often provides significant symptom relief with lower risks than traditional open surgery. However, potential complications include bleeding, infection, and unintended damage to nearby structures.

Specific Considerations for Atrial Fibrillation

In the context of atrial fibrillation, RFA has been shown to improve symptoms, exercise capacity, and quality of life, even in patients with concurrent heart disease 1. Additionally, RFA has been associated with reduced mortality and morbidity due to heart failure and thromboembolism 1.

Recommendations

Based on the strongest and most recent evidence, radiofrequency ablation is a recommended treatment for atrial fibrillation, particularly for patients with paroxysmal or persistent AF who have not responded to medical therapy 1. Key considerations for RFA in atrial fibrillation include:

• The procedure should be performed by an experienced operator using a circular mapping catheter and guided by intracardiac echocardiography.
• The goal of the procedure is to achieve circumferential electrical isolation of the pulmonary veins.
• Patients should be carefully selected and evaluated for potential complications, such as pulmonary vein stenosis and atrioesophageal fistula.

From the Research

Radiofrequency Ablation Overview

• Radiofrequency ablation is a medical procedure used to treat atrial fibrillation (AF) by destroying the abnormal electrical pathways in the heart that cause the arrhythmia 2, 3.
• The procedure involves using a catheter to deliver radiofrequency energy to the affected area of the heart, which heats and destroys the abnormal tissue 4, 5.

Efficacy of Radiofrequency Ablation

• Studies have shown that radiofrequency ablation is effective in reducing the recurrence of atrial fibrillation and improving quality of life for patients with symptomatic paroxysmal AF 2, 3, 6.
• A meta-analysis of randomized controlled trials found that radiofrequency ablation was associated with a significantly lower risk of all-cause death and cardiovascular hospitalization compared to antiarrhythmic drug therapy 6.
• Radiofrequency ablation has also been shown to improve long-term outcomes and quality of life for patients with AF, with significant improvements in physical and mental component scores on the Medical Outcomes Study 36-Item Short Form Survey (SF-36) 6.

Complications and Risks

• While radiofrequency ablation is generally a safe procedure, there are potential complications and risks, including cardiac tamponade, phrenic nerve palsy, and atrial flutter episodes with 1:1 atrioventricular conduction 2, 3.
• A study found that radiofrequency ablation was associated with a higher risk of cardiac tamponade, but no difference in the risk of heart failure, stroke, or transient ischemic attack 6.

Indications and Approaches

• Radiofrequency ablation is commonly used to treat paroxysmal supraventricular tachycardia, and has replaced arrhythmia surgery as the definitive cure for most arrhythmias 5.
• The procedure is typically performed as an elective procedure, and has several advantages, including no exercise restrictions, no need for chronic drug therapy, and the avoidance of hospital visits for breakthrough episodes 5.
• Recent advances in mapping technologies and substrate ablation have improved the management of complex arrhythmias, including persistent AF 4.