Atrial fibrillation or flutter: Approach to Care

Atrial fibrillation, an abnormal rhythm in the upper chambers of the heart, is a leading cause of stroke and, according to the American Heart Association, affects approximately 2.2 million Americans.

University of Florida cardiovascular surgeons and cardiologists are collaborating to provide the full spectrum of  care for patients. Treatments range from medicine to surgery, and each patient’s treatment plan is tailored specifically to what is the best for them.


Therapies

  • Medications to restore a normal rhythm
  • Novel blood thinning medications to prevent stroke
  • Cardioversion to shock the heart back into normal rhythm
  • Catheter-based ablation interventions to eliminate the trigger points on the heart, which enable abnormal rhythms, including cryoballoon therapy
  • The “Mini-Maze” operation, or minimally invasive pulmonary vein isolation procedure
  • Traditional open “Maze” surgery for atrial fibrillation patients who are refractory to the above therapies
 

Symptoms of atrial fibrillation include fatigue, dizziness, shortness of breath, and loss of blood pressure, however, some people with the condition do not experience symptoms. According to the American Heart Association, the likelihood of developing atrial fibrillation increases with age, and three to five percent of people over 65 have the condition. Atrial fibrillation episodes can be paroxysmal (intermittent), persistent or permanent.


Cryoablation

UF cardiologists now offer a cryoballoon catheter-based ablation procedure, which is designed for use in patients who are unresponsive to drug treatment and have paroxysmal, or intermittent, atrial fibrillation. Unlike traditional ablation treatments that use radiofrequency, or heat, to destroy faulty electrical circuits in the heart, the cryoballoon catheter procedure uses a coolant, which allows for greater catheter stability.


“Mini Maze” Procedure

For people who suffer from atrial fibrillation, but are otherwise fairly healthy, a minimally invasive Maze procedure, or “Mini Maze” has continued to develop over the last several years. For the Mini Maze, your surgeon will access your heart by making three small incisions between your ribs, through which a tiny camera and video-guided instruments are inserted. As with the open heart Maze procedure, the surgeon will identify the faulty areas where abnormal electrical signals are getting through, create precise scars (ablations) to block those signals, and remove or close off the left atrial appendage, where stroke-causing blood clots often form. The Mini Maze procedure has proven to be an effective treatment and offers many more patients the option of ablation therapy without having to undergo major open heart surgery.


“Hybrid” Approach

Committed to offering the latest in care, UF physicians now offer a “hybrid” approach to treating patients in persistent atrial fibrillation. The procedure combines catheter-based ablation, which interrupts atrial fibrillations on the inside of the heart, and the Mini-Maze procedure, which ablates the outside of the heart, into one single operation designed to more effectively prevent the abnormal electrical signals which cause atrial fibrillation.

“We are excited to offer this new procedure which combines the efficacy of minimally invasive surgery and the mapping ability of cardiology in one setting,” said Thomas Beaver, M.D., M.P.H., an associate professor and director of minimally invasive cardiac surgery. “We are impressed with our initial results, especially in patients that have been in atrial fibrillation for many years.”

In the past, these procedures have been performed in phases, however, the primary point of the hybrid procedure is to complete both at once so the patient does not have to come back and undergo anesthesia and a subsequent procedure.