Catheter ablation for persistent atrial fibrillation is a much more complex ablation. The first part involves isolation of the pulmonary veins (see ablation for paroxysmal atrial fibrillation).
This treats the trigger for atrial fibrillation. Then additional areas in the heart are targeted. The technique utilized is very dependant on the electrophysiologist perfoming the procedure. The most up to date technique for catheter ablation for persistent atrial fibrillation is the step wise technique developed by Dr. Michel Haïssaguerre and Pierre Jaïs at the Université Bordeaux, Hôpital Haut-Lévêque in Bordeaux, France.
Currently in the United States the number of electrophysiologists with extensive experience with ablation of persistent atrial fibrillation is very limited (http://a-fib.com/Facilities.htm#SpecialistsInPersistent/ChronicA-Fib). Our practice prides itself as being one of the few in country with extensive experience with this procedure.
Dr Peykar traveled to France in June of 2008 and spent time in the electrophysiology lab at the Université Bordeaux with the world’s best, Dr. Haïssaguerre and Jaïs to learn this technique. To his knowledge, he is the only EP in the state of Florida currently performing this technique for persistent atrial fibrillation. Since June of 2008, Dr. Peykar has performed more than 250 ablations for atrial fibrillation and more than 400 catheter ablations since starting the complex arrhythmia ablation program in Charlotte County in January of 2008.
Since the procedure is much more complex, the success rates for catheter ablation of persistent atrial fibrillation are much lower. Typically, a success rate of 60% with first attempt at ablation is expected, with 50% needing a second ablation. The second ablation is usually done after three months as it can take this long for the scars in the heart to form. The first ablation can take 3-5 hours and is done under general anesthesia. A transesophageal echocardiogram (A transesophageal echocardiogram (TEE) is a test that uses ultrasound sound waves to look at your beating heart. For this test you swallow a device called a transducer, or probe. The transducer is carefully placed in your esophagus behind your heart) is done to rule out a clot in the heart at the beginning of the procedure.