Monday, January 13, 2014

Afib Ablation

Atrial fibrillation is the most common sustained cardiac arrhythmia. The number of patients with afib continues to grow and many treatment options are available. Patients with afib can be extremely symptomatic or have no symptoms at all. Some patients have few spells a year, while others have many spells a week or are even in afib all the time. These are the factors that will determine what option is the best one for you.

We now know that in the majority of patients afib is triggered by abnormal impulses originating in the pulmonary veins. These impulses will go into the left atrium and trigger the arrhythmia.

Atrial fibrillation is often caused by abnormal electrical activity coming from the pulmonary veins. Afib ablation is a procedure used to block these impulses by ablating either with heat or cold energy. After ablation the abnormal electrical impulses can’t go into the heart and cause afib.
Atrial fibrillation is often caused by abnormal electrical activity coming from the pulmonary veins. Afib ablation is a procedure used to block these impulses by ablating either with heat or cold energy. After ablation the abnormal electrical impulses can’t go into the heart and cause afib.



















Patients that are symptomatic with afib can be treated with medications. If drugs fail there are other options, such as atrial fibrillation ablation.


Afib ablation 

Atrial fibrillation ablation is a procedure aimed at eliminating afib triggers. This is accomplished by ablating at the ostium (or the mouth) of the pulmonary veins. The goal is to electrically isolate the veins – while there is still blood flow,  the abnormal electrical signals in the veins can’t go to the heart anymore. In order to achieve that we can either use radiofrequency energy or cold delivered via a balloon (cryoballoon ablation).



RF ablation of the pulmonary veins for afib

Radiofrequency Ablation of the pulmonary veins:


Ablation catheter is positioned at pulmonary vein and ablation is performed by heating the tissue. Ablation is guided by a circular catheter called Lasso








Cryoballoon afib ablation performed by positioning balloon at the pulmonary vein ostium




Cryoballoon ablation of the pulmonary vein:


Cryoballoon positioned at the pulmonary vein and ablation is performed by getting the tissue around the vein down to very cold temperatures.




Afib ablation is the best option for patients that have failed or have not tolerated medications.  Ablation is the only treatment option that could cure afib.


Afib ablation and X-ray Exposure

Afib ablation is typically performed using fluoroscopy (X-ray image) and a 3D mapping system. High exposure to X-ray can be detrimental, and it may even cause cancer or blood disorders. At St Vincent's Hospital we perform afib ablations using minimal or even no fluoroscopy at all. Most procedures at our center use about 30-40 seconds of fluoroscopy, while in most centers in the country over 30 minutes are used for each case.

We have experience in performing procedures using minimal or no fluoroscopy, and over 300 procedures have been performed using this novel technique.



Atrial fibrillation ablation is a great option for patients whose quality of life was affected by afib. 


Jose Osorio, MD
Cardiac Electrophysiologist
St Vincent's Hospital
Birmingham, AL



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