Atrial fibrillation (AFib) is the most common type of heart arrhythmia and can be dangerous if not diagnosed and treated effectively. Early diagnosis and treatment can help reduce the risk of stroke, heart failure, and other complications.
University of Iowa Health Care cardiac electrophysiologists offer several new treatments for patients who may have persistent symptoms, even after initial treatment. Paari Dominic, MBBS, MPH, shares the following guidance for referring providers:
This hybrid approach combines minimally invasive heart surgery and a traditional catheter ablation to treat long-standing, persistent, or permanent AFib. It's one of the least invasive and most successful methods for surgically treating AFib that doesn’t improve with other treatments.
Candidates for convergent procedure:
Persistent AFib (lasts longer than 12 months without any intervening sinus rhythm)
Permanent AFib (sinus rhythm could not be restored, have symptoms of fatigue, shortness of breath, palpitations, chest pressure, dizziness, or light headedness)
Intolerance to AFib medications
Previous AFib treatments were unsuccessful
Underlying cardiomyopathy
Vein of Marshall ablation
This minimally invasive chemical ablation is for patients with persistent AFib. If AFib symptoms continue or become more persistent after a traditional AFib ablation, this option can be used to directly eliminate triggers.
Candidates for vein of Marshall ablation:
Recurrent AFib after a prior AFib ablation
Atrial flutter after an AFib ablation
Persistent but not long-standing persistent AFib
Co-existent cardiomyopathy or fatigue, shortness of breath, palpitations, chest pressure, dizziness, or lightheadedness
Ganglionated plexi ablation
Vagal nerve activity can sometimes trigger AFib. Additionally, patients who undergo an Afib ablation can have slow heart rates, often needing a pacemaker. For these reasons, ablation of the ganglionated plexi—nerves outside the wall of the left atrium—in the left upper chamber of the heart may prevent recurrence of AFib and increase basal heart rates after an ablation and prevent the need for a pacemaker.
Candidates for ganglionated plexi ablation:
Recurrent AFib after a prior AFib ablation
Persistent but not long-standing persistent AFib (underlying sinus rhythm is slower than 50 bpm)
Co-existent cardiomyopathy or fatigue, shortness of breath, palpitations, chest pressure, dizziness, or lightheadedness
If you or your patient have been diagnosed with AFib and are looking for a treatment or second opinion, make an appointment with our cardiac electrophysiology team.
