Atrial Fibrillation

When the two upper chambers of your heart (the atria) beat irregularly or out of sync with the lower chambers (the ventricles), atrial fibrillation occurs. As a result, the heart can beat faster than normal or beat irregularly, causing poor blood flow to the body. This form of arrhythmia is fairly common, affecting more than two million Americans. Atrial fibrillation is often associated with other forms of heart disease.

Symptoms can include heart palpitations, shortness of breath, fatique and weakness.

Treatment Options

Surgery
The standard treatment for heart arrhythmia is one of three variations of the Maze procedure.

Cox-Maze Procedure:
Incisions are made in the atria (the top chambers) to create lesions that will interrupt the electrical signals that are causing the heart to beat irregularly. During the procedure, extra tissue may also be removed in the top chambers if they need to be enlarged. Finally, the left atrial appendage (a bit of extra tissue in the left side of the heart) may be closed to prevent blood clots from forming and causing a stroke. This procedure is usually performed in concert with other heart surgery since it involves opening up the chest and exposing the heart.

Modified-Maze Procedure
A variation of the traditional procedure, radiofrequency, cryothermy, microwaves, laser or ultrasound energies may be used to create the lesions, rather than incisions.

Mini-Maze Procedure
One of the newest alternatives to the Cox-Maze procedure is the minimally invasive Mini-Maze. Tiny incisions are made on each side of the chest, allowing surgeons to access the heart without having to perform open heart surgery.  The surgeon places a special clamp-like tool on the left atrium, and then performs ablation on the tissue between the jaws of the clamp, similar to traditional ablation. Mini-Maze is ideal for patients who otherwise do not need open heart surgery, yet need to have atrial fibrillation episodes either eliminated or significantly reduced.

Ablation
When Atrial Fibrillation (AF) doesn’t respond to medical therapy, AF ablation may be recommended. Currently there are three different types of ablation therapy, robotic ablation, cryoablation and radio frequency ablation.

Approximately 80 to 85% of all patients will have their atrial fibrillation episodes totally eliminated or at least significantly reduced through ablation therapy.

Robotic Ablation (Stereotaxis)
One of the latest treatments to be adopted, robotic ablation is effective in the diagnosis and treatment of complex arrhythmias, such as atrial fibrillation. In contrast to traditional ablation therapies, robotic ablation allows the catheters to be positioned exactly in the heart using computerized, magnetic navigation. This not only increases success rates, but reduces the time to it takes to do the procedure.

An additional advantage is that the robotic catheter is softer and more flexible, greatly reducing the chance that the heart wall will be distorted or damaged. When combined with the precision mapping, robotic ablation can improve the safety and outcome of complex atrial fibrillation procedures.

Cryoablation
Cryoablation therapy is a non-surgical, minimally invasive procedure. A catheter with a cooling tip subjects the cells to sub-zero temperatures that isolate or destroy the tissues that are causing atrial fibrillation.

Cryoablation is done by freezing the tissue or heart pathways that interfere with your normal heart rhythm, the cells that are responsible for the arrhythmia are altered so they can’t conduct impulses.

Radiofrequency (RF) Ablation
Radiofrequency (RF) ablation is performed using a catheter. Using real-time x-rays (fluoroscopy), the catheter is guided to the exact site where the cells are creating the abnormal heart rhythm. A mild, painless RF wave is transmitted to the region, which destroys the cells that are causing the irregularity.

Medical Management
Medications can be prescribed to patients who are experiencing palpitations. These prescribed medications can alter the conduction of the electrical impulses that are sent to the atrioventricular node, slowing them down. In doing so, the heart rate will return to its normal rhythm.

Medications include:
Beta-blockers: Beta-blockers act upon the involuntary nervous system of the heart, blocking beta-adrenergic substances such as adrenaline. This relieves stress on the heart, allowing it to beat more slowly.

Calcium channel blockers: This class of drugs blocks calcium from the heart muscle and arteries, helping the heart pump more efficiently and slowing its rate.

Digoxin: Often used to treat heart failure, digoxin slows the electrical conduction between the atria and ventricles, reducing the incidences of atrial fibrillation.

Blood Thinners: Used to reduce the risk of blood clots in the left atrium, blood thinners can reduce the risk of stroke in patients who suffer from atrial fibrillation.

Cardioversion: Certain patients can have their sinus rhythm converted by shocking the heart electrically. A medication called ibutilide is administered intravenously to shock the heart in patients with chronic atrial fibrillation to get the heart to return to normal rhythms.