Aggressive Ablation for Chronic Afib?

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Aggressive ablation for chronic Afib (atrial fibrillation) comes with a host of short and long-term side effects. Anyone considering undergoing an ablation procedure then, must consider the risks and benefits.

Background: I developed chronic (permanent) atrial fibrillation as a result of chemotheray-induced cardiomyopathy in late 2010. I underwent aggressive chemotherapies and an ASCT for multiple myeloma, an incurable blood cancer, in 1995.

My chronic afib was kind of scary. At first anyway. I explored possible therapies to but my heart back into a normal sinus rhythm. I don’t remember the exact chain of events but while sitting in the hospital one day, a nurse that I happened to be chatting with casually mentioned that many people live long, normal lives with chronic atrial fibrillation.

Meaning, I could either try to fix my chronic Afib or not. Both choices came with risks and benefits.

What are the possible adverse effects of aggressive ablation for chronic atrial fibrillation?

Aggressive ablation for chronic atrial fibrillation (AF) can have several potential adverse effects and complications, including:

1. Cardiac Complications

Atrial Esophageal Fistula – A rare but life-threatening complication due to thermal injury to the esophagus.
Pericardial Effusion & Cardiac Tamponade – Caused by accidental perforation of the heart.
Pulmonary Vein Stenosis – Narrowing of the pulmonary veins leading to breathlessness, cough, and hemoptysis.
Heart Block – Damage to conduction pathways requiring pacemaker implantation.
Proarrhythmia – Ablation can trigger new arrhythmias.

2. Thromboembolic Events

Stroke or Transient Ischemic Attack (TIA) – Clots can form during or after the procedure, leading to embolic events.
Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE) – Due to prolonged immobilization or catheter-related thrombosis.

3. Vascular Complications

Hematoma – Bleeding at the catheter insertion site.
Pseudoaneurysm & Arteriovenous Fistula – Damage to blood vessels during catheter insertion.

4. Esophageal and Phrenic Nerve Injury

Esophageal Damage – Can lead to ulcers, bleeding, or fistula formation.
Phrenic Nerve Palsy – Causing diaphragmatic paralysis and respiratory difficulty.

5. Recurrence of Atrial Fibrillation

Despite aggressive ablation, AF recurrence is common, sometimes necessitating repeat procedures.

6. General Procedural Risks

Infection – Rare, but possible at the catheter site or inside the heart.
Contrast-induced Nephropathy – In patients with kidney disease, due to contrast dye use.

Catheter Ablation – What are the risks with Dr. David Schwartzman

After doing some research, I decided that I preferred to live with chronic Afib. I have lived with chronic afib since late 2010. I’m writing this post in March of 2025.

The study linked below is a more aggressive procedure that what I researched so I thought I should write about it.

Please don’t misunderstand me. I am not any sort of medical professional. I am a long-term myeloma survivor who lives with many long-term side effects from FDA approved, safe and effective therapies.

I believe that more people think like I do and may assume that medical procedures like aggressive ablation for chronic afib have few if any side effects.

Email me at David.PeopleBeatingCancer@gmail.com if you have questions about managing your MM or your side effects.

Hang in there,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Aggressive Ablation Better Than Regular for AF

“TOPLINE:

Aggressive ablation provided more favorable outcomes at 12 months than regular ablation in patients with persistent atrial fibrillation (AF). Patients undergoing aggressive ablation also had enhanced AF and atrial tachycardia (AT)–free survival.

METHODOLOGY:

Previous studies suggest using aggressive ablation for persistent AF, but real-world evidence with the approach is lacking.
Researchers conducted a retrospective cohort study using data from 4833 patients with persistent AF undergoing catheter ablation at 10 clinical sites in China from 2019 to 2023.
After propensity score matching, two groups (n = 1560 patients each) were established. One group received regular ablation (mean age, 72.59 years; 61.8% men); the other received aggressive ablation (mean age, 72.5 years; 59.2% men).
Patients in the group receiving regular ablation underwent pulmonary vein isolation (PVI) alone or PVI plus anatomical ablation, whereas those in the aggressive treatment group underwent PVI, anatomical ablation, and extensive electrogram-guided ablation.
The primary endpoint was freedom from any episode of AF or AT lasting more than 30 seconds after the blanking period (five half-lives before the end of the first 3 months) without the use of anti-arrhythmic drugs at the 12-month follow-up.

TAKEAWAY:

A higher proportion of patients in the aggressive ablation group than in the regular ablation group achieved freedom from recurrence of AF and AT (66.2% vs 59.3%; P < .001) and AF alone (78.1% vs 70.6%; P < .001), with no significant differences in the incidence of adverse events between the groups.
Patients receiving aggressive ablation experienced a higher rate of procedural AF termination than did those in the other group (67% vs 21%; P < .001). Patients who experienced AF termination showed improved AF/AT-free survival (hazard ratio, 0.596; 95% CI, 0.514-0.691).
Patients who underwent aggressive ablation had higher rates of both AF/AT-free survival (67.5% vs 59.9%; P < .001) and AF-free survival (78.7% vs 70.3%; P < .001) than those from the regular group who underwent anatomical ablation alone.
Moderately aggressive ablation involving two attempts during a single procedure was associated with improved clinical outcomes.

IN PRACTICE:

“Aggressive ablation resulted in more favorable outcomes than regular ablation, with moderately aggressive ablation potentially offering the best clinical outcomes. AF termination appears to be a reliable ablation endpoint,” the authors wrote.”

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