New Procedure Treats Atrial Fibrillation

Doctors at Washington University School of Medicine in St. Louis are performing a new procedure to treat atrial fibrillation, a common irregular heartbeat.

Available at only a handful of U.S. medical centers, this “hybrid” procedure combines minimally invasive surgical techniques with the latest advances in catheter ablation, a technique that applies scars to the heart’s inner surface to block signals causing the heart to misfire. The two-pronged approach gives doctors access to both the inside and outside of the heart at the same time, helping to more completely block the erratic electrical signals that cause atrial fibrillation.

Atrial fibrillation affects more than 2 million Americans, a number that continues to increase as the population ages. While not fatal in itself, patients who suffer from atrial fibrillation are at increased risk of stroke and congestive heart failure. And many, especially those who feel the fibrillations, have shortness of breath, chest pain, fatigue and feelings of anxiety, among other problems.

“For some patients, it’s a difficult way to live,” says Phillip S. Cuculich, MD, assistant professor of medicine at Washington University School of Medicine in St. Louis and a cardiac electrophysiologist who treats patients with atrial fibrillation at Barnes-Jewish Hospital.

Atrial fibrillation occurs when the smaller upper chambers of the heart, called atria, get irregular electrical signals that disrupt the coordinated pumping of blood through the heart to the rest of the body. Instead of a normal beat, these signals cause weak flutters that prevent adequate blood flow to the ventricles, the heart’s main pumps.

Despite its prevalence, atrial fibrillation remains tricky to treat. Medications that maintain a normal heart rhythm often stop working after a period of time.

When medication is no longer effective, doctors typically recommend catheter ablation, which involves threading long, thin tubes through a vein in the groin into the heart. The tips of these catheters can be heated, allowing doctors to perform a series of ablations, or burns, on the heart’s inner surface. The goal of ablation therapy is to create scar tissue that isolates the irregular electrical signals and blocks them from spreading over the heart and causing fibrillation. After a catheter ablation procedure, about 70 percent of patients remain free of symptoms after one year.

Although success rates for catheter ablation are better than medication, catheter ablation does not always work. Some patients may require a second or third procedure to achieve a successful result.

“The heart is a remarkable thing,” Cuculich says, “It’s very sturdy and can reconnect across those ablation lines.”

For hard-to-treat patients, doctors have recommended the Cox-Maze surgical procedure, developed in 1987 by James L. Cox, MD, at Washington University.