Atrial fibrillation treatment
What is Atrial fibrillation (AF)?
Atrial fibrillation is a disturbance in heart rhythm caused by abnormal electrical circuits. These stimuli created in the atrium of the heart pass to the chambers, causing irregular heartbeat. AF patients have a high rate of mortality due to embolisms (clots) that block arteries and cause strokes.
The following therapeutic strategies for AF management are offered by the Medical Center’s multi-disciplinary team specialists:
- Heart rate control: Using medications to slow the heart rate during AF
- Rhythm control: Electrical cardioversion to terminate AF and restore normal sinus rhythm
- Prevention of cardioembolism: AF promotes clot formation within the left atrium. This predisposes patients to clot dislodgement and remote arterial blockage by the clot (a condition termed cardioembolism), which can cause severe complications. This is a major cause of debilitating and even fatal strokes. Several therapies are available to prevent this serious outcome
- Warfarin (as also known as Coumadin) and the newer novel oral anticoagulants (such as Pradax, Xarelto and Eliquis): This class of medications is the most effective pharmacological means of preventing clots, though use of these drugs requires careful consideration, and, in the case of Coumadin, frequent blood testing, to avoid excessive bleeding risk.
- Left atrial appendage occlusion: The left atrial appendage is the most common site of clot formation within the left atrium due to AF. Occlusion of the left atrial appendage by catheterization techniques prevents clotting within this structure and obviates the need for anti-clotting medications
- Rate control through medication: Medications are used to achieve a resting heart rate that is not too fast (usually around 80 beats per minute) and a heart rate of about 110–120 beats per minute during exercise. This is important to alleviate palpitations and to avoid damage to heart function due to long-standing very rapid heart rates.
- Pacemaker and RFA: This approach uses a radiofrequency ablation (RFA) procedure to interrupt the conduction of rapid AF from the atria to the ventricles by disrupting a specific component of the heart's conduction system. It requires the implantation of a permanent pacemaker to ensure that the heart rate is not dangerously slow after the ablation.
- Medical rhythm control or electrical cardioversion: This non-invasive method uses drugs or electrical cardioversion (an electric shock), to reset heart rhythm to normal. Medications to preserve normal rhythm are often required on an ongoing basis following this procedure.
- Cox maze procedure: This procedure for treating AF is a complex surgical procedure in which incisions are created in the atria to induce scars that prevent conduction the AF electrical circuits.
- Less complex ablation methods: Radiofrequency, laser ultrasound, microwave and cryo (freezing) methods are used to achieve scarring that blocks abnormal AF electrical circuits within the heart. At the Tel Aviv Sourasky Medical Center, this type of ablation is performed using either cauterization techniques or minimally invasive surgical techniques termed thoracoscopy.