Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2010 Aug 23;3(2):275.
doi: 10.4022/jafib.275. eCollection 2010 Aug-Sep.

Invasive Management of Atrial Fibrillation and the Elderly

Sandeep M Patel  1 , Samuel J Asirvatham  2   3
Affiliations
Review

Invasive Management of Atrial Fibrillation and the Elderly

Sandeep M Patel et al. J Atr Fibrillation. .
No abstract available

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Illustration of the two types of atrial fibrillation. Paroxysmal AF typically occurs in younger patients with normal hearts, however may be seen for the first time in the elderly and is often more symptomatic than persistent AF. Paroxysmal is often “trigger”-related with the pulmonary veins and other thoracic veins targeted for ablation when treating this type of AF. Persistent AF involves abnormalities of the atrial myocardium itself, and ablation approaches often require more then pulmonary vein isolation alone
Figure 2.
Figure 2.. Typical electrocardiogram of AF illustrating the common reasons or symptoms seen in patients. Periods of rapid ventricular rates may give rise to palpitations, and the marked irregularity results in unpredictable ventricular filling and may result in fatigue or exertional dyspnea
Figure 3.
Figure 3.. Illustration of the primary approaches to manage symptoms in patients with AF. With rate control strategies AF continues, but drugs to slow the AV node (yellow arrow) are used to minimize patients’ symptoms (palpitations). With rhythm-control strategy, an attempt is made to maintain the patient in sinus rhythm. AV node ablation is an effective mean to achieve a rate control, whereas focal ablation targets rhythm control when pharmacotherapy has failed and patients remain symptomatic
Figure 4.
Figure 4.. Illustration of the primary approaches in trigger ablation. Circumferential ablation (hatched yellow lines) is done around the pulmonary veins, as well as the superior vena cava. In addition, to address substrate abnormalities, linear ablation, both in the right and left atrium is performed
Figure 5.
Figure 5.. Electrocardiogram of typical atrial flutter. Antiarrhythmic agents are generally more effective for atrial fibrillation than atrial flutter. In such cases, combined approaches using membrane active drugs for AF and either ablation or antitachycardia pacemaker-based therapy for atrial flutter can be useful
Figure 6.
Figure 6.. Cartoon illustration of the principle underlying the surgical maze procedure. In the classic cut-and-sew maze procedure, suture lines are placed around the pulmonary veins, as well as in the right and left atria. The atrium is effectively compartmentalized and thus minimizing the chance of the atria fibrillating, yet the sinus node impulse is still allowed to “navigate the maze” to activate the ventricle via the AV node (see text for details)
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Crandall Mark A, Bradley David J, Packer Douglas L, Asirvatham Samuel J. Contemporary management of atrial fibrillation: update on anticoagulation and invasive management strategies. Mayo Clin. Proc. 2009 Jul;84 (7):643–62. - PMC - PubMed
    1. Haïssaguerre M, Jaïs P, Shah D C, Arentz T, Kalusche D, Takahashi A, Garrigue S, Hocini M, Peng J T, Clémenty J. Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers. J. Cardiovasc. Electrophysiol. 2000 Jan;11 (1):2–10. - PubMed
    1. Asirvatham Samuel J. Advances in catheter ablation: a burning trail! Indian Heart J. 2012 Apr 14;63 (4):379–85. - PubMed
    1. Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, Vicedomini G, Salvati A, Dicandia C, Mazzone P, Santinelli V, Gulletta S, Chierchia S. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation. 2000 Nov 21;102 (21):2619–28. - PubMed
    1. Bunch T Jared, Weiss J Peter, Crandall Brian G, May Heidi T, Bair Tami L, Osborn Jeffrey S, Anderson Jeffrey L, Lappe Donald L, Muhlestein J Brent, Nelson Jennifer, Day John D. Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in octogenarians. Pacing Clin Electrophysiol. 2010 Feb;33 (2):146–52. - PubMed

LinkOut - more resources