Atrial fibrillation (AF) is the most common arrhythmia in medical practice — and among the most difficult to effectively treat with medication. Affecting over 2 million people, AF has long been associated with increased long-term cardiovascular risk. However, more recent attention has focused on quality-of-life issues. Many AF patients report a substantial impairment in quality-of-life, an impairment that is reversed when normal sinus rhythm can be restored and maintained.Though anti-arrhythmic drugs are utilized as first-line therapy for most patients with AF, pharmacotherapy is plagued by an AF recurrence rate of up to 40-60 percent in the first year, as well as side effects.
Increased cardiovascular risks, decreased quality of life, and inconsistent effectiveness with medical therapy has led to an increased use of catheter ablation in the treatment of AF. And, electrophysiologists at the Cooper Heart Institute are clearly at the forefront of this treatment evolution in the Delaware Valley.
“The patient population eligible for catheter ablation has increased in the past several years,” says Andrea Russo, MD, Director of Electrophysiology and Arrhythmia Services for the Cooper Heart Institute. “As refinements have occurred in techniques and technology, the patient population who could benefit from catheter ablation has increased.”
Candidates for AF ablation include:
- Symptomatic atrial fibrillation
- Failure to maintain sinus rhythm after trial of at least one antiarrhythmic drug
- Paroxysmal or persistent atrial fibrillation
AF ablation is contraindicated in patients with left atrial thrombus or those who are unable to receive anticoagulation. Patients with very severe left atrial enlargement, or very long-standing persistent AF, have lower success rates.
Catheter-based radiofrequency ablation is performed using electroanatomic mapping technology and is well-tolerated by patients. Refinements in technology have led to improved patient experience and outcomes.
“Advances in mapping technology have revolutionized ablation therapy,” says Dr. Russo. “Conventional mapping was a more time-consuming process that limited the clinician’s flexibility to rapidly identify multiple tachycardia foci. In addition to enhancing efficiency, the new mapping technology may also reduce fluoroscopy time, potentially enhancing patient safety.”
Electroanatomic or CARTO mapping technology is derived from the principle that metal coils in the ablation catheter tip will produce an electronic current when positioned in a magnetic field. Cooper now utilizes state-of-the art, 3-D technology via the CARTO® 3 and CARTOMerge Image Integration System. These systems provide advanced catheter location, Fast Anatomical Mapping (FAM), and software that merges CT/ MRI images with mapping to allow rapid, precise navigation.
Mapping provides color-coded, real-time images, which can be rotated in any direction for comparison and study of specific areas, as well as identifying potential ablation targets.
Long-term success rates for elimination of symptomatic atrial fibrillation are in range of 50-80%, varying due to factors, such as type of AF and left atrial size. In many cases, the success rate of catheter ablation may be better than additional antiarrhythmic drugs in maintaining sinus rhythm.
“Our experience at Cooper, and that acquired at centers throughout the country supports the fact that catheter ablation is related to a reduction in severity and frequency of symptoms,” says Dr. Russo. “And, most importantly, AF ablation can offer patients a curative option that may significantly improve quality of life.”
For more information on atrial fibrillation ablation or to refer a patient to the arrhythmia service, please call 856.968.7093