Atrial fibrillation (AFib) is a type of irregular heartbeat that affects
about 2.3 million people in the U.S. It occurs when there’s a malfunction
in the heart’s electrical signals, causing it to beat rapidly and
According to the National Stroke Association, AFib raises a person's
risk for stroke by 500 percent. However, properly treating AFib can greatly
reduce this risk.
During a free online health lecture, top experts from the AFib Clinic at
Boulder Heart described a range of innovative treatment options for bringing
your heart back to a normal rhythm, including minimally invasive procedures
such as catheter ablation, the new WATCHMAN and hybrid ablation.
Pillars of Treating AFib
Sameer Oza, MD, one of the most experienced cardiac electrophysiologists in the Denver-Boulder
area, started off the lecture by describing pillars to treating AFib:
Stroke prevention - Cardiologists often prescribe blood-thinning medications (anticoagulants)
to prevent blood clots and reduce the risk of a stroke. Sometimes your
doctor may recommend a catheter-based procedure to seal off your heart’s
left atrial appendage.
Heart rate control - Your doctor may also prescribe drugs that help slow your heart rate.
Those who cannot tolerate medications can also undergo atrioventricular
(AV) node ablation – a cardiac catheterization procedure that’s
performed in conjunction with the placement of a permanent pacemaker.
Heart rhythm control - Medications or cardioversion, a procedure where an electrical shock
is delivered to the heart, can restore normal heart rhythm.
Risk factor modification - To reduce your risk of complications associated with AFib, the
American Heart Association says you should:
- Get regular physical activity
- Eat a heart-healthy diet, low in salt, saturated fats, trans fats and cholesterol
- Manage high blood pressure
- Avoid excessive amounts of alcohol and caffeine
- Don’t smoke
- Control cholesterol
- Maintain a healthy weight
Catheter Ablation to Restore Normal Heart Rhythm
If you wish to avoid medications or cardioversion — or if medications
don’t work well enough — Dr. Oza said that
catheter ablation offers the best alternative for restoring a normal heart rhythm. This
minimally invasive procedure selectively destroys the tissue creating
problematic electric signals and interfering with the heart’s regular rhythm.
Using an all-digital biplane cardiac imaging system and a three-dimensional
cardiac mapping system, the cardiac electrophysiologist inserts narrow,
flexible catheters into a vein, usually in the groin area, and then guides
the catheters into the heart. Depending upon the type of catheter being
used, the physician either applies electrical energy to destroy the malfunctioning
tissue (radiofrequency ablation) or freezes it (cryo-ablation).
Foothills Hospital hosts one of Colorado’s most sophisticated
electrophysiology (EP) labs for catheter ablation procedures.
Watchman: An Alternative to Blood Thinners for Stroke Prevention
Following Dr. Oza’s presentation on catheter ablation, interventional
Srini Iyengar, MD, BCH's structural heart program director, spoke about the
According to Dr. Iyengar, blood-thinning medications, such as warfarin
(Coumadin®), are the most common treatment for protecting AFib patients
from stroke. These clot-preventing medications can greatly reduce stroke
risk if taken properly and no side effects are seen.
Yet, more than half of all AFib patients are not prescribed these medications.
For certain individuals, there are barriers to taking a blood thinner,
including dangerous interactions with other medications, dietary restrictions,
high prescription costs, and concerns about bruising or excessive bleeding
from an injury.
Dr. Iyengar stated because of these concerns, the Watchman procedure could
be an alternative to taking blood-thinning medications for some AFib patients.
Watchman is a one-time procedure performed under general anesthesia in
a catheterization laboratory setting. The procedure usually lasts about
an hour and the patient is typically in the hospital for 24 hours following
the procedure. Learn more about Watchman
Minimally Invasive Surgical and Hybrid Procedures
BCH's director of thoracic and cardiovascular surgery
Bryan Mahan, D.O, followed Dr. Iyengar with a presentation on surgical and advanced minimally
invasive procedures generally reserved for difficult-to-treat AFib. These
include the Cox-Maze 4 procedure and hybrid ablation:
Cox-Maze 4 is a minimally invasive heart procedure. Through small incisions and punctures
in the chest, a surgeon uses radiofrequency or freezing to create scar
tissue in the upper chambers of the heart. The scar tissue then interrupts
the electrical signals causing AFib. According to Dr. Mahan, this procedure
has high success, with some studies showing a 95 percent cure rate 10
years after the surgery.
Thoracoscopic hybrid ablation is a collaborative procedure performed by both a heart surgeon and an
electrophysiologist. The heart surgeon creates scar tissue on the outside
of the heart, while the electrophysiologist does the same on the inside
using a catheter-led device to freeze the malfunctioning heart tissue.
This scar tissue then blocks the damaged electrical pathways that cause
AFib. The procedure involves small incisions on each side of the chest
and a few small punctures in the groin.
Dr. Mahan explained that these procedures are most commonly performed when
a patient is having heart surgery for some other reason such as a coronary
artery bypass, atrial valve replacement or mitral valve repair.
PowerPoint slides from the free health lecture titled “Innovative treatments for atrial
Call 303-442-2395 to schedule a consultation with Boulder Heart’s
specialized AFib cardiology team.