Some patients with atrial fibrillation cannot be managed with medications for a variety of reasons. Some experience side effects or do not respond to treatment. Others simply do not want to take medications and seek an alternative treatment strategy. Interventional treatments such as cardiac catheter ablation, either radiofrequency/RF catheter ablation or cryoablation and surgical ablation, utilizing the Cox maze and mini-maze procedures are other possible options after pharmacological therapy has failed.
Cardiac Catheter Ablation
A cardiac or heart catheter ablation is a less invasive, non-surgical procedure, which typically involves introducing a catheter into the heart through a vessel in the groin area. The procedure uses radiofrequency energy to destroy a small area of the heart tissue. During a cardiac ablation procedure, the physician ablates the areas of the heart that are responsible for the abnormal electrical activity or arrhythmias such as Afib, atrial flutter, or atrial tachycardia.
A common one-size-fits-all technique is to ablate the tissue surrounding the pulmonary veins called pulmonary vein isolation, or PVI. PVI uses a radiofrequency (RF) catheter or by freezing the tissue, sometimes referred to as cryoablation and uses a technology called a cryoballoon.
The minimally invasive, maze or mini-maze procedure involves inserting a catheter through small incisions in the chest, with a video camera inserted through another incision. The surgeon then creates lesions around the atrium (a process called ablation), and because it does not conduct electrical activity, the scar tissue that forms after the ablation is meant to isolate the abnormal electrical impulses from the rest of the heart. Surgical ablation is often performed in conjunction with other cardiac surgery procedures, such as coronary artery bypass and mitral valve repair.
Pacemakers are small electrical devices that are implanted under the skin near the collarbone. They are wired to the heart to regulate a patient’s heartbeat by firing electrical impulses to help it return to a normal rhythm.