Electrophysiology and Heart Rhythm Disturbances
Medications and Procedures to Treat Atrial Fibrillation
For most patients with atrial fibrillation (also known as "afib" or "atrial fib"), the condition can be controlled with medications; the goal is to prevent or treat blood clots, and then bring the heart rate and rhythm back to normal.
We have expertise in the newest medications for management of atrial fibrillation, including anti-arrhythmic medications and newer non-Coumadin anticoagulants that have demonstrated improved outcomes and significant reduction in stroke and embolisms.
One side effect of anticoagulant medications is the increased risk of bleeding. These medications require careful monitoring by a physician to ascertain the correct dose and minimize risk of bleeding.
For some patients, anticoagulant medication may not be effective and other treatments may be required.
Electrical cardioversion is a procedure that delivers low-level electrical energy to a patient’s chest in order to reset the heart to its normal rhythm. The patient is under mild sedation during the procedure. For some patients, treatment with blood-thinning medication to eliminate blood clots is given before the procedure. Electrical cardioversion is successful in controlling atrial fibrillation in most patients, although in some atrial fibrillation may return. Anti-arrhythmia medications may be prescribed after the procedure for continued management of the condition.
Catheter ablation is used to ablate (destroy) tissue in the area of the heart that is the source of faulty electrical activity. A catheter is used to determine the source, and then the physician uses the catheter to deliver radiofrequency, laser or cryotherapy ablation to cause scarring that will disrupt the faulty electrical activity. The goal is to prevent the abnormal signals and restore the heart to normal rhythm.
Common types of ablation are:
- Pulmonary vein isolation ablation, which destroys tissue in the pulmonary veins when that is the source of the unwanted electrical currents; and
- AV node ablation, which destroys tissue in the AV (atrioventricular) node if that is the source of unwanted electrical signals sent from the atria (upper chambers of the heart) to the ventricles (lower chambers of the heart).
Surgical incisions in the atria may also be used to destroy abnormal electrical pathways. When local freezing, radiotherapy or ultrasound is applied to these pathways, further destruction of the abnormal pathways occurs, causing the heart rhythm to revert to normal.
Our surgeons have completed hundreds of successful surgical procedures for atrial fibrillation, using both cryoablation and bipolar radiofrequency ablation. Ours is the only center in Rhode Island that performs complex ablations, and we are one of the few centers in the nation that offers a minimally invasive hybrid endocardial-epicardial convergent ablation approach for atrial fibrillation.
Single-Lead Implantable Cardiac Defibrillator
Cardiovascular Institute electrophysiologists were the first in New England, and among the first in the country, to treat a patient with a single-lead, implantable cardiac defibrillator (ICD) that incorporates a sensor in the atrium. This type of single-lead ICD with a passive atrial sensor is a revolutionary, more precise technology for defibrillation. It does the job of two leads and can be implanted in less time, reducing a patient’s exposure to radiation and risk of postoperative infections. It also gathers much more electrical information about the heart, enabling a more accurate decision-making process. Unlike traditional single-lead ICDs that are designed to only sense and correct changes in ventricular rhythm, our state-of-the-art single-lead ICD can sense changes in the atrial rhythm. This significant advancement in detecting and treating atrial arrhythmias improves the overall management of cardiac arrhythmias.
LARIAT Suture Delivery Device
Ours is the only program in Rhode Island and one of the few in the nation offering treatment with the LARIAT Suture Delivery Device. Approximately 90 percent of strokes in atrial fibrillation patients result from blood clots in the left atrial appendage (LAA), which is a small pouch that is a normal part of the left atrium. For patients who cannot take blood-thinning medications, the LARIAT procedure provides another method to prevent blood clots from traveling from the LAA to the brain, addressing the most common cause of heart-related stroke, while avoiding the potentially serious side effects associated with anticoagulant medications.
Rhode Island Hospital was one of the first hospitals in New England, and the only hospital in the Boston region, to perform the Ex-Maze (extracardiac maze) procedure, a minimally invasive surgical procedure designed to treat patients with longstanding atrial fibrillation. The technique is an option with excellent outcomes for patients who have had previous cardiac ablation procedures that were unsuccessful in controlling their condition. Patients who have the Ex-Maze procedure experience quicker recoveries than those who have open-heart procedures. Antony Chu, MD, director of complex ablations at the Cardiovascular Institute, was one of the first physicians in the nation to perform this procedure.