Atrial Fib. Noninvasive Treatment

austin heart, BSN, RN · Oct 27, 2005

Echo study is not the preferable way to check for clots pre-cardioversion. Prefered method is TEE as it supplies better visualization.

austin heart, BSN, RN · Oct 27, 2005

Hey Y'all
Was just droppin' by and happened to re-read the OriginalPost. 'what are non-invasive treatments' for AF.
Humm.....if the OP is still hanging around, were you implying that there's INVASIVE treatments? Were you thinking of like the EP Lab.
Just happened to notice, was curious.
Papaw John

Most popular invasive treatment these days is ablation....

http://www.af-ablation.org/

Editorial Team / Admin · Oct 27, 2005

CTA (CT Angiogram) is also a reliable way to check the atria for clots. :)

papawjohn · Oct 27, 2005

Hey AustinHeart!!!

Gosh, coronary care evolves so quickly---when I knew anything about it, the EP Lab and Ablation were connected with Wolf-Parkinson-White and similar re-entry type tachycardias. It was easy to 'picture' in my mind the scarring of a single pathway. Hard to imagine ablation doing the same thing for the numerous connections and web of pathways that is my mental picture of AFib. I'll look at your link when I have a little more time to think about it.

Thanx for the input.

Papaw John

Editorial Team / Admin · Oct 27, 2005

hey austinheart!!!
gosh, coronary care evolves so quickly---when i knew anything about it, the ep lab and ablation were connected with wolf-parkinson-white and similar re-entry type tachycardias. it was easy to 'picture' in my mind the scarring of a single pathway. hard to imagine ablation doing the same thing for the numerous connections and web of pathways that is my mental picture of afib. i'll look at your link when i have a little more time to think about it.
thanx for the input.
papaw john

yes, relatively new procedure for a fib. here is a little more about it:

http://www.enloe.org/guide_to_services/heart_program/cardiothoracic_surgery/ablation_surgery_to_treat_atrial_fibrillation.asp

http://www.dogpile.com/_1_wl9tyj046nbww7__info.dogpl.iso/search/web/ablation%2bfor%2batrial%2bfib/1/-/1/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/-/417/top

Dinith88 · Oct 28, 2005

Hey AustinHeart!!!
Gosh, coronary care evolves so quickly---when I knew anything about it, the EP Lab and Ablation were connected with Wolf-Parkinson-White and similar re-entry type tachycardias. It was easy to 'picture' in my mind the scarring of a single pathway. Hard to imagine ablation doing the same thing for the numerous connections and web of pathways that is my mental picture of AFib. I'll look at your link when I have a little more time to think about it.
Thanx for the input.
Papaw John

Hey John, when i first heard about ablating a-fib i thought it was a lie. It goes against the whole 'conventional' ablation-stuff...or at least i thought.

There're big differences though between WPW/rentrant SVT ablations and AF ablations.

First off..as you know, in 'traditional' ablations, an irritable focus is 'burned' away and then hopefully (and usually) the svt/wpw is cured.

The way they do AF ablations is very different and much more complex/difficult.

Recently (past few years?) it's been discovered that many a-fibs are 'triggered' or 'initiated' by abnormal impulses origionating in the left atrium (thats an important difference...traditional ablations are right-atrium) at the junction of the pulmonary veins and the left atrium. The idea behind a-fib ablations is that if you 'isolate' this area...basically by 'burning' a ring around it with an ablation, the impulses will be unable to 'jump' this ring and trigger the AF.

(the MAZE procedure uses this same principal..only it's an open-heart/surgical procedure with all the inherent risks..)

Anyway, the reason why a-fib ablations are so hard to do is because the left-heart circulation is 'arterial' and is much more difficult to navigate with a catheter (they cant go through arterial puncture the way angiograms are done). The way they do it is by venous entry (like standard ablation technique) but they then have to cannulate/punch a hole through the septum (ouch!) to pass the catheter into left heart. Also, a big risk is that if they ablate too close to the pulmonary veins they can cause bad pulmonary-vein stenosis.

This af-ablation technique is unfortunately not for all a-fibers. It works best in younger people with paroxysmal a-fib. (ie it wont help people who have af because of cardiomyopathies, thyroid problems, etc., etc.)

Also, the jury is till out on whether these patients will be permanently 'cured' of the af. The impressive numbers touted in many studies were done on a very 'select' group of patients (mostly younger, healthier people with paroxysmal a-fib)...and no 'long-term' follow-ups have been done because the procedure is relatively new.

The procedure takes several hours (unlike traditional ablation) and because of it's complexity is done mostly in university-type settings.

Also...the thing everyone has to keep in mind with the AF ablations is that if all a-fibs could be cured by ablation (in the same way, with the same success as traditional svt ablations) then dont you think they'd be curing everyone with this procedure??? People who state 'well..just go get an a-fib ablation and it'll be cured' really dont have a handle on the whole a-fib ablation thing. As i've said, the jury is still out...

sorry for the rant, i'm just very iterested in this topic!

papawjohn · Oct 28, 2005

Hey Dinith88

Well thats just fascinating!!! And thanx for the excellent very clear explanation.

Papaw John

ldymeg · Oct 29, 2005

We put them on a Cardizem drip, load them with Amio and get the Lovonox on board. Works like a charm and they often covert within two to three days without needing cardioversion.

amy7902 · Oct 29, 2005

Magnesium Sulfate 4 Grams IV usually within 1 hour helps. The patient I had got tired of problem and went for ablation.

RN12345656 · Nov 2, 2005

(the MAZE procedure uses this same principal..only it's an open-heart/surgical procedure with all the inherent risks..)
The procedure takes several hours (unlike traditional ablation) and because of it's complexity is done mostly in university-type settings.
Also...the thing everyone has to keep in mind with the AF ablations is that if all a-fibs could be cured by ablation (in the same way, with the same success as traditional svt ablations) then dont you think they'd be curing everyone with this procedure??? People who state 'well..just go get an a-fib ablation and it'll be cured' really dont have a handle on the whole a-fib ablation thing. As i've said, the jury is still out...

Hey Dinith--

I have to agree with you regarding the success rate with ablation. I can't tell you how many times I've seen a post CABG and/or Valve Pt who have had the Maze procedure--and postop they are still in Atrial Fib!! And ditto for the traditional ablations. I see ALOT of Aortic Valve replacements with postop Afib as well. Do you or anyone know the rationale behind that?

Also, are you familiar with AtriCure bipolar radiofrequency ablation? It's surgical ablation, however it's a minimally invasive procedure. The surgeons where I work are doing it. It obviously decreases the risks involved.

RN12345656 · Nov 2, 2005

Anybody know if there's a logarithm or protocol for Acute A-Fib that Dr's learn or count on?
Papaw John

We have standing orders/Atrial Fib protocol (for new onset Afib) where I work. We use Cardizem--0.25mg/kg bolus then Cardizem gtt 10mg/hr. Parameters are: Sustained HR>120bpm & SBP >100.

:nurse:

Dinith88 · Nov 3, 2005

Hey Dinith--
I have to agree with you regarding the success rate with ablation. I can't tell you how many times I've seen a post CABG and/or Valve Pt who have had the Maze procedure--and postop they are still in Atrial Fib!! And ditto for the traditional ablations. I see ALOT of Aortic Valve replacements with postop Afib as well. Do you or anyone know the rationale behind that?
Also, are you familiar with AtriCure bipolar radiofrequency ablation? It's surgical ablation, however it's a minimally invasive procedure. The surgeons where I work are doing it. It obviously decreases the risks involved.

No, i'm unfamiliar w/the AtriCure ablation. How's it done? Is it less 'invasive' (and superior?) than one done(attempted) in an EP-lab?

And as far as a reason for a-fib from AVR's (and any other heart surgery...but especially from valves) is mostly from endocardial edema caused by the procedure itself (and compounded by electrolyte abnormalities, etc.). This 'irritation' can take upwards of a month to subside. As far as how long they typically keep these people on meds (post-op hearts triggering afib) to control it i'm unaware (meaning if they've converted...if still in afib they onbviously could be on them for life).Thats a good question for a surgeon (or cardiologist) i suppose...