Cooper Offers Innovative Ablation Therapy for Atrial Fibrillation

Atrial fibrillation is the most common arrhythmia–affecting over 2 million patients–and among the most difficult to eliminate. Ablation therapy for the treatment of atrial fibrillation has been utilized with limited success since 1996. Early catheter ablations were often unsuccessful because of the difficulty in achieving lesion continuity and the avoidance of sites surrounding the pulmonary veins.

Subsequent research determined that these sites were the focal origin for over 90% of paroxysmal atrial fibrillation. This site identification resulted in the development of multiple pulmonary vein isolation techniques, with varying success in treatment and prevention of recurrence. However, the latest technique– available at advanced centers like Cooper–is showing tremendous promise.

Circumferential pulmonary vein ablation is a percutaneous transcatheter approach that utilizes a left atrial catheter technique. The procedure, first performed by Dr. Carl Pappone in Italy, involves encircling the pulmonary veins with radio-frequency pulsation, providing both a continuous and contiguous lesion.

“The target population for this procedure is most often patients suffering from paroxysmal atrial fibrillation or persistent atrial fibrillation of less than 5 years duration,” says Steven Levi, M.D.,

Cooper electro-physiologist. Patients appropriate for this procedure include:

• Symptomatic atrial fibrillation
• Failure of effective control with medical therapy
• Left ventricular ejection fraction of 40% or greater
• Left atrial size of <5.5cm
• Persistent atrial fibrillation < 5 years

“Atrial size is an important consideration,” says Dr. Levi. “An enlarged atrium increases both the number of possible arrhythmia sources and the extent of areas being ablated.”

The catheter-based procedure is well tolerated in most patients. A rare complication of atrio-esophageal fistula has been reported in the literature. To reduce this possible complication, lower power and temperature settings have been recommended for ablations to the posterior left atrial wall. The success rate for this technique has been reported as high as 80% in patients with paroxysmal atrial fibrillation, with a slightly lower rate in persistent atrial fibrillation. However, chronic atrial fibrillation has a significantly lower success rate, so patient selection is important.

“In general, we do not use ablation as first-line therapy,” says Dr. Levi. “However, if the patient is young and does not want to maintain a regime of anti-arrhythmic medications and anticoagulant therapy, ablation may be the appropriate treatment option. It can be a quality-of-life issue. Now with advances in mapping technology, we are often able to offer arrhythmia patients curative treatment rather than simply management of their symptoms,” adds Dr. Levi.

For more information on atrial fibrillation ablation or to refer a patient to Dr. Levi, please call: (856) 546-3003.