Dynamic Hybrid Afib Ablation

Offering patients promising new treatment

High Density Mapping on the inside of the heart confirms the previous therapy delivered to the outside.Physicians then complete the hybrid approach and confirm success on a final voltage map seen here.
Atrial fibrillation, or A-fib, is the number one cardiac arrhythmia (heart rhythm problem) in the U.S., affecting as many as six million people. Approximately 70 percent of them are between 65- and 85-years-old.

What’s more, these numbers are predicted to increase sharply. This troubling trend is attributable in large part to our aging population and lifestyle — poor diet, and lack of exercise and sleep — that contribute to obesity, high blood pressure, diabetes, coronary artery disease and obstructive sleep apnea — all risk factors for atrial fibrillation.

Given these statistics and the Coachella Valley’s large retiree population, it’s no surprise that atrial fibrillation is a significant problem here in the desert. 

"Over the last ten to 15 years, catheter ablation has become the first-line treatment for paroxysmal or intermittent artial fibrillation, the kind that comes and goes and last less than a week at a time."- Leon Feldman, MD
“In truth, there’s so much atrial fibrillation here that I could limit my practice to treating it alone and be quite busy,” says Leon Feldman, MD, Cardiac Electrophysiologist and Co-Director of Eisenhower Health’s Electrophysiology Laboratory. 
At Eisenhower Health, however, there is a team of specialists available to treat atrial fibrillation, now offering a new and increasingly effective therapy known as the convergent procedure. This procedure uses radiofrequency energy to create tiny scars internally and externally in the heart; the scar tissue blocks abnormal electrical signals and restores a normal heartbeat — sinus rhythm.  

A collaborative approach between electrophysiologists and cardiothoracic surgeons has allowed for the development of the hybrid ablation treatment by incorporating a minimally invasive surgical procedure with a catheter-based procedure. This combination has proven highly successful in treating the most complicated type of atrial fibrillation.

During the initial phase of treatment which involves a minimally invasive surgical procedure, the surgeon makes a small incision to perform the radiofrequency ablation under direct visualization with a camera to create scar tissue in targeted areas on the heart’s outer surface.  

Approximately one month later, the electrophysiologist performs the ablation by inserting catheters into a vein, guiding them to the heart to deliver the energy to create scar tissue in specific areas inside the heart, using sophisticated three-dimensional mapping.

This new hybrid procedure, which entails a two- to three-day hospital stay, offers renewed hope to A-fib patients who don’t respond to medical therapy or traditional ablation technique. 

“For many years, the first-line treatment for people with atrial fibrillation was antiarrhythmic drug therapy combined with blood thinners to minimize symptoms and reduce the risk of stroke,” says Dr. Feldman. “For patients with stubborn atrial fibrillation, medications were used simply to control heart rate, but couldn’t restore a regular heart rhythm.”

“In other words, we could treat atrial fibrillation symptoms but not the atrial fibrillation itself,” notes Eisenhower Cardiothoracic Surgeon Daniel Logsdon, MD. “And the longer someone is in atrial fibrillation, the more damage it can do to the heart, so it’s important to return patients to normal sinus rhythm as soon as possible.”

Traditionally, ablation has been done either from inside the heart (endocardial) via a catheter-based procedure performed by an electrophysiologist, or from the outside of the heart (epicardial) in a procedure performed by a cardiothoracic surgeon, usually as part of open-heart surgery to fix another heart problem, such as coronary artery disease or a faulty valve.

“Over the last ten to 15 years, catheter ablation has become the first-line treatment for paroxysmal or intermittent atrial fibrillation, the kind that comes and goes and lasts less than a week at a time,” explains Dr. Feldman. “There’s a nearly 80 percent chance of successfully treating this type of atrial fibrillation with ablation.

“But unfortunately, many patients have persistent types of atrial fibrillation that don’t respond as well to this approach,” he notes.

For these atrial fibrillation patients, the new hybrid approach offers an important, potentially life-changing treatment option.

"In a recent major clinical trial, 75 percent of patients undergoing the hybrid procedures had a 90 percent reduction in their atrial fibrillation, versus only 55 percent of patients with catheter ablation alone."- Daniel Logsdon, MD
“In a recent major clinical trial, 75 percent of patients undergoing the hybrid procedure had a 90 percent reduction in their atrial fibrillation, versus only 55 percent of patients with catheter ablation alone,” Dr. Logsdon says. “These were patients who could never be out of atrial fibrillation before, so that’s a huge difference. And they were able to stop their anti-arrhythmia and blood thinner medications.”

Also, during the surgical portion of the hybrid procedure, Dr. Logsdon can place an atrial clip at the base of the left atrial appendage (LAA), significantly reducing the risk of strokes related to blood clots, enabling patients to stop taking blood thinners afterwards.

Dr. Logsdon is quick to emphasize that a patient’s primary cardiologist remains a vital member of this team.

“They not only refer the patient for ablation therapy but are responsible for their patient’s long-term rhythm management post-procedure,” explains Dr. Logsdon. This includes providing guidance about managing weight, blood pressure, and alcohol and caffeine consumption, all of which can have an impact on atrial fibrillation.

“Now, with this FDA-cleared and Medicare-approved hybrid procedure, we have something that shows real promise,” says Dr. Feldman. “That’s a real distinction from where we were just six months ago.” 

For more information or to contact Eisenhower Desert Cardiology Center, call 760.346.0642, or visit EisenhowerHealth.org/DesertCard.

About Atrial Fibrillation

Atrial fibrillation occurs when the electrical signals that coordinate the heartbeat don’t work properly, causing the heart’s upper chambers (the atria) to beat chaotically and irregularly, out of sync with the heart’s lower chambers (the ventricles). While many people with atrial fibrillation have no symptoms, the condition may cause palpitations (a fast, pounding heartbeat), shortness of breath or weakness. These symptoms may come and go (what’s called paroxysmal atrial fibrillation), or they may be persistent (lasting more than seven days) or longstanding persistent (lasting longer than a year). 
What makes atrial fibrillation so concerning is that a chaotic heart rhythm can cause blood to pool in the atria and form clots. If a blood clot in the left atrium breaks free, it can travel to the brain and cause a stroke. Atrial fibrillation also increases the risk of heart failure and other heart-related complications along with an increased incidence of dementia.