(AF or AFib) is the most common irregular heart rhythm in the United States. It is an abnormal heart rhythm originating in the atria (top chambers of the heart). Instead of the impulse traveling in an orderly fashion through the heart, many impulses begin simultaneously and spread through the atria, causing a rapid and disorganized heartbeat.
The goals of treatment for atrial fibrillation include regaining a normal heart rhythm (sinus rhythm), controlling the heart rate, preventing blood clots and reducing the risk of stroke.
Many options are available to treat atrial fibrillation. These include medications, lifestyle changes, procedures and surgery. The choice of treatment for you is based on your heart rhythm and symptoms.
When medications do not effectively correct or control AF or when medications are not tolerated, a procedure may be necessary. Cleveland Clinic offers a non-surgical option (pulmonary vein antrum isolation) as well as several surgical treatments for atrial fibrillation (Maze procedure and surgical pulmonary vein isolation).
This procedure is performed in the electrophysiology lab by a specially trained cardiologist. During the procedure, catheters are passed through the femoral veins (in the groin) and into the heart. Two catheters are inserted into the right atrium and two into the left atrium. The left atrium is accessed through a trans-septal puncture, and intracardiac echocardiography is used to visualize the atrium during the procedure. One catheter in the left atrium is used to map or locate the abnormal impulses coming from the pulmonary veins. The other catheter is used to deliver radiofrequency energy to ablate, or create lesions, outside the pulmonary veins. The procedure is repeated for all four pulmonary veins. The lesions heal and form a circular scar around the pulmonary veins within four to eight weeks. The scar tissue blocks any impulses firing from within the pulmonary veins, thereby "disconnecting" the pathway of the abnormal rhythm and curing atrial fibrillation.
Surgical Treatment for Atrial Fibrillation
Includes the Maze procedure and surgical pulmonary vein isolation. The Maze procedure involves making a series of precise incisions in the right and left atria to confine the electrical impulses to defined pathways. Surgical pulmonary vein isolation is a modification of the Maze procedure in which the surgeon uses alternative energy sources such as radiofrequency waves, cryothermy, microwave or laser to create lesions that interrupt the random electrical pathways. By blocking the abnormal electrical impulses from being conducted through the heart, this promotes normal conduction of impulses through the proper pathway. Surgical treatment for atrial fibrillation can be performed during other types of heart surgery, such as valve or bypass surgery.
At Cleveland Clinic, surgery for treatment of atrial fibrillation often can be performed with minimally invasive (endoscopic or "keyhole") surgical techniques.
3D Image of Postoperative CT—Left Atrial
Robotically-Assisted Catheter Ablation
During the robotically-assisted catheter ablation procedure, the surgeon’s hands control the movement and placement of the endoscopic instruments to open the pericardium (thin sac that surrounds the heart). The instruments are used to precisely place the catheter for ablation, in which energy is applied to correct the abnormal heart rhythm. Catheter ablation is used to treat certain forms of atrial fibrillation (an irregular heart rhythm arising from the upper chambers of the heart).
The Gillinov-Cosgrove Clip*
Left Atrial Appendage
The left atrial appendage is a small, ear-shaped tissue flap located in the left atrium. This tissue is a potential source of blood clots in patients with atrial fibrillation. Physicians and researchers at Cleveland Clinic have developed a ligation device for isolating and removing the left atrial appendage during heart surgery. Following its removal, the tissue is closed with a special stapling device. Clinical trials of this device began in mid-2006. Note that Cleveland Clinic has the potential to receive a royalty payment as a result of sale of the clip.
Watchman® Left Atrial Appendage
Filter System Note: Device
not yet FDA-approved for
use in the United States.
The Watchman® Left Atrial Appendage Filter System is under study as an alternative solution to removing the left atrial appendage. It consists of a rounded, self-expanding device that isolates the left atrial appendage and prevents clots from dislodging. It can be implanted through a catheter into the ostium of the left atrial appendage in combination with other interventional procedures such as pulmonary vein antrum isolation. Studies are under way to test the safety and effectiveness of this device.
*Disclosure: Note that Cleveland Clinic has the potential to receive a royalty payment as a result of sale of the clip.
Images used with permission by © Intuitive Surgical, Inc.