Is atrial scar-based catheter ablation a promising strategy for persistent atrial fibrillation?
Atrial scar-based catheter ablation is a promising strategy for ablation of persistent atrial fibrillation. Recent findings: In this review, we outline the role of atrial scar/fibrosis in the pathophysiology of atrial fibrillation and how this encouraged clinical studies assessing the atrial substrate using scar-based mapping.
How is atrial fibrillation (AFIB) treated?
(The pulmonary veins are the blood vessels that deliver oxygenated blood from the lungs to the heart.) If the opening of the veins can be electrically isolated from the rest of the left atrium, using a special catheter designed for this purpose, atrial fibrillation can often be reduced in frequency or even eliminated.
When is atrial fibrillation ablation used?
Atrial fibrillation ablation may be used if medications or other treatments don't work. Sometimes it's the first treatment for certain patients. Atrial fibrillation ablation is most often done using thin, flexible tubes called catheters inserted through the veins or arteries to the heart. Less commonly, ablation is performed during cardiac surgery.
What is the role of internal cardioversion in the treatment of atrial fibrillation?
Internal cardioversion may also be considered after failed transthoracic cardioversion if such facility is available. TOE guided DCC of atrial fibrillation may be used to reduce the period of anticoagulation before cardioversion without increasing the risk of thromboembolism.
What are the two types of ablation?
There are two ways your doctor can do ablation. Catheter ablation is the more common procedure. Catheter ablation, also called radiofrequency or pulmonary vein ablation, isn't surgery.
What is the treatment of choice for atrial fibrillation?
Cardioversion. Cardioversion may be recommended for some people with atrial fibrillation. It involves giving the heart a controlled electric shock to try to restore a normal rhythm. Cardioversion is usually carried out in hospital so the heart can be carefully monitored.
What is the first line treatment for atrial fibrillation?
Beta-blockers and calcium channel blockers are first-line agents for rate control in AF. These drugs can be administered either intravenously or orally. They are effective at rest and with exertion. Intravenous diltiazem or metoprolol are commonly used for AF with a rapid ventricular response.
Is ablation a cure for AFib?
Does Ablation Cure AFib? AFib may go away for a long time, but it can return. It's rare, but if you have persistent or chronic AFib, you might need a second ablation within 1 year. If you've had AFib for more than a year, you may need one or more treatments to fix the problem.
Which is better cardioversion or ablation?
Conclusion: In patients with AF, there is a small periprocedural stroke risk with ablation in comparison to cardioversion. However, over longer-term follow-up, ablation is associated with a slightly lower rate of stroke.
What is cardioversion for atrial fibrillation?
Cardioversion is a medical procedure that uses quick, low-energy shocks to restore a regular heart rhythm. It's a treatment for certain types of irregular heartbeats (arrhythmias), including atrial fibrillation (A-fib). Sometimes cardioversion is done using medications.
What is catheter ablation for atrial fibrillation?
Catheter ablation is a way to treat irregular heartbeats, or arrhythmias, like atrial fibrillation (AFib), atrial flutter, or supraventricular tachycardia (SVT). It destroys the tissue that's causing your heartbeat to get off course. This creates scar tissue inside your heart. This scar tissue is a good thing.
What two treatments may help a patient with atrial fibrillation?
Atrial fibrillation treatment may involve: Medications. Therapy to reset the heart rhythm (cardioversion) Surgery or catheter procedures....Medications used to treat atrial fibrillation include:Beta blockers. ... Calcium channel blockers. ... Digoxin. ... Anti-arrhythmic medications. ... Blood thinners.
How do you treat atrial fibrillation with RVR?
Drugs called beta-blockers. They control your heart rate. Your doctor will get them to you in your vein (they'll call this intravenously) if you have AFib with RVR....The most commonly used drugs are:Esmolol (Brevibloc)Metoprolol (Lopressor, Toprol)Propranolol (Inderal, Innopran)
Are you awake during catheter ablation?
You will probably be awake during the procedure. But you might be asleep. The doctor will give you medicines to help you feel relaxed and to numb the areas where the catheters go in. An EP study and ablation can take 2 to 6 hours.
What is the difference between atrial flutter ablation and atrial fibrillation ablation?
In atrial fibrillation, the atria beat irregularly. In atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles, so you may have four atrial beats to every one ventricular beat.
When is ablation necessary?
Facts About Catheter Ablation Not everyone with a heart arrhythmia needs a catheter ablation. It's usually recommended for people with arrhythmias that can't be controlled by medication or with certain types of arrhythmia from the heart's upper chambers, called the atria.
What is the best beta blocker for atrial fibrillation?
Bisoprolol* or metoprolol succinate are first-choice beta-blockers for patients with atrial fibrillation as they are prescribed once-daily and do not require dose adjustment in patients with renal impairment. Bisoprolol is preferred as it is more cardioselective than metoprolol and may cause more bradycardia.
What is the most effective antiarrhythmic drug?
Amiodarone is considered the most potent antiarrhythmic agent. The adverse event profile with amiodarone can be intolerable, with gastrointestinal effects the most common side effect.
What is the drug of choice for arrhythmia?
AMIODARONE — Among available antiarrhyth- mics, amiodarone (Cordarone, and others) is the most effective in preventing recurrences of atrial fibrillation and of ventricular tachycardia or fibrillation.
What is the most common cause of atrial fibrillation?
Problems with the heart's structure are the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include: Coronary artery disease. Heart attack.
What is the treatment for irregular heartbeats called?
Atrial fibrillation ablation is a treatment for an irregular and chaotic heartbeat called atrial fibrillation (A-fib). It uses heat or cold energy to create tiny scars in your heart to block the abnormal electrical signals and restore a normal heartbeat.
Where are catheters inserted during cardiac ablation?
During cardiac ablation, catheters are passed through a vein in order to reach your heart. Catheters may be inserted in your groin, your shoulder or your neck. One of the following ablation techniques is used to create small scars in your heart and block the abnormal heart rhythms: Heat (radiofrequency energy)
What are the risks of ablation?
Possible atrial fibrillation ablation risks include: 1 Bleeding or infection at the site where the catheters were inserted 2 Blood vessel damage 3 Heart valve damage 4 New or worsening arrhythmia 5 Slow heart rate that could require a pacemaker to correct 6 Blood clots in your legs or lungs (venous thromboembolism) 7 Stroke or heart attack 8 Narrowing of the veins that carry blood between your lungs and heart (pulmonary vein stenosis) 9 Damage to your kidneys from dye used during the procedure 10 Death in rare cases
What is the purpose of AV node?
The atrioventricular (AV) node doesn't stop the extra signals from entering the ventricles. The result is a rapid and chaotic heartbeat. Atrial fibrillation ablation is done to restore a normal heart rhythm.
How long does it take for a cryoablation catheter to be inserted?
If you have severe pain or shortness of breath, let your doctor know. The procedure usually takes three to six hours.
What happens after a catheter is inserted?
Following your procedure, you'll be moved to a recovery area to rest quietly to prevent bleeding from the site where the catheters were inserted into the blood vessels. Your heartbeat and blood pressure will be monitored continuously to check for complications.
Can you have a stroke after cardiac ablation?
Most people see improvements in their quality of life after cardiac ablation. But there's a chance that your abnormal heartbeat may return. If this happens, the procedure may be repeated or you and your doctor might consider other treatments. The procedure hasn't been shown to reduce your risk of a stroke. You may need to take blood thinners to reduce your stroke risk.
What are the different types of atrial fibrillation?
There is no general agreement on the terminology to describe various types of atrial fibrillation. 6 It may be usually classified as acute and chronic atrial fibril lation. 7 Chronic atrial fibrillation may be further subclassified as paroxysmal, persistent, and permanent. 7,8 When episodes of atrial fibrillation recur and each is self terminating, this is called paroxysmal atrial fibrillation. The term, “persistent” is used when the spontaneous remission of atrial fibrillation does not occur and atrial fibrillation is likely to persist if not cardioverted. It is regarded as permanent when it cannot be reverted to sinus rhythm, even by electrical cardioversion. Most atrial fibrillation usually starts as paroxysmal atrial fibrillation. In this simple but therapeutically useful classification, there may be overlap between acute onset and other types of atrial fibrillation. There are published complex classifications of atrial fibrillation which are beyond the scope of this article. 6,9,10
How to achieve atrial ablation?
Atrial ablation can be achieved either by catheter based technique or open heart surgery. In the catheter based technique, multiple linear ablations are made in the right or/and left atria by radiofrequency energy. The success rate of left atrial ablation is higher than the right atrial ablation. 39 More recently foci of atrial tissue with abnormal automaticity triggering atrial fibrillation were detected in abnormal sites mainly within the pulmonary veins (>90%) which were considered suitable for catheter ablation. 11,45 Chen et al showed that, of all ectopic foci in the pulmonary veins which were demonstrated to initiate atrial fibrillation, radiofrequency ablation was successful in eliminating 95% of the foci. 49 Moreover, 86% of the 79 patients studied remained in sinus rhythm at the end of 6 +−2 months of follow up. Although a few potential complications namely pulmonary vein stenosis, systemic embolism and pericardial effusion were reported, radiofrequency ablation of atrial fibrillation foci within pulmonary veins seems promising.
How does an implantable atrial defibrillator work?
The principle of the implantable atrial defibrillator was derived from that of the implantable cardioverter defibrillator for the treatment of ventricular tachyarrhythmia. It involves putting in transvenous leads in the right atrium and also in coronary sinus which are connected to the defibrillator located subcutaneously in the infraclavicular region. The device is usually triggered manually at a preset delivery energy varying from 0.1 to 10.0 joules. However, a majority of patients reported significant discomfort with energy >2.0 joules. 50 The Metrix system trial which enrolled 51 selective patients with atrial fibrillation showed success rate of 86% without significant induction of ventricular tachyarrhythmias or unsynchronised delivery of energy or thromboembolism. 51 However, the early recurrence rate was high at 27%. It is considered that by terminating atrial fibrillation promptly with the implantable atrial defibrillator that it will decrease the duration of atrial fibrillation and thereby may help reduce/prevent atrial fibrillation induced atrial remodelling. 52 Although patient tolerability is usually poor and the need for long term anticoagulation is not clear, an implantable atrial defibrillator as a back up device in addition to pharmacological therapy is a therapeutic option for difficult atrial fibrillation.
What are the complications of cardioversion for atrial fibrillation?
The serious complication of cardioversion for atrial fibrillation is thromboembolism in 5%–7% without anticoagulation and 1%–2% after conventional anticoagulation. 1 However, from the data of 1164 patients who underwent transoesophageal echocardiography (TOE) guided DCC and who had atrial fibrillation or atrial flutter, Grimm reported that TOE guided DCC was associated with very low thromboembol ic complications of <0.1%. 28 This strategy involves performing TOE after intravenous unfractionated heparin for 1–5 days (keeping the partial thromboplastin time between 1.5 and 2.5 times control) or warfarin therapy for at least five days with an international normalised ratio of 2–3. 28 When atrial thrombus is excluded, DCC is performed. If a thrombus is detected, DCC should be postponed and the patient should be warfarinised for six weeks or longer. 6 If the thrombus resolves, DCC can then be performed; if not, it is generally abandoned. 6 In a trial of TOE guided cardioversion for 242 patients with atrial fibrillation and atrial flutter, two thirds of patients with atrial fibrillation and atrial flutter of >48 hours’ duration were successfully cardioverted without increasing risk of thromboembolism. 29 The authors also showed that the reduction in time to DCC was associated with better maintenance of sinus rhythm at one month, in comparison with those patients who underwent conventional oral anticoagulation before cardioversion.
How common is atrial fibrillation?
Atrial fibrillation is the commonest cardiac arrhythmia. It affects 5% of British people above the age of 65 years and 10% above 75. 1 It accounts for more than 35% of all hospital admissions for cardiac arrhythmias in the United States. 2 Although thought to be immediately non-life threatening, its presence increases mortality by up to twofold. 3 The most important morbidity and mortality associated with atrial fibrillation result from stroke. The attributable risk of stroke increased from 1.5% for patients with atrial fibrillation aged 50–59 years to 23.5% for those aged 80–89 years. 4 It is also associated with congestive heart failure. These result in a significant increase in the of cost of health care in the community. Moreover, ischaemic stroke secondary to atrial fibrillation carries about twice the risk of death in comparison with stroke from other causes. 5 Despite the high prevalence of atrial fibrillation and the increased morbidity and mortality associated with it, its treatment strategy remains less well defined. We review the literature and present here the evidence based treatment options for this most common sustained cardiac arrhythmia.
What is the most common cardiac arrhythmia?
Atrial fibrillation is the commonest sustained cardiac arrhythmia. It accounts for >35% of all hospital admissions for cardiac arrhythmias in the United States. The presence of atrial fibrillation increases the mortality of a population by up to twofold. The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50–59 years ...
How much does stroke risk increase with atrial fibrillation?
The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50–59 years of age to up to 23.5% for such patients aged 80–89 years. Although the diagnosis of atrial fibrillation is usually straightforward, effective treatment is not. This article will discuss how rhythm control of atrial fibrillation can best be achieved, ...
What is maze surgery?
Open-heart maze procedure. Maze heart surgery is a complex procedure in which a surgeon creates small cuts in the upper part of your heart. The cuts are then stitched together and scar tissue forms. The scars interfere with the transmission of electrical impulses that can cause AFib. Normal heartbeat is then restored.
How does a pacemaker work?
It is implanted under the skin near the collarbone and sends out an electrical signal to keep a steady contracting rhythm in the heart. Some pacemakers sense when the heartbeat is too fast or too slow and fire impulses that help the heart return to the proper rhythm and speed.
What is the procedure called when you have a large area of your heart?
Atrioventricular node ablation. In some cases, you may need a more extensive type of ablation, known as atrioventricular node ablation (AVN). This procedure is similar to the catheter ablation surgeries described above, but it destroys a larger area of your heart, known as your atrioventricular node.
What type of energy is used for ablation?
But other types of energy, rather than radio waves, can also be used. Other types of ablation include sonar, microwave, and cryoablation. If you undergo cryoablation, your surgeon will freeze an area of your heart tissue to destroy and scar it.
How long does it take for a heart catheter to be inserted?
They are typically performed in hospitals over the course of about two hours. During the procedure, your surgeon will likely insert a catheter through a vein in your groin or neck. They will thread the catheter through your vein to the upper and lower chambers of your heart.
Is it rare to have a heart ablation?
While any medical procedure carries risks, complications from ablation surgeries are rare. More serious complications include stroke or abnormal fluid collection around your heart, but these complications are rare. Your healthcare team will closely monitor you after your procedure to watch for signs of problems.
Is the maze procedure invasive?
This minimally invasive procedure involves a low level of risk and high success rate. If you have more complicated heart problems that require open-heart surgery, your surgeon can use the maze procedure to treat your A-fib. This procedure is more invasive and involves higher levels of risk.
Can radiofrequency ablation be used to treat irregular heartbeats?
Misfiring electrical signals won’t be able to cross the scar tissue. Radiofrequency ablation is the most common type of ablation used. According to the American Heart Association (AHA), it can cure irregular heartbeats in over 90 percent of cases. But other types of energy, rather than radio waves, can also be used.
Difficulties
- Most cardiac arrhythmiasare caused by a small, localized area somewhere within the heart that produces an electrical disruption of the normal heart rhythm. For most arrhythmias, then, ablation simply requires locating that small abnormal area and disrupting it. In contrast, the electrical dis…
Going After Triggers
- Electrophysiologists have learned they can often improve atrial fibrillation by ablating the "triggers" of the arrhythmia, namely PACs (premature atrial contractions, premature beats arising in the atria). Studies suggest that in up to 90% of patients with atrial fibrillation, the PACs that trigger the arrhythmia arise from specific areas within the left atrium, namely near the openings …
Effectiveness
- Despite recent advances, the ablation of A-fib is still a lengthy and difficult procedure, and its results are less than perfect. Ablation works best in patients who have relatively brief episodes of atrial fibrillation—so-called paroxysmal atrial fibrillation. Ablation doesn't work as well in patients who have chronic or persistent atrial fibrillation, or who have significant underlying cardiac disea…
Complications
- The risk of complications with catheter ablation for atrial fibrillation is higher than it is for other kinds of arrhythmias. This is because for A-fib, the ablation procedure tends to take substantially longer, the scars needed to be produced tend to be larger, and the location of the scars that are produced (in the left atrium, usually near the pulmonary veins) increases the risk of complication…
A Word from Verywell
- Anyone with atrial fibrillation who is being asked to consider ablation therapy ought to keep a couple of important facts in mind. First, the success rate of the procedure, while reasonably good, is not measurably better than it is with anti-arrhythmic drugs—at least, not after a single ablation procedure. Second, there is a very slight risk of serious complications. Despite these limitations, …
Overview
Why It's Done
- Atrial fibrillation ablation is done to reset the heart's rhythm. A health care provider may recommend this type of ablation if you have A-fibsymptoms, including a fast, fluttering heartbeat, that hasn't improved with medication or other treatments.
Risks
- Possible atrial fibrillation ablation risks include: 1. Bleeding or infection at the site where the catheters were inserted 2. Blood vessel damage 3. Heart valve damage 4. New or worsening irregular heartbeats (arrhythmias) 5. Slow heart rate that could require a pacemaker to correct 6. Blood clots in the legs or lungs (venous thromboembolism) 7. Stroke or heart attack 8. Narrowin…
How You Prepare
- Your health care provider may order several tests to get more information about your heart condition before your atrial fibrillation ablation. You'll need to stop eating and drinking the night before your procedure. Your care provider will tell you how or if you should continue any medications before atrial fibrillation ablation.
What You Can Expect
- Before
Atrial fibrillation ablation is done in the hospital is done in the hospital. A care provider will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax. The amount of sedation needed for the procedure depends on your specific arrhythmia and other he… - During
One of the following ablation techniques is used to create small scars in the heart and block the irregular heartbeats: 1. Heat (radiofrequency energy) 2. Extreme cold (cryoablation) You may feel some minor discomfort when the catheter is moved into your heart or when the dye is injected a…
Results
- Most people see improvements in their quality of life after cardiac ablation. But there's a chance that the irregular heartbeats may return. If this happens, the procedure may be repeated or your health care provider might recommend other treatments. The procedure hasn't been shown to reduce the risk of a stroke. Blood thinners may be needed to reduce stroke risk.
Clinical Trials
- Explore Mayo Clinic studiesof tests and procedures to help prevent, detect, treat or manage conditions.