Atrial Fibrillation Treatment

What is Atrial Fibrillation?
In atrial fibrillation (AF), the two upper chambers of the heart (atria) are out of sync and do not beat in coordination with the lower chambers. It is the most common heart arrhythmia - affecting more than three million Americans - and has a variety of causes. AF is known to occur more frequently in older patients and those with heart disease. However, it can happen to anyone at any time. It is now recognized as a cause of problems as seemingly insignificant as fatigue and dizziness or as serious as stroke and heart failure.

About Our Program
Because AF is a complex disease, the Interventional Atrial Fibrillation Program at Eisenhower Smilow Heart Center offers a multidisciplinary approach to the treatment of AF. Cardiologists, cardiac electrophysiologists (heart rhythm specialists), cardiac surgeons and other clinicians may be involved in the assessment of a patient, make treatment recommendations and perform diagnostic and/or treatment procedures.

In addition to its clinical excellence, our program utilizes state-of-the-art technology and equipment not available at most medical centers. Eisenhower has the only full-service Electrophysiology Laboratory in the Coachella Valley and the EnSite 3000® 3-D mapping system that allows the diagnosis and treatment of complex heart rhythm problems utilizing a minimally invasive approach. Each patient undergoes a thorough assessment by our dedicated AF physician team.

About Our Physicians
The Co-Directors of the Interventional Atrial Fibrillation Program are Board Certified Cardiologists/Electrophysiologists Leon Feldman, MD and Andrew Rubin, MD; and Board Certified Cardiothoracic Surgeon Joseph Wilson, MD.

How is Atrial Fibrillation Treated?
There are a number of medical and surgical treatment options for AF. Therapies may be used alone or in combination to ensure the best possible outcome for each patient.

Medical Therapy
Medications are the primary therapy used to control AF, but are not curative. They are used to slow an elevated heart rate and to prevent the devastating complications of stroke. Unfortunately, may drugs have undesirable side effects, require constant monitoring and/or become less effective over a period of time.

When drugs are not effective in treating AF, cardioversion may be an option. Electric cardioversion is performed with an external defibrillator that delivers a small electrical shock to the chest. The goal is to reset the heart's electrical activity and allow the return of normal rhythm. Cardioversion is usually successful in establishing a normal rhythm, but not always successful in maintaining it.

Curative Treatments
There are two main curative treatment options for patients with AF. The procedures are catheter ablation and thoracoscopic ablation.

Catheter Ablation
Catheter ablation involves inserting narrow wires through small incisions in the groin and into blood vessels leading to the heart. The catheter is guided by X-ray images on a fluoroscope. Within the heart, electrodes on the catheter tip allow detailed electrical measurements in order to locate the site of the arrhythmia. During this process, a detailed 3-dimensional computerized map is made to determine to precisely localize the problem area.

Once an abnormal electrical circuit is identified, a specialized catheter is threaded into the heart chamber to cauterize or ablate the affected area. Following the ablation, repeat mapping can be accomplished to help determine the success of the procedure. Most patients are discharged without restriction the following morning. This treatment is effective in selected patients at a rate of 70 to 80 percent.

Thoracoscopic Ablation
Minimally invasive surgical ablation is an advanced technique that allows surgeons to treat AF without major, open-heart surgery.

The surgeon gains access to the heart through three keyhole-sized incisions on each side of the chest. Using an endoscope - a tiny video camera - inserted through the small incisions, the surgeon is able to see the heart without having to open the chest cavity. The surgeon inserts a wet radiofrequency ablation instrument to create the ablation around the pulmonary veins. Then, the left atrial appendage is occluded. The subsequent formation of scar tissue provides a barrier to "short circuit" atrial fibrillation.

This procedure is proving to be fast, safe and effective in approximately 80 to 85 percent of cases and typically require a one to two night stay.

For patients who have AF and require bypass surgery or valve repair, and open Maze procedure may be performed simultaneously.

Referrals and Evaluation
The physicians at the Eisenhower Smilow Heart Interventional Atrial Fibrillation Program welcome the opportunity to consult with referring physicians and patients with AF to discuss treatment options and recommend the most appropriate treatment for each patient.

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