How does ablation treat atrial fibrillation?

I was in on the case of a 64-year old male with both afib and aflutter. The EP attending explained that ablation is good for patients with medically refractory afib/aflutter.

Ablation is useful in patients with  paroxysmal afib to get them off anticoagulation. It doesn’t tend to work as well with patients who have persistent afib.

When ablating someone with afib, realize that aberrant signals are often coming from the left atrium (Flutter tends to come from around the tricuspid annulus in the right atrium).You have to puncture the intra-atrial septum–risking aortic or pericardial perforation–to reach the left atrium from the IVC.

Cryo-ablation is aimed at the pulmonary veins. Cryo-ablation seems faster, safer, more effective than radiofrequency ablation (can take 6-7 hrs), but is probably more expensive. A 3D map with CT and electrical sensing is created. That map is used along with  potentials generated on the sensing catheter and dye under fluoro to make sure your ablating catheter is positioned correctly. The areas around the pulmonary veins are ablated until the potentials disappear.  you ablate the areas around the pulmonary veins until the potentials disappear or until you feel confident the temperature has done its job. Cryo-ablation seems faster, safer, more effective than radiofrequency ablation (can take 6-7 hrs), but is probably more expensive.

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