Atrial Fibrillation

Condition

Atrial fibrillation (AF) is caused by abnormal electrical signals throughout the upper chambers of the heart, and is the most common type of arrhythmia in the United States. While many patients who have AF may not experience symptoms, the condition can lead to an increased risk of stroke or heart failure.

Treatment

The goals of treatment include preventing stroke, controlling heart rate, restoring a normal heart rhythm, as well as identifying and managing underlying causes. These treatable and reversible conditions include obesity, obstructive sleep apnea (OSA), hypertension, hypo- or hyperthyroidism, inflammatory and infectious diseases, as well as stress. Some patients require a procedural intervention to achieve control of their atrial fibrillation and its symptoms.

We perform extensive ablation of sites associated with triggers originating outside of the pulmonary veins such as the entire posterior wall, the roof, the anterior part of the left atrium, left atrial appendage (LAA), the coronary sinus, and the superior vena cava. Ablating these structures has shown to dramatically increase freedom from atrial fibrillation over the long term when combined with pulmonary vein isolation. The left atrial appendage deserves special attention when identifying and ablating patients with certain types of atrial fibrillation.

Our team of experts has made important contributions that have helped advance the field of catheter ablation. We recently published the results of the BELIEF Trial, which showed that after both a single and redo procedures in patients with persistent atrial fibrillation, empirical isolation of the left atrial appendage improved long-term freedom from atrial arrhythmias without increasing complications. As a result, we are among a select few centers in the world that are pioneers in this technique. 

Research

The BELIEF Trial

Heart Graphic 5

The BELIEF trial randomized patients with LSPAF to standard ablation plus non-PV triggers plus empirical LAAEI (left) versus standard ablation plus non-PV triggers ablation (right). (Top) Lesion set in anteroposterior view. (Bottom) Lesion set in posteroanterior. Adapted from J Am Coll Cardiol 2016;68:1929–40.

SVC: superior vena cava, IVC: inferior vena cava, CS: coronary sinus, LAA:  left atrial appendage 

 

The aMAZE Study 

Case Studies

Patient with paroxysmal atrial fibrillation

Heart Graphic 2

This patient underwent catheter ablation. All four pulmonary veins were successfully isolated.

 

Patient with persistent atrial fibrillation

Heart Graphic 3

This 74-year-old female underwent pulmonary vein isolation and left atrial appendage isolation with radiofrequency energy. Top: Electroanatomic (EAM) voltage map of the left atrium illustrating isolation of the left atrial appendage (LAA) (low voltage/red).