Clinical Briefing: "Curative" Atrial
Fibrillation Ablation
September / October 2005
Atrial fibrillation (A-Fib) is a heart rhythm disturbance
in which disorganized atrial activity replaces sinus rhythm.
A-Fib is initiated by the premature discharge of foci or
triggers most commonly located in the left atrium at the
orifice of the pulmonary veins. The ventricular response
to A-Fib is irregular and may be rapid. In A-Fib, patients
can experience palpitations, fatigue, breathlessness, dizziness,
or mild chest discomfort or pain.
Although symptomatic A-Fib can be prevented in some patients
with life-long medical therapy, nearly 50% of patients will
prove resistant and may be considered for A-Fib ablation.
A-Fib ablation involves using catheters to isolate or, less
commonly, directly burn the triggers that initiate atrial
fibrillation. A-Fib ablation procedures have been performed
more than 1,000 times over the last six years by the team
of electrophysiologists at the University of Pennsylvania
Health System.
“Catheter ablative therapy has allowed us to ‘cure’ A-Fib
and eliminate not only severe symptoms, but the need for
lifelong anti-arrhythmic medication,” said Francis
Marchlinski, MD.
Case Study
 Mr. J is a 57-year-old gentleman who had
atrial fibrillation for approximately seven years. His A-Fib
proved resistant to digoxin, beta blockers, calcium channel
blockers and propafenone. He was treated with amiodarone
only to experience photophobia, nausea and hypothyroidism.
He developed more frequent and then persistent A-Fib with
symptoms of lightheadedness, near-syncope, and constant palpitations
made worse by physical activity. After being in A-fib for
four months, an echocardiogram revealed the left atrial size
increased to 4.8 cm and a LV ejection fraction decreased
to 15% from normal values one year prior. Mr. J anxiously
searched for a “cure” for his
A-Fib.
His cardiologist referred him to the Penn Cardiac Care
Electrophysiology program. After a thorough evaluation and
discussion of benefits and risks, his electrophysiologist
indicated that he was an appropriate candidate for A-Fib
ablation procedure. Mr. J underwent the A-Fib ablation procedure
in 2003 and has remained without symptoms and without A-Fib
to date. His cardiac function and atrial size have returned
to normal. The “cure” of his A-Fib has allowed
him to stop his anti-arrhythmic medications and eliminate
the need for coumadin. His quality of life has greatly improved
as a result of his A-Fib ablation and he has resumed vigorous
exercise.
Clinical Trials
NAVISTAR® THERMOCOOL® Catheter for the Radiofrequency
Ablation of Symptomatic Paroxysmal Atrial Fibrillation (PAF)
The study compares two types of treatment for PAF that
are designed to restore a normal heart rhythm. The treatments
being compared are:
- catheter ablation with an investigational radiofrequency
catheter to prevent atrial fibrillation, and
- standard drug therapy (antiarrhythmic drugs) to restore
a normal heart rhythm.
Areas of Expertise
- Diagnostic electrophysiology studies
- ICD and pacemaker implants
- Ablations — using the latest approved as well as
investigational equipment for ventricular/ supraventricular
tachycardia and atrial fibrillation
- Tilt-table testing
- Pacemaker and device clinic
- Transtelephonic arrhythmia monitoring
- Telephone pacemaker follow-up
- Cardioversions
- Biventricular device therapy to treat heart failure.
Our Team of Faculty
Our board-certified electrophysiologists
are dedicated exclusively to treating and eliminating serious
and potentially life-threatening heart rhythm disturbances.
Over the last five years, the team has published more than
20 original articles in the medical literature describing
techniques for improving the outcome of atrial and ventricular
arrhythmia ablation.
Several members of the staff serve on
the editorial board of the Journal of
the American College of Cardiology, the American
Journal of Cardiology and the
Journal of Pacing and Cardiac Electrophysiology and are recognized
in the Best Doctors in America and Philadelphia magazine’s “Top
Docs” issue.
Francis E. Marchlinksi, MD
Director, Cardiac Electrophysiology
University of Pennsylvania
Health System
Professor of Medicine
David J. Callans, MD
Professor of Medicine
Director, Electrophysiology Laboratory
Hospital of the University
of Pennsylvania
Joshua Cooper, MD
Assistant Professor of Medicine
Hospital of the University
of Pennsylvania
Sanjay Dixit, MD
Assistant Professor of Medicine
Hospital of the University of
Pennsylvania
Edward Gerstenfeld, MD
Assistant Professor of Medicine
Hospital of the University of
Pennsylvania
David Lin, MD
Assistant Professor of Medicine
Hospital of the University of
Pennsylvania
Andrea M. Russo, MD
Clinical Associate Professor of Medicine
Director, Electrophysiology
Laboratory
Penn Presbyterian Medical Center
Aneesh Tolat, MD
Pennsylvania Hospital
Ralph Verdino, MD
Assistant Professor of Medicine
Hospital of the University of
Pennsylvania
Kar-Lai Wong, MD
Director, Electrophysiology Laboratory
Pennsylvania Hospital
Access
Patient appointments are available at:
Hospital of the University of
Pennsylvania
Rhoads Building, Ground Floor
3400 Spruce Street, Philadelphia
Penn Presbyterian Medical Center
Philadelphia Heart Institute Building, Third Floor
39th and Market Streets, Philadelphia
Pennsylvania Hospital
Cathcart Building, Third Floor
800 Spruce Street, Philadelphia
Penn Medicine at Radnor
250 King of Prussia Road
Radnor, PA
Penn Cardiac Care at Cherry Hill
1400 East Route
70
Cherry Hill, NJ
To refer a patient and/or consult with a doctor:
Please contact your UPHS physician liaison with any concerns
or problems you may experience when referring your patient.
Locations
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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