Current AF Treatment Options
There are a number of treatments available depending on the patient’s AF, all with varying success rates.
Cardioversion
Cardioversion (electric shock treatment) is combined with antiarrhythmic drugs. This treatment sees a failure in >60% of patients within 1 year. There are also some possible side effects from the drugs including irreversible liver or lung fibrosis, thyroid problems, 1:1000 risk of sudden death because the drugs may cause additional heart rhythm problems.
Surgical Ablation
This includes an open chest called Thorascopic surgery. The failure rates are at approximately 50%. This is a traumatic procedure and invasive procedure requiring an extended hospital stay.
Catheter Ablation
Minimally invasive catheter ablation is a complex procedure which requires a highly specialised team. The procedure typically takes 3 to 4 hours. Complications can be found in 1-5% of patients-most self limiting or treatable. This procedure requires a short hospital stay (typically 1 night).
Catheter Ablation Principles
Delivery of Radiofrequency (RF) energy to tissue renders it electrically inert
Closely spaced RF lesions create continuous lines and barriers to electrical activation
3D navigation systems allows creation of a cardiac geometry and visualisation of catheters within that geometry
Force sensing allows predictable lesions
Catheter Ablation of AF
Isolation of the pulmonary veins (PVs) performed by either freezing or burning at the PV exit, to create a ring of electrically dead tissue that disrupts the conductive pathway. This prevents the electrical activity from entering the LA and triggering AF.
The video to the left shows the sites of RF burns placed around the LA (blue dots) which eventually join up to form a continuous line of conduction block.
It is likely that more ablation is needed and to date this has resulted in extensive ablation performed all over the LA
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