The latest in Afib treatments
Innovative developments mean patients with Afib have more options than ever before.
Atrial fibrillation (Afib) is the most common type of arrhythmia (irregular heartbeat). Because it can lead to blood clots and stroke, it's important to seek specialized and personalized treatment.
Traditionally, the condition was treated with medication to either keep people in Afib and slow down their heart rate to a safe level, or to shift their heart back to a normal rhythm.
While medications are effective for many patients, they have limitations and can come with unpleasant or potentially dangerous side effects.
"A recent study shows that patients who are on antiarrhythmic drugs for Afib end up getting more pacemakers and having more hospitalizations for slower heart rates. There is a benefit-versus-risk assessment when you start patients on antiarrhythmic drugs for Afib," says cardiac electrophysiologist Paari Dominic, MBBS, MPH.
An alternative to medication is Afib ablation (also known as catheter ablation). During an ablation, we purposely damage heart tissue to create scar tissue. This prevents the abnormal electrical signals that cause arrhythmia from being transmitted.
"What we are doing is isolating the veins electrically from the heart. Mechanically, they're still connected and continue to carry on with their normal function, but we are preventing the arrhythmia-causing signals from reaching the rest of the heart by disconnecting them electrically," Dominic says.
Ablation has been used for decades, but in recent years ablation tools and techniques have become more sophisticated, resulting in better outcomes. New guidelines recommend ablation as an initial treatment option for specific patients. Evidence shows that catheter ablation is superior to drug therapy to control irregular heart rhythms.
New heart treatments
Ablation tools and techniques have become more sophisticated, resulting in better outcomes for Afib.
What are the types of ablation?
University of Iowa Health Care electrophysiologists offer several different types of ablations, including the following:
Pulsed field ablation
In early 2024, the U.S. Food and Drug Administration approved FARAPULSE, a pulsed field ablation system, to treat Afib. "Instead of using heat or cold, we use micro pulses of electricity that make tiny holes in the cells, causing the cells to die. It's called programmed cell death," Dominic says.
Pulsed field ablation is more precise than thermal ablation, making it a faster, safer, and more effective treatment for Afib.
Vein of Marshall ablation
Vein of Marshall ablation is a type of chemical ablation. After a catheter and small balloon are inserted into the vein of Marshall—a small vein in the back of the heart known to trigger Afib—ethanol is injected, damaging the vein to eliminate Afib.
Ganglionated plexi ablation
The ganglionated plexi—nerves located outside the heart wall—regulate cardiac rhythm. Damaging these nerves through an ablation procedure can prevent Afib from being triggered.
Convergent procedure
The convergent procedure brings together the expertise of electrophysiologists and cardiothoracic surgeons in a two-stage approach.
The procedure combines minimally invasive heart surgery and ablation to treat Afib. This is one of the least invasive and most successful methods for surgically treating Afib that hasn't improved with other treatments.
