Physicians Offer
Cure for Atrial Fibrillation
March / April 2003
Penn Cardiac Care electrophysiologists have found a new
technique, atrial fibrillation (A-Fib) ablation, to be effective
in curing A-Fib, a common heart rhythm disorder in which
disorganized electrical activity in the atria replaces the
normal organized electrical activity of the heart, sinus
rhythm. Patients with A-Fib often suffer a rapid heartbeat,
palpitations, weakness, shortness of breath and fatigue due
to the irregularity of the heart's rhythm and rapid heart
rates. The disease may begin with occasional bouts of an
irregular heartbeat, but over time, will often progress to
a persistent abnormality. One out of every five people develop
this arrhythmia in their lifetime, leaving them completely
disabled.
Until recently, ablation procedures for A-Fib were only
directed at keeping the heart rate under control by permanently
blocking the electrical road from the atria to the ventricles.
A pacemaker would then be used to provide regular electrical
activity to the ventricles. This technique did not cure the
arrhythmia nor eliminate the need for medications. "Now,
instead of placating the symptoms of atrial fibrillation,
A-Fib ablation provides a cure for patients who are refractory
to medications for A-Fib, allowing patients to resume their
lives without relying on mechanical devices such as a pacemaker
or medication, including anticoagulation therapy," says
Francis
E. Marchlinski, MD, director of Cardiac Electrophysiology
for Penn Cardiac Care at the University of Pennsylvania Health
System.
Through A-Fib ablation Penn electrophysiologists identify
the specific triggers or hot spots that disturb the normal
heart rate. These triggers are rapidly and effectively targeted
with the use of sophisticated electrical recording and ablation
equipment. "By eliminating these triggers early, we
can prevent the progression of A-Fib and preserve the heart's
natural ability to beat regularly," says Andrea
M. Russo, MD, director of the Electrophysiology Laboratory at Penn
Cardiac Care at Penn Presbyterian Medical Center.
In more than 90 percent of cases, these triggers originate
from fibers at the edges of the pulmonary veins. A-Fib ablation
eliminates the arrhythmia by isolating these fibers. A small
amount of energy is precisely delivered to the atrial muscle
surrounding the opening of the pulmonary veins. "Experience
and monitoring techniques have minimized the risks of this
procedure. By utilizing intracardiac echo during the ablation
procedure, we can now image the atria during the entire procedure
and have dramatically reduced the risk of significant vein
narrowing or pulmonary vein stenosis," explains Dr.
Marchlinski.
Traditionally, electrophysiologists attempt to control A-Fib
via antiarrhythmic drug therapy to maintain a normal sinus
rhythm. Unfortunately, 40 to 50 percent of patients will
continue to have episodes of arrhythmia while taking this
medication. The success of additional drug therapy in maintaining
normal rhythm is less than 20 to 30 percent after failure
with any one antiarrhythmic drug. Because of the low success
rate and side effects of antiarrhythmic drugs, some physicians
keep the heart rate controlled with safer medications that
act to slow the rate by blocking the A-Fib impulses from
reaching the ventricles.
In some patients these medications
may not be completely effective and may fail to control
the symptoms of A-Fib. In addition, chronic anticoagulation
therapy
with coumadin is still necessary in most patients. In comparison,
ablation cures more than 70 percent of patients with one
procedure and, if a second procedure is required, the percentage
increases to approximately 90 percent. The ability to eliminate
both symptoms and the need for chronic drug therapy may
be quite appealing to many patients. At Penn, A-Fib ablation is no longer considered an experimental
procedure and has been the standard of care since 1999. Since
then Penn electrophysiologists have pioneered various techniques
that have further improved the success and safety of the
procedure. Dr. Marchlinski and his colleagues have published
more than 30 articles on ablation tools and techniques, patient
follow-up, and the effect of ablation on heart muscle function. "Drug
therapies have been shown not to work and limit the patient's
quality of life. Ablation can cure patients with extremely
low risk and actually may improve heart muscle function," says
Dr. Marchlinski.
Patients are encouraged to initially try medication to control
atrial fibrillation, however, those with symptomatic, recurrent
A-Fib or one who has difficulty controlling heart rate through
medication may be candidates for A-Fib ablation.
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