Warfarin Institute of America
DEDICATED TO YOUR HEALTH SINCE 2000
Radio Frequency Ablation for the Treatment of Atrial Fibrillation (A-FIB)
By: Rhiannon Trepanier and Rich Blaskovich, PharmD. Candidates
University of Colorado School of Pharmacy
WHAT IS A-FIB?
A-Fib is classified as an irregular heart beat in the upper chambers of the heart (atria).
The electrical impulses which control the heart rate become irregular.1 This causes these upper chambers of the heart to beat rapidly (up to 400-600 beats per minute) resembling a quiver rather than an actual beat. This quivering can cause blood in the atria to pool and not circulate correctly. This pooling may form clots which can become dislodged and flow to the brain to cause a stroke.1, 2
A-Fib affects nearly 0.5% of the entire adult population and the incidence increases markedly with age.1 Approximately 4% of the population over the age of 60 has suffered at least one episode of A-Fib and this condition affects 10% of all people over the age of 80.2, 3 A-Fib may be caused by damage to the heart caused by rheumatic fever, high blood pressure or other forms of heart disease.2 In many cases, the actual cause of A-Fib is never determined. Common symptoms of A-Fib include palpitations or a sudden fluttering feeling in the chest, dizziness, shortness of breath, and feeling faint. Some patients experience no symptoms at all while others claim they feel as though their heart is going to “jump out of their chest”.4
INITIAL THERAPY
The goals of therapy are to 1) control the heart rate, 2) control the rhythm, and 3) decrease the risk of having a stroke.3
Heart rate control can be achieved through cardioversion (an electric shock to the heart) or medications such as digoxin, calcium channel blockers (diltiazem or verapamil), or beta blockers (metoprolol, atenolol, etc.). Calcium channel blockers and beta blockers are often much better than digoxin at controlling rapid heart rates.2, 4, 5
Rhythm control can also be achieved through medications such as flecanide, amiodarone, and sotalol.2, 5
Anticoagulation therapy is used to reduce the risk of stroke. Patients with A-Fib have a 4-7% chance each year of having a stroke. Warfarin drug therapy with a goal INR of 2-3 has been shown to decrease this risk by up to 85%.2, 3
LONG TERM CARE
It is possible to manage A-Fib without drug therapy, but not all patients are candidates. One method is called Radiofrequency Ablation. If this procedure is successful, it can help return the heart to a regular rate and rhythm allowing the patient to discontinue medication therapy.
WHAT IS RADIOFREQUENCY ABLATION THERAPY?
Radiofrequency ablation works by scaring or destroying the areas of the heart causing the irregular impulses. The scarred tissue blocks the irregular impulses hopefully preventing A-Fib from happening. In some cases, patients may also need to have a pacemaker.6 The abnormal or irregular impulses can come from two different areas of the heart: the pulmonary vein (blood vessel that brings blood from the lungs to the heart) or the upper chamber of the heart (atrium).5, 6
A catheter is used to perform the ablation. The radiofrequency catheter is inserted through the groin area into a vein and threaded into the heart.5, 6 All patients are given a medication to help them relax while a local anesthetic is used to numb the area where the catheter is inserted. Areas within the heart that are causing the irregular impulses are targeted by the catheter and radiofrequency energy is used to scar or destroy the tissue. This procedure is performed in the hospital so that the patient can be monitored closely.1,6
POST PROCEDURE RECOVERY
Patients usually recover fairly quickly after this procedure and spend an average of 1 to 2 days in the hospital primarily to monitor heart rate.6 One study has shown that approximately 89% of the procedures are successful (usually more successful if performed within one year of diagnosis of A-Fib7) and patients experience increased exercise tolerance, improved circulation, and improved quality of life.1, 6 Risks of radiofrequency ablation include bruising, a damaged or leaking blood vessel, puncture of the heart, arrhythmias, stroke, and sudden death (2%). Patients can also experience narrowing of the pulmonary artery or paralysis of the diaphragm (the muscle responsible for drawing air into the lungs).1, 6, 7
While successful ablation usually leads to discontinuation of medications for arrhythmias, it is recommended that some patients still continue lifelong anticoagulation therapy to prevent the risk for strokes.6
PATIENT EXPERIENCES
Please note that the following patient experiences are not typical. Radiofrequency ablation procedures are successful 89% of the time. The following interviews were conducted with patients in an anticoagulation clinic, thus there is bias toward those whose procedures were unsuccessful.
Jack, a 63 year old male, underwent radiofrequency ablation on his AV node in October 2002. Jack explained that he was diagnosed with A-Fib in the 1960’s. His symptoms during his A-Fib episodes made him feel tired, nauseated, irritable, sweaty and dizzy. Jack began taking antiarrhythmic medications and warfarin to treat his A-Fib in the late 1990’s. Although the procedure was to cost approximately $40,000 (with a personal copay of $10,000) he decided to undergo radiofrequency ablation in hopes of a cure. He claimed the procedure took about one hour and he was fairly comfortable under complete anesthesia. The doctor threaded two catheters into his heart: one through his groin and one through his neck to cauterize his AV node. Jack claims that while he was a “little sore” around his groin and neck areas he really did not experience any pain and was released to go home 26 hours after the procedure. Although he did restart the warfarin post procedure, unfortunately, eight days after returning home, Jack experienced a minor stroke and his A-Fib returned (these are risks of the procedure). He explained that the entire right side of his body became paralyzed and he felt very confused. Luckily his wife was with him and able to quickly take him to the hospital for treatment. Today, Jack has recovered almost all function and only has minor difficulty with writing. He has remained on warfarin therapy and has had to resume antiarrhythmic medications to treat his A-Fib. His doctors have offered to repeat the procedure, but Jack has declined.
Joanna, a 71 year old female, has had a long and complicated cardiac history. While she is unable to remember exactly when she was diagnosed with A-Fib, she recalls beginning treatment in the early 1990’s. Joanna describes her episodes of A-Fib as feeling a “skipped beat” and several rate changes. She feels tired, but no other uncomfortable symptoms. She has undergone several electrical current cardioversions and all have failed. Joanna suffered a stroke in 1994, which she has since recovered from, received a mechanical mitral valve in 1995, and has also undergone a triple bypass surgery. Finally, in June 2002, Joanna decided to try radiofrequency ablation therapy. The doctors inserted the catheter through her neck and into the right side of her heart for the procedure. Before the procedure was complete, the doctors were aware that it had failed and decided to place a pacemaker. This more extensive procedure did keep Joanna in the hospital longer for recovery. She claims there were no other complications and she was actually fairly comfortable and not at all frightened. In December 2002, a second attempt was made for a successful ablation procedure. Unfortunately, this also failed and Joanna continues to rely on the pacemaker to aid in controlling her A-Fib and she continues on warfarin therapy.
References:
© 2006 Rhiannon Trepanier and Richard Blaskovich - Used By Permission.
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Last updated June 13, 2007