Non-Surgical AFib Treatment Options
The electrophysiologists at the atrial fibrillation program within Tampa General Hospital’s Heart and Vascular Institute diagnose and treat a high volume of heart arrhythmias, including atrial fibrillation (AFib).
Medications are frequently used to treat AFib and can include:
- Anticoagulants for stroke prevention
- Medications for heart-rate control during atrial fibrillation
- Antiarrhythmic medications for prevention of atrial fibrillation
In addition, we put major emphasis on treating conditions that are strongly associated with atrial fibrillation—such as hypertension, obesity and sleep apnea—and can have a significant impact on treatment success.
Thanks to technological advances in minimally invasive approaches to AFib treatment, we are also able to treat many patients with non-surgical atrial fibrillation procedures if lifestyle changes and medications are not sufficient.
Electrical cardioversion “resets” the heart to a normal heart rhythm to allow medications to successfully maintain the normal rhythm. Cardioversion frequently restores the normal heart rhythm, but its effect may not be permanent. During the procedure, short-acting anesthesia is given that puts the patient to sleep and an electrical shock is delivered through patches placed on the chest wall. This shock will synchronize the heartbeat and restore normal rhythm.
Ablation is one of the common, minimally invasive types of electrophysiology procedures. During ablation, an electrical frequency is delivered through flexible catheters inserted into the heart via a vein in the leg to eliminate tissue that either triggers or perpetuates atrial fibrillation. This procedure can eliminate or significantly reduce the severity and frequency of atrial fibrillation episodes in the majority of patients.
Ablation strategies used at TGH are highly individualized and tailored to each patient’s needs and include:
Pulmonary Vein Ablation
Because AFib usually begins in the pulmonary veins or at their attachment to the left atrium, energy is applied around the connections of the pulmonary veins to the left atrium during the pulmonary vein ablation procedure (also called pulmonary vein antrum isolation or PVAI). During the procedure, a physician inserts catheters (long, flexible tubes) into the blood vessels of the leg and sometimes the neck, and guides the catheters into the atrium. Energy is delivered through the tip of the catheter to the tissue targeted for ablation. Frequently, other areas involved in triggering or maintaining AFib are also targeted. Small circular scars eventually form and prevent the abnormal signals that cause AFib from reaching the rest of the atrium. However, the scars created during this procedure may take from two to three months to form. Once the scars form, they block any impulses firing from within the pulmonary veins, thereby electrically “disconnecting” them or “isolating” them from the heart. This allows a normal heart rhythm to be restored.
Because it takes several weeks for the lesions to heal and form scars after a pulmonary vein ablation, it is common to experience AFib early during the recovery period. Rarely, AFib may be worse for a few weeks after the procedure and may be related to inflammation where the lesions were created. In most patients, these episodes subside within one to three months.
New Ablation with Advanced MRI Mapping
Traditionally, a catheter is used to identify the areas of the atria to target for ablation. Tampa General Hospital is the only hospital in the Tampa Bay area offering a new advanced mapping technique done on the MRI, to provide better diagnostic information to develop a personalized treatment plan of areas to target and improves the success rate of ablation. Click here to read more about ablation with advanced MRI mapping.
Atrial Flutter Ablation
Atrial flutter ablation is a minimally invasive procedure where the physician targets the area in which the circuit for atrial flutter is located. By inactivating this tissue, the atrial flutter can be eliminated.
Ablation of the AV Node
AV node ablation is reserved for patients who have therapy refractory atrial fibrillation and/or atrial flutter not amenable to conventional ablation. During this procedure, catheters are inserted through the veins (usually in the groin) and guided to the heart. Radiofrequency energy is delivered through the catheters to sever or injure the AV node. This prevents the electrical signals of the atrium from reaching the ventricle.
This result is permanent, and therefore, the patient needs a permanent pacemaker to maintain an adequate heart rate. Although this procedure can reduce AFib symptoms, it does not cure the condition. Because the patient will continue to have AFib, an anticoagulant medication is prescribed to reduce the risk of stroke. It is important to note that due to better treatment alternatives, ablation of the AV node is rarely used to treat AFib.
Other Ablative Approaches to Treat Atrial Fibrillation
Other approaches to ablation procedures we employ include:
- Posterior wall isolation achieved either by heat (radiofrequency energy) or freezing (cryoballoon ablation)
- Scar modification geared toward closure of discrete conduction channels within scar tissue by heat (radiofrequency energy)
- Ablation of associated focal arrhythmias or atrial flutters by point or linear ablation by heat (radiofrequency energy)
- Hybrid ablation procedures using both cryo- and radiofrequency energy
Leading Atrial Fibrillation Treatments & Procedures
Our program is nationally recognized for the treatment of AFib and other cardiac arrhythmias, giving our patients access to the most advanced treatments. Patient education is a cornerstone of our care model, and we’ll make sure you understand your condition and treatment options. At TGH, you’ll have the information you need to make educated decisions about your immediate and long-term care.
Contact TGH to learn more about our atrial fibrillation program or use our Find a Doctor database to find an electrophysiologist. TGH has been named one of America's Best Hospitals for Cardiology & Heart Surgery and Best Florida Hospital for Cardiology & Heart Surgery by U.S. News & World Report for 2020-2021.