Innovative Ablation Techniques Lead the Charge in AFib Treatment

Atrial fibrillation (AFib) is the most common cardiac rhythm disorder worldwide. It is a rapid, quivering or irregular heartbeat that disrupts the normal flow of blood through the heart, leading to blood clots, stroke, or even heart failure. As the population ages, the number of people affected by this electrical epidemic is projected to increase significantly.

The statistics are staggering—people with AFib are five times more likely to have a stroke, and those who leave the condition untreated can double their heart attack risk. It can affect anyone; in my practice, I’ve treated everyone from active teenagers to seniors.

Here’s the good news about AFib: In the last decade, we’ve made major strides in understanding the mechanisms of AFib and applying advanced technology, some of which use robotic systems. For example, one of these advances allows me to treat complex heart conditions with a magnetically guided surgical robotic approach while sitting in a “control room.” Through various ablation techniques, I can use different types of energy sources to surgically destruct abnormal tissue in the heart that is triggering or sustaining an irregular heart rhythm.

These advanced and minimally invasive techniques allow patients with AFib to go on to lead active, healthy lives without enduring open-heart surgery or years of drug therapy. The success rate for catheter ablation of atrial fibrillation in select patients can approach as high as 75% for a first procedure and up to 90% with a second procedure.

 

AFib: A rising epidemic

AFib currently affects about 2.7 million people in the United States. According to the American Heart Association, the number of people with the condition is expected to rise to 12 million by 2050. The problem is that many people don’t even know they have it, while others who have been diagnosed, don’t understand the severity.

The heart is like an engine, with an electrical system, plumbing, valves, and pistons. When the heart develops an electrical problem like atrial fibrillation, some of the pistons “stop working”, so to speak. The top chambers of the heart, the atria, develop a quivering-like motion which is ineffective in moving blood around. As a result, symptoms of “impaired engine performance” can develop, including reduced exercise tolerance, shortness of breath, fatigue, lightheadedness, and chest discomfort. Furthermore, with the impaired contraction, blood tends to stagnate and cause the formation of a clot, which can travel to the brain and cause a stroke.

 

Ablation: A safe and minimally invasive option

For some, lifestyle changes, drug therapy, or simple procedures may be all it takes to help with this cardiac condition. But, for others, ablation techniques are necessary to stop this life-threatening condition.

For those of us who specialize in heart rhythm disorders, this is an exciting era of treatment. The various types of advanced technology used in atrial fibrillation ablation techniques are proving to be less invasive, extremely accurate, and highly effective in curing arrhythmia and allowing the heart to pump normally again.

Two primary ablation technologies are used in the treatment of AFib: radiofrequency (RF) energy and cryo-energy. Other energy sources, such as laser balloon and ultrasound, have been developed, but, so far, RF and cryo have proven to be the safest and most effective.

With cryoballoon, a steerable sheath and guide wire are moved through each of the pulmonary veins, and a cryoballoon is positioned at the vein opening. Liquid nitrogen is used to freeze the tissue, resulting in electrical isolation of the veins.

Another new procedure, called convergent ablation, is used for persistent and permanent atrial fibrillation patients. This is a hybrid procedure that involves both a cardiac surgeon and cardiac electrophysiologist. The surgeon creates a small incision in the patient’s abdomen instead of a large chest incision. The surgeon then uses radiofrequency ablation on the back wall of the left atrium from the outside of the heart. The electrophysiologist then threads a catheter through to the inside of the heart, and, using radiofrequency ablation, fills in any gaps from the inside of the heart to stop the irregular heartbeat.

 

Benefits of robotic-driven navigation systems

While ablation is not a new treatment option, the advanced mapping and magnetic system we’re using for our catheter ablation procedures is. Stereotaxis is a minimally invasive system that uses flexible catheters, 3D imaging, and remote magnetic technology to deliver an energy source, such as radiofrequency waves.

With this new system, a soft and flexible catheter is manually inserted into the patient’s heart through the femoral vein in the groin region. The patient lies next to a robotic tool and large magnets are then placed on each side of the patient’s chest. The doctor sits in a “control room” and uses a computer-mouse interface to change the position of the magnets, which then “pull” the catheter through the sensitive pathways of the heart. When the diseased part of the heart is found, heat (via radiofrequency energy) is applied to eliminate the small areas of heart muscles that are causing the irregular rhythm.

Unlike standard ablation with stiff catheters, this new technology not only results in more precise movement of the catheter, but it also reduces the risk of perforating the heart wall. In addition, computer imaging eliminates the need for x-rays, reducing radiation exposure often associated with high-tech surgical techniques.

 

Personalized treatment

Atrial fibrillation is a progressive disease, which is why cardiac electrophysiologists try to catch it as early as possible. Not all patients with AFib should be treated the same, and many require a multi-faceted approach including risk factor management, rhythm monitoring, drug therapy, and catheter ablation. In today’s world, there are many treatment options for a disease that was once considered incurable. The key, as always, is early recognition and intervention, and a comprehensive management and treatment program with a trusted, specialized physician.

Aseem D. Desai, MD, FACC, FHRS
Aseem Desai, MD, FACC, FHRS, is a highly-trained cardiac electrophysiologist and Co-Director of the Heart Rhythm Center at Mission Hospital in Mission Viejo, California. Mission Hospital’s Stereotaxis laboratory is the only one of its kind in Orange County, and Mission Hospital is one of only 500 hospitals in the world to offer this advanced technology. Dr. Desai graduated from Northwestern University’s Honors Program in Medical Education and did his residency, chief residency, and cardiology and electrophysiology fellowships at Stanford University Medical Center. He is a Fellow and Member of the Heart Rhythm Society. Prior to joining Mission Hospital, Dr. Desai served as an Assistant Professor of Medicine and Director of Implantable Device Therapy at the University of Chicago Hospitals. Dr. Desai’s areas of interest include atrial fibrillation, ventricular tachycardia, robotic catheter ablation, and cardiac resynchronization. Dr. Desai is involved in clinical research and has several academic publications. He has lectured regionally and nationally to patients and physicians. Dr. Desai provides personalized care based on the statement: “Doctor, if I were a family member of yours, what would you recommend?”

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