Atrial fibrillation is the most common persistent arrhythmia in adults. This results in a very rapid and uncoordinated movement of the two atria. The symptoms caused by an irregular, usually rapid heart rate impair quality of life and also increase the risk of stroke and mortality.
Due to the increase in risk factors such as high blood pressure and obesity, as well as rising life expectancy, the prevalence of atrial fibrillation is on the rise—placing a corresponding burden on patients. The symptoms caused by an irregular, often rapid heart rate impair quality of life and increase the risk of heart failure, stroke, and mortality.
During our specialized consultation hours, we work with primary care physicians to develop a personalized treatment plan for each patient. Catheter ablation has become the treatment of choice for symptomatic atrial fibrillation in many cases. In cases of paroxysmal atrial fibrillation without structural heart disease, 80–90% of patients can be successfully treated. In female patients with heart failure, it has even been shown that catheter ablation for atrial fibrillation can increase the probability of survival. Basically, the earlier the treatment, the higher the chances of success. At our center, we use state-of-the-art methods involving CT and MRI, fusion techniques with dynamic fluoroscopy images, 3D mapping systems (Figure 1), and intracardiac echocardiography (ICE). Thanks to these technologies, it is now possible to perform such procedures with very little or no radioactive X-ray radiation at all.
Pulsed Field Ablation (PFA) is a new technology for treating cardiac arrhythmias, particularly atrial fibrillation (Figure 1). This form of energy is very specific to the heart muscle tissue and can therefore spare surrounding structures during ablation. Paralysis of the phrenic nerve is the most common complication of cryoenergy-based ablation of atrial fibrillation (cryoballoon). Because of the more selective effect on the myocardium with PFA, this complication occurs only extremely rarely. Atrioesophageal fistula is a dreaded, fortunately very rare complication of radiofrequency energy-based ablation of atrial fibrillation, and is often fatal. This complication can also be practically eliminated by using PFA, as the heart muscle is selectively ablated and the esophagus is spared. Other complications such as severe narrowing of the pulmonary veins have also not been described with PFA. Several international studies have shown that pulmonary vein isolation using PFA is at least as effective as—and in some cases even more effective than—technologies used to date (cryoballoon and radiofrequency). This new, effective, and safe technology for treating cardiac arrhythmias has been used successfully at the University Hospital for several years.
Figure 1: Catheter-based 3-D mapping-guided ablation of atrial fibrillation using the new, efficient, and minimally invasive technology of Pulsed Field Ablation (PFA, electroporation)
Atrial fibrillation can also be treated surgically on an open heart (“Cox-Maze procedure”). The atria are opened and closed again by means of incisions, which prevents the development and spread of atrial fibrillation. Today, a similar scar pattern can also be created surgically using ablation forceps with radiofrequency energy or cold. Surgical ablation is primarily performed on patients with atrial fibrillation who are undergoing cardiac surgery for another reason (e.g., coronary artery bypass surgery). After unsuccessful catheter ablation, a mini-thoracotomy can be performed on the open atrium without opening the chest, even without an accompanying operation. This procedure is usually combined with closure of the left atrial appendage to reduce the risk of stroke.
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University Hospital of Zurich
University Heart Center Zurich
100 Rämistrasse
8091 Zurich
University Hospital of Zurich
University Heart Center Zurich
100 Rämistrasse
8091 Zurich
