Silicon Valley Cardiology
The Management of Atrial Fibrillation
Silicon Valley Cardiology started its highly successful Atrial Fibrillation (AF) Ablation program in 2003 for one purpose- to improve the quality of life of our patients with atrial fibrillation. At that time our options for treating AF were limited. The only option for a cure of the condition involved open heart surgery. We would try medications to suppress the arrhythmia which helped some people, but many were not effectively treated with drugs. Our patients simply were not receiving adequate relief of symptoms. AF ablation targeting the areas in the heart that caused the arrhythmia offered a potential solution. Very few centers in the United States offered AF ablation at that time. After researching the best ways to perform the procedure, including traveling to Europe to evaluate the techniques of the early ablation pioneers, we embarked upon our AF ablation program.
Who is a candidate for AF Ablation?
A consultation with one of our physicians is important to determine the best treatment for your atrial fibrillation. The right answer is not always ablation and sometimes we may recommend medication or other treatments. We will determine if you are a candidate for ablation by determining its impact on your quality of life, the effect of AF on your heart by reviewing your echocardiogram, and your goals, be they to be rid of symptoms or medications. We will also determine whether there are additional cardiac factors such as mitral valve disease or weakening of your heart’s pumping function that influence the best course of action for you. We have learned through our research that the shorter the duration of AF since diagnosis, the higher the chance for success with ablation. For some patients ablation will not be appropriate. We will always determine your best therapy options and discuss them with you.
2003 to today-Evolution of AF Ablation
Since our first AF ablation in 2003 this procedure has evolved dramatically. Our motivation to refine this procedure has and always will be about making this the safest and most effective procedure for our patients. We have now published many scientific articles in peer-reviewed medical journals to share what we have learned with the other electrophysiologists who do AF Ablations to help everyone do these procedures safer and more effectively. The following paragraphs outline the critical elements behind the success of our program.
A personalized approach The physicians of Silicon Valley Cardiology meet personally with each person before the ablation to review your medical history and all of your prior AF treatments and tests. We draw upon our experience in over 7000 AF ablations to try to give each patient a realistic expectation of what their personal chance of a successful AF ablation may be, as well as review the risks and benefits of having an AF ablation. Your ablation will be done by the physician you meet at this initial consultation and there will be no “trainees” doing your procedure. We are able to care for patients who travel long distances to have us perform their AF ablation, as seen in this map: Geographic distribution of Sequoia AF ablation patients (PDF).
Technology We continually evaluate new ablation techniques and technologies and work closely with industry to bring the best technologies to the bedside. We have been at the forefront of many new technologies such as irrigated tip catheter ablation and force sensing catheters, as well as the use of a radiofrequency wire rather than a sharp needle to enter the left atrium, which have improved AF ablation safety and efficacy. We have also pioneered the use of less intense anticoagulation during the ablation which lowers bleeding complications as well as the use of the new blood thinners dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa) following ablation. With the advent of these newer drugs, we have modified our procedures to fit with this new therapy. We have carefully evaluated and rejected other new technologies such as cryoablation, magnetic or robotic surgery, as well as the Topera rotor mapping system, which we feel only drive up the costs of AF ablation, can increase procedure time dramatically for some of these technologies, and increase complications, all without benefiting patients with a better outcome or a safer ablation. Recent studies confirm that these technologies are not superior to the use of radiofrequency ablation used by experienced physicians, and lead to longer procedure times and higher fluoroscopy radiation doses. We have partnered with our surgeons to also offer hybrid ablation as a strategy to cure atrial fibrillation in those few patients in whom prior ablations have not eliminated the arrhythmia. If a technology is not going to help you, our patient, we are not going to use it.
Procedural volume When it comes to any type of procedure or surgery, a center’s volume of cases is an important determinant of success and safety. We have performed over 7000 AF ablations which is on par with the busiest centers in the world. This type of volume has allowed us to collectively gain wisdom on the best way to approach your AF. Physicians from other centers frequently come to our hospital to observe our cases and learn from our large experience.
What can you expect? In long term follow up of patients treated through the end of 2015, our physicians have cured patients with paroxysmal (intermittent and self terminating) AF with a single procedure in 84% of the procedures, and for those with persistent AF, 81% of the procedures were successful. If a second procedure is needed, more than 90% of patients were cured and off medications. Our short term analysis suggests that since 2015, the long term results will be even better due to our shared experiences and the advent of newer technologies. In the past three years, utilizing contact force catheters, we have moved the single procedure success rate to 90% for patients with paroxysmal atrial fibrillation.
Research and Patient Follow-Up We have dedicated significant resources to our AF research and follow-up program. This includes tracking all AF ablations we have done since 2003. We are not only interested in your immediate safety and outcome after an AF ablation, but also how you do over the years. Our goal is to give you a life-time free of AF. Knowing what has worked well for patients in the past helps guide how we do things in the future. We have published many of these findings to help other electrophysiologists understand the long-term outcomes of AF ablations.
Support Staff/Nurses All of our staff and nurses are just as committed to helping you as we are. They will support you with guidance and review of instructions both before and after the ablation. They have been through this process many times and can answer just about any question for you. Very few nurses have this level of experience with AF Ablation. We also invite you to read our summary of what you can expect for Your ablation procedure.