Harvard Heart Letter

Repeat "zaps" often needed to stop atrial fibrillation

The common heart rhythm problem known as atrial fibrillation is characterized by rapid, erratic beating of the heart's upper chambers. It has traditionally been treated with drugs. A procedure called atrial ablation aims to restore a normal rhythm by destroying patches of heart tissue that generate errant "beat now" signals.

A doctor does this with small bursts of electricity delivered from inside the heart. There's no need for surgery — the tissue-zapping device is introduced into the heart from an artery in the groin, much like artery-opening angioplasty.

Sometimes a single ablation session is enough to quell atrial fibrillation. But in a study from California, one-third of atrial fibrillation sufferers needed a second ablation procedure. (This is consistent with other reports, which show a similar percentage.) When the California researchers combined results from patients who had successful first and repeat procedures, 87% were free of atrial fibrillation three years later. The percentage was higher (95%) for those with intermittent atrial fibrillation, often called paroxysmal atrial fibrillation, and lower (78%) for those with long-standing, persistent atrial fibrillation (American Heart Journal, July 2011).

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