Atrial Fibrillation Ablation

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Atrial Fibrillation Ablation

• Research Month
• Daniel Zalkind, M.D.
• Georgetown University Hospital

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Our Goal
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Atrial Fibrillation

• Cardiac Arrythmia
• Normal SA node impulses are hidden/overwhelmed by
  disorganized electrical activity in the atria
• Impulses originate in atria and at pulmonary
  veins
• May cause palpitations, fainting, chest pain or
  CHF and stroke

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Types of Afib

• Paroxysmal (less than 7 days)
• Recurrent (more than 7 days)
• Permanent/Chronic

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Cardiac Electrical Activity
http//www.mmi.mcgill.ca/mmimediasampler2002/image
s/shrier-29no3firstframe.gif
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Etiology
http//www.americanheart.org/downloadable/heart/22
2_ja20017993p_1.pdf
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New Treatment Options (2006)
http//www.acc.org/qualityandscience/clinical/guid
elines/atrial_fib/pdfs/af_full_text.pdf
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Typical Technique (EP Lab)

• A circumferential anatomic approach guided by a
  non-fluoroscopic navigation system
• A wide area of circumferential ablation is
  performed outside the pulmonary vein ostia. High
  power (100 W-gt50W) and temperature (65C-gt55)
  settings are used with an 8-mm tip ablation
  catheter.

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Cardiac Electrical Map w/ Ablation Points-Pappone
Technique

• http//content.onlinejacc.org/content/vol0/issue20
  06/images/large/06011235.gr1.jpeg

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Study Design

• Retrospective, Case Series from One Operator in
  One Center
• Goal 1 Clinical Factor effecting procedure
  success, i.e. age, presence/absence of HF,
  co-morbities
• Goal 2 Timeliness of use within 5 years vs. 10
  years of diagnosis
• Goal 3 To follow pts. 3 years post procedure
  and to expand to more centers

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IRB approval

• Retrospective data falls within IRB approval for
  ongoing studies with similar data sets
• Pt contact will have to be approved by IRB

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Progress So Far

• Pt identified (within last two years, imaging
  available, procedure notes, follow up notes,
  etc.)
• Database/Excel spreadsheets created
• Initial Statistics

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Over the Next 6-12 months

• Addition of more cases to improve power and P
  values
• MedStar statistics department will assist
• IRB approval for pt. contact and followup for 1
  and 3 year intervals

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Thank You

• Zayd Eldadah, M.D., Ph.D.
• Michael Adams, M.D.
• Dan Boxer, M.D.
• Brent Lampert, D.O.