Catheter ablation involves guiding a small tube through the veins and into the heart, where electrodes are used to eliminate the heart cells causing arrhythmia.

Atrial fibrillation describes an arrhythmia, or abnormal heart rhythm. In atrial fibrillation, the upper chambers of the heart (the atria) wiggle ineffectively without pumping properly, and with chaotic rather than orderly contraction.

Often, but not always, people with atrial fibrillation experience a rapid, irregular heartbeat that can be bothersome or even frightening, and also can sometimes cause low blood pressure, low heart output, and faintness or fatigue. Left unchecked, prolonged rapid heart beating can lead to formations of blood clots in the atria that can travel to the brain causing a stroke. A prolonged, uncontrolled heart rate can weaken the heart muscle, resulting in heart failure.

Dr. Peter Libby, Chief of the Division Cardiovascular Medicine, and Dr. Laurence M. Epstein, Chief of the Cardiac Arrhythmia Service at Brigham and Women’s Hospital (BWH) offer insight into management of atrial fibrillation.

“The management of atrial fibrillation is a large and controversial topic that requires individual consultation with an experienced cardiologist or arrhythmia specialist called an electrophysiologist,” explains Dr. Libby. “The first step is to seek and treat underlying triggers, including high levels of thyroid hormone, heart failure, heart valve disease, and alcohol or drug use.”

“Today, there are many options for the management of AF (atrial fibrillation) — including controlling the rate of the heartbeat and taking blood thinners, attempting to restore and maintain normal rhythm with electrical treatment and/or medication, and performing minimally invasive procedures to ‘ablate’ the source of the disordered heart rhythm,” he says.

The choice between these options, which each have their place in the therapy of this complex condition, depends on each particular medical situation and should involve the patient’s input. Not all options are appropriate for all individuals with AF. The doctor and patient should discuss the pros and cons of the various management options.

Dr. Epstein says, “Ablation is an option for individuals who tolerate atrial fibrillation poorly and who do not achieve adequate control with medication.”

The procedure involves passing wires into the heart through the veins in the legs and isolating the source of the abnormal rhythm. “In very experienced hands, it is a quite effective and fairly safe procedure, but it does not always provide permanent protection from recurrence of the arrhythmia, and it has some risks,” explains Dr. Epstein.

“Fortunately, many management options are available today, and new treatments and strategies on the horizon continue to improve our ability to deal with this condition and to reduce its complications,” ends Dr. Libby.

– JCL

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