SIDNEY PEYKAR M.D., F.A.C.C. J.C. ESTRADA, M.D., M.P.H.
CLINICAL CARDIAC ELECTROPHYSIOLOGY COMPLEX ARRHYTHMIA ABLATION AND CARDIAC DEVICES
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Paroxysmal Atrial Fibrillation



Pulmonary vein atrium isolation:

Research has shown that most atrial fibrillation signals come from the four veins that drain blood from the lungs- i.e. the pulmonary veins. During this procedure, special catheters are inserted into the heart.

A catheter with a radiofrequency tip is used to create lesions in the heart. The lesions heal and within 4 to 8 weeks, form a circular scar around the pulmonary veins. The scar blocks any impulses firing from within the pulmonary veins, thereby "disconnecting" the pathway of the abnormal rhythm and curing atrial fibrillation.

The expected cure rate for this procedure is multifactorial but typically around 80-85%

Dr. Peykar's procedure times are typically much shorter than many and usually take 2-3 hours. About 15% of patients need a touch up procedure at 2-3 months.

What is the Difference Between an Atrial Fibrillation ablation and Ablation of the AV node?

During this procedure, the radiofrequency energy is applied to injure the AV node, which connects the top and bottom chambers of the heart. The end result is a permanent, very slow heart rate, since the electrical impulses from the top chamber of the heart cannot travel down to the lower chamber. Therefore, the patient needs a permanent pacemaker to maintain an adequate heart rate. This procedure does not CURE atrial fibrillation. It only prevents the lower chambers of the heart from beating fast (tachycardia) and the patient's life becomes dependant on the pacemaker. If the pacemaker lead becomes dislodged, the patient can die. This procedure is usually reserved for very infirmed patients who are not candidates for a catheter ablation for atrial fibrillation. This procedure is being widely done by electrophysiologists who do not perform atrial fibrillation ablations as they can not offer pulmonary vein isolation as an option. Many studies have shown that patients do much better clinically with a pulmonary vein isolation and most can forgo getting a pacemaker implanted. [American Heart Assocation Patient Page]