ATRIAL FIBRILLATION

Nobody wants to have atrial fibrillation. Unfortunately, it is the most common arrhythmia in the world. Whether it causes you debilitating symptoms or just an occasional fluttering in the chest, physicians have long known that atrial fibrillation is associated with an increased risk of stroke, heart failure, and death. Fortunately, the last decade has witnessed a revolution in the treatment of atrial fibrillation. Advances continue to be made at a startling pace.

Keeping pace with the changing and varied options for managing atrial fibrillation is challenging. Though many primary care physicians and cardiologists are familiar with the traditional management of atrial fibrillation, cardiac electrophysiologists (cardiologists who have had additional, specialized training in the management of arrhythmias) focus on treatments which are on the cutting edge of controlling the symptoms and consequences of atrial fibrillation. We believe strongly that every patient with atrial fibrillation should be seen at least once by a cardiac electrophysiologist.

The Atrial Fibrillation Clinic at the Arrhythmia Center is uniquely committed to the care of patients with atrial fibrillation. We work with you to review your entire medical history. We discuss carefully with you both the ways in which a combination of lifestyle modification, medications, and minimally invasive procedures such as catheter ablation can keep you safe and well in the years to ahead. Come talk to us.

What is catheter ablation?

For many years, the only treatment available to patients with atrial fibrillation were medications to minimize the symptoms of palpitations and blood thinners to help decrease the rates of stroke. Occasionally these medications were well tolerated and effective, but often they failed to adequately control the symptoms. Not infrequently, they caused serious side effects.

Fortunately, over the past decade, research by electrophysiologists has identified the triggers of atrial fibrillation in the vast majority of patients. This research has found that in most patients with atrial fibrillation, the pulmonary veins, which are blood vessels that drain oxygenated blood from the lungs to heart, start to develop abnormal electrical activity. This abnormal activity can travel from the veins into the heart, setting off a chain reaction that results in atrial fibrillation.

Electrophysiologists have developed a non-surgical procedure called atrial fibrillation ablation to prevent the abnormal signal from the pulmonary veins from invading in the heart, preventing the initiation of atrial fibrillation. In this procedure, burning or freezing energy is used to create an electrical roadblock at the point where the veins connect to the heart. We can preserve the ability of the veins to deliver blood while preventing those same veins from triggering atrial fibrillation.

The efficacy of catheter ablation and safety of the procedure have led the American Heart Association, the American College of Cardiology, the European Society of Cardiology, the Asia-Pacific Heart Rhythm Society, the Society of Thoracic Surgeons, and the Heart Rhythm Society all to endorse ablative therapy for the treatment of symptomatic atrial fibrillation.

I don't want to have atrial fibrillation anymore. Am I a good candidate for atrial fibrillation ablation?
The best candidates for ablation are patients who are less than 80 years of age, who experience symptoms from their atrial fibrillation, and who do not have severe problems with their heart valves.

How successful is the ablative procedure?
It depends a great deal on the patient. For candidates who have atrial fibrillation only intermittently and have a normal heart, the ablation eliminates symptomatic atrial fibrillation about 75% of the time. For patients who have been in constant atrial fibrillation for years on end or who have significant structural problems with their hearts, the success rate is less than 50%.

Do you use burning or freezing energy for the procedure?
It depends. We have extensive experience in both radiofrequency (burning) as well as cryo (freezing ablation). In recent years, we have moved to performing the majority of our procedures using cryo energy, as we believe it results in a safer, quicker, and more efficacious procedure. That said, some patients are better served by radiofrequency ablation or by a combination of radiofrequency and cryoablation.

Why should I have the electrophysiologists from Island Cardiac perform the procedure?
Practice makes perfect. When it comes to atrial fibrillation, it is clear that experienced operators have higher rates of success and far fewer adverse events. The electrophysiologists at Island Cardiac are among the most experienced physicians in the Tri-State area.

At Island Cardiac, our electrophysiologist have pioneered many of the newest treatments for atrial fibrillation. We were the first in Long Island to perform the cryoballoon procedure for atrial fibrillation and to date, we have performed more cryoballoon procedures than any other center in New York State. We have also performed the first nContact convergent ablation procedure on Long Island. This combined endovascular and epicardinal approach is designed specifically for patients who are not traditional candidates for ablation.

I've already tried the ablation and it didn't work for me. Is there value in coming to the Arrhythmia Center?
Though the general techniques involved in atrial fibrillation ablation are similar from physician to physician,there are important differences. We have access to specific technologies which are particularly useful in patients with atrial fibrillation which has been refractory to previous ablation. We have successfully treated patients who have had previously unsuccessful ablations.

Am I awake for the procedure? How long does it take?
We perform every case with a board certified anesthesiologist familiar with the particulars of atrial fibrillation ablation. You will not feel or remember the ablation. Ablation times vary from patient to patient but generally are less than two and a half hours.

How long am I in the hospital after an ablation?
Patients who have an ablation for atrial fibrillation stay overnight and go home the following day.

Do I need to be on blood thinners for my atrial fibrillation? If so, which ones?
The decision about which patients require blood thinners and which specific medicines are best suited to a patient needs to be individualized. Talking with you and examining the details of your medical history, we will help choose the best medications for you. Not everyone with atrial fibrillation needs to be on blood thinners.

I have had bleeding problems with blood thinners but I am worried about strokes? Do I have any options?
Some patients are at high risk for a stroke or have already had a stroke, but cannot tolerate blood thinning medications because of problems with bleeding. Some of these patients may be candidates for a minimally which may significantly decrease the risk of stroke from atrial fibrillation.