Endocardial radiofrequency ablation for treatment of atrial fibrillation (AF)

Advantages:

1.  Decreased risk of cerebro-vascular events.

2.  Improved cardiac function.

3.  No need for anti-coagulation therapy.

4.  Decreases the need for chronic medications.

What is endocardial radiofrequency ablation for treatment of atrial fibrillation?

This is an innovative operation for the treatment of atrial fibrillation (AF) combined with any other heart surgery, and has been performed over the last few years in the Department of Cardiothoracic Surgery at the Tel Aviv Sourasky Medical Center.

The operation is intended for patients who suffer from AF, either permanently or intermittently.  This irregular heart rhythm arises as a result of the electrical flow circuits inside the atria and causes in decreased cardiac output and over-production of blood clots in the heart, with all the accompanying complications.

This irregular heart rhythm is treated during the operation in order that it may be reversed to a regular heart rhythm.  This is performed with an innovative instrument that works on a radio frequency basis, during which the passage of the irregular electrical flow circuits on the atria's muscular wall and create new passages through which the electrical current can pass normally, so that the patient remains with a regular heart rhythm after the operation.

In addition, the left atrial appendage is sutured and closed during the operation.  The appendage is the location where blood clots may form that could cause cerebro-vascular events.  In this manner, the risk of such cerebro-vascular events in the future is reduced considerably.

If the patient undergoes mitral valve repair, the native repaired valve remains in place (the advantage of which is that the patient does not need anti-coagulation therapy, the complications involved in a prosthetic valve are avoided, and the long-term results are improved) and, together with a regular heart rhythm, the anti-coagulation therapy can be discontinued three months after the operation.  In addition, the patient can return to full and normal activity within a short space of time.

Patients undergoing other cardiac surgery procedures, such as aortic valve replacement or coronary artery bypass and also suffer from atrial fibrillation, can undergo treatment for AF without opening the heart (epicardial) with the assistance of new equipment. 

The procedure can also be performed without connection to cardio-pulmonary bypass if the patient undergoes such surgery.

Video clip:

Ablation for Atrial Fibrillation - 1:31 min.

Professional articles regarding Ablation for AF (refer PubMed):

1. Endocardial radiofrequency ablation during mitral valve surgery:  effect on cardiac rhythm, atrial size, and function.  Fayad G et al, Ann Thorac Surg 2005;79:1505-11.

Dept. of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center