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

CREATION OF LEFT ATRIAL GEOMETRY
video

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

TREATMENT SPECIFIC TO PERSISTENT AF

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