Ablation Therapy and Surgery
Catheter Ablative Therapy
for Atrial Fibrillation
The
Electrophysiology Program at Penn Medicine, led
by Frank
Marchlinski, MD, is among the most active
centers in the world—a fact attributable to
the program's unique
combination of interventional care and research for A-Fib and tachycardia.
"Catheter
ablative therapy at Penn permits
patients to have long-term elimination
of atril fibrillation (A-Fib) and
its associated severe symptoms. Because
the majority of patients no longer
need antiarrhythmic drug therapy,
their quality of life is dramatically
improved."
– Francis
E. Marchlinski, MD*
Director, Cardiac Electrophysiology
Program
*Recognized in 2007
by Best Doctors
in America
and America's
Top Doctors |
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Currently,
the program is advancing arrhythmia management
by developing new catheter-based curative ablation
techniques (pulmonary vein isolation, or PVI)
and technology-driven strategies to eliminate
ventricular tachycardia and A-Fib. PVI catheter
ablation has been found to cure up to 85 percent
of patients with paroxysmal atrial fibrillation
who are refractory to medications. The Penn EP
team has demonstrated that catheter ablation
can eliminate paroxysmal AF in over 90 percent
of patients. The catheter based technique is
minimally invasive and has been the standard
treatment for several thousand patients at Penn
since the 1990's.
Penn electrophysiogists have
more recently demonstrated efficacy of catheter
ablation for A-Fib in the very elderly patient
population, those with depressed cardiac function
and those with more persistent forms of A-Fib.
The electrophysiologists are collaborating with
the cardiovascular surgical team to evaluate
new tools and modifications of intraoperative
maze techniques in those patients requiring concomitant
open heart surgeries. The routine use of sophisticated
imaging tools, ablation of complicated arrhythmia
substrates and ground-breaking percutaneous epicardial
mapping and ablation has established the Electrophysiology
Program at Penn as an international patient referral
and training center.
Antiarrhythmic Surgery
The maze procedure remains the predominant surgical approach to A-Fib, and is commonly
done in conjunction with other open chest surgeries, including mitral valve repair/replacement
and CABG.** Penn cardiovascular surgeons have expanded the parameters of the surgery
in recent years by performing minimally invasive maze procedures to treat A-Fib in patients
undergoing aortic valve replacement surgery. The number of patients undergoing surgical
correction of A-Fib has increased significantly over the last five years. In 2007, more than
95 patients underwent maze procedures at Penn.
2007 National
Institutes of Health /
National Heart, Lung
and Blood Institute
Grant**
Penn is one of seven U.S. centers awarded
this highly competitive National Institutes
of Health/National Heart, Lung and
Blood Institute (NIH/NHLBI) funded UO1
Cardiothoracic Surgery Network grants.
One of the three NIH/NHLBI-sponsored
trials ongoing at Penn will be initiated
for patients undergoing mitral valve
surgery who have coexistent atrial
fibrillation. Patients will be randomized to
no adjunctive therapy, concomitant left
atrial radiofrequency maze procedure,
or concomitant bi-atrial radiofrequency
maze procedure.
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