Atrial fibrillation is the most common form of heart arrhythmia in the United States, affecting nearly three million Americans.
Atrial fibrillation (sometimes referred to as AFib or AF) occurs when the upper chambers of the heart (the atria) beat fast and irregularly. Atrial fibrillation isn’t typically life threatening, but it is associated with an increased risk of stroke or other complications. There are, however, a multitude of ways that AFib can be treated.
Medications (drugs) are the first line of treatment for atrial fibrillation, and Duke offers the latest drug options. Medications can be used alone or in combinations to reduce the risk of stroke, to help control the heart rate during AF, to restore a normal heart rhythm, and to reduce the amount of AF an individual experiences.
The most conservative treatment strategy is to give medications to slow the heart rate response to AF without necessarily preventing AF from occurring. However, rate control as a treatment strategy is often not good enough because many individuals continue to experience fatigue or are bothered by the irregular heart beat associated with AF even when the overall heart rate is maintained within a normal range. In these individuals, treatment to restore and maintain a normal heart rhythm is often preferred.
Medications to stabilize the heart rhythm, called “anti-arrhythmic” drugs, work to terminate or stop AF if it is occurring, and to make it less likely that AF will be initiated or sustained in the future. This treatment strategy is referred to as a rhythm-control strategy.
While anti-arrhythmic drugs are effective in about half of patients, there are potential side effects of these medications, and certain anti-arrhythmic drugs should not be used when individuals have other heart problems. Accordingly, it is not uncommon that these drugs don’t work or can’t be used due to side effects or co-existing medical problems.
Catheter ablation and surgical ablation procedures are options to treat AF when drugs don’t work or can’t be used. Experienced teams can offer these procedures to patients when needed.
Catheter ablation is a procedure during which catheters (long, flexible tubes) are passed to the heart through the blood vessels, and used to identify and cauterize regions of the heart that are responsible for producing or sustaining AF. The entire procedure is done though special IVs placed into the veins and arteries located in the groin area. Occasionally an IV is also placed in a large vein located in the neck. No surgical incisions are required.
Catheter ablation for AF is an evolving procedure that is now offered at only a limited number of centers in North Carolina. Duke providers have extensive experience performing this complex procedure and hundreds of patients have been successfully treated with catheter ablation for AF at Duke.
Advanced computer mapping systems are routinely used to pinpoint the source of the abnormal electrical signals and to direct catheters to the target sites. The latest technologies to perform catheter ablation are available at Duke, including:
- Robotic catheter navigation systems to guide precise movement of the catheter in the heart
- Cryothermy (freezing) ablation systems
- Irrigated radiofrequency (heating) catheter ablation systems
- Computerized catheter mapping systems to help determine exactly which sites in the heart should be targeted. These new systems also allow integration of heart imaging using intracardiac ultrasound, magnetic resonance imaging, and computed tomography to increase the accuracy of the ablation procedure.
Success controlling the symptoms of AF can be achieved in more than 90 percent of individuals, although some patients require continued use of medications to control AF after the ablation procedure.
Surgical ablation is done through incisions in the skin of the chest and is most often offered in conjunction with other heart surgeries such as coronary bypass surgery or surgery to repair leaky or narrowed heart valves.
Radio-frequency energy, microwave energy, or freezing (cryothermy) can be used to create lines of electrical block in regions of the left and right atria (upper heart chambers) to reduce or prevent the occurrence of atrial fibrillation.
With either catheter or surgical ablation for atrial fibrillation, successful control of AF can be achieved in many patients in whom AF produces significant symptoms or fast heart rates that can’t be adequately controlled with medications.
Current guidelines for treatment of AF suggest that catheter ablation is the preferred therapy when patients have significant symptoms due to atrial fibrillation, and anti-arrhythmic drug therapy doesn’t work well enough.
Patients with or without other heart problems including heart failure can be considered for this procedure. Surgical ablation is also a possibility, and is well suited to patients with symptomatic atrial fibrillation who need heart surgery for other reasons.
