Dr. Robert S. Fishel – JFK Medical Center – Treating Atrial Fibrillation


– The treatments involve both
treating the rhythm problem itself so people don’t
get the rhythm problem, and if they do get it, also
treating the risks of stroke associated with this rhythm problem. So there’s basically a
number of options you have for patients, but one of
those options should include, for many patients, a blood
thinning drug to help prevent stroke if they have atrial fibrillation. If you want to treat the
arrhythmia, there’s a number of different options
that you have in treating atrial fibrillation. One is medications. And medications will help, or
anti-arrhythmic medications, and we have about a dozen
different rhythm control medications available to us. And the other alternative
for patients with atrial fibrillation, if medications
fail, is catheter ablation. It’s basically a
minimally-invasive procedure. With catheter ablation, a
catheter can be inserted through a vein in the leg
and can be traced up into the heart under X-ray using
three dimensional guidance systems, which we have
here at JFK Medical Center. And we can actually map the
electrical system of the heart and identify these usual suspect cells, these areas in the heart,
where atrial fibrillation tends to come from. Once we have mapped and
identified the areas of the heart where atrial fibrillation comes from, we can then apply the
catheter to these areas. Now the catheter’s a
very special catheter. It can map and navigate
in three dimensions. It has a temperature sensor on it. It has an internal cooling system in it and it’s steerable. So it’s a high technology
piece of equipment; it’s not just a plastic catheter. And once we have found these
areas, we can then pass an electrical current through
these areas and actually heat the tissue underneath where
the catheter’s touching. The catheter has a cooling
system in it, so it actually doesn’t heat the tissue on top
of it, but heats the tissue deep to it. And you can actually create
a series of what’s called catheter ablations. Ablations, we actually
eliminate these abnormal areas using this catheter. And basically, what you can do,
is take an area of the heart where a-fib is coming
from, and put it in jail. Isolate it electrically by
doing a series of ablations around it with the catheter. There are other treatments available for atrial fibrillation,
sorry, from catheter ablation, and one of the treatments
is a treatment called the maze procedure. And what this procedure
does, is the chest is opened surgically and the heart
is exposed and the areas that are causing atrial
fibrillation are basically destroyed with a scalpel. The heart’s then sewn back
together and the chest is closed and these abnormal areas
that have caused a-fib have been taken out with
the surgeon’s scalpel. And this procedure will work very well for atrial fibrillation. The problem, obviously, is
it’s an invasive procedure. But understanding that you
can fix a-fib surgically, has led us to the ability to
also fix it in many patients with a minimally-invasive procedure with a catheter ablation.

2 thoughts on “Dr. Robert S. Fishel – JFK Medical Center – Treating Atrial Fibrillation

  1. I had the catheter ablation around 1997. I did not work. They woke me up in the recovery room and said, "we couldn't find the source of those rogue electrical signals that are causing your afib. But no big deal. You can control it with pills."

    Well, I was hoping to wake up cured, but I have to take the pills. I have been admitted to the hospital three times with severe afib episodes since that failed procedure. Technically, the last one was termed kind of a baby heart attack.

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