Microwave Ablation - A New Use for an Old Technology

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US Cardiology 2004;2004:1(1):1-8

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Atrial Fibrillation

Atrial fibrillation (AF), the chaotic and disorganized activity of the upper chambers of the heart, is the most common cardiac rhythm disturbance. It affects approximately 1% of the US population, or almost three million people. It occurs more frequently in the aged, affecting about 5% of people over 70 and as many as 10% of people over the age of 80. AF is also considered to be the leading cause of stroke in the US, leading to as many as 30% of strokes in the elderly population.

Besides being a costly arrhythmia, AF is also extremely troubling to patients and their physicians. Most people experience symptoms ranging from a relatively minor feeling of discomfort or 'doomÔÇÖ to severe frank palpitations and even syncope. As patients go in and out of AF, they present frequently to emergency rooms for control of their heart rate and/or rhythm, consuming large amounts of time and energy for treatment.

Despite having to deal with AF for many decades, the medical profession has made remarkably little progress in treating it. Currently accepted therapies with drugs and electrical cardioversion are palliative, not curative. Many patients are told to 'live withÔÇÖ their arrhythmia as nothing can be done - they are managed chronically with anti-coagulation and rate control. Patients in whom ventricular rate may be particularly difficult to control sometimes have their cardiac conducting system purposefully destroyed (artioventricular (AV) nodal ablation) and a permanent pacemaker implanted.

In comparison with pharmacologic therapy, surgical therapy for AF has been practised for the last 15 years and has enjoyed as much as a 97% cure rate with long-term follow-up.1-4 As it is practised today, however, CoxÔÇÖs Maze-III procedure remains poorly accepted due to its complexity and morbidity. Over the last few years, there has been an explosion of interest and activity in developing less invasive techniques that would be more widely accepted by patients and physicians yet that maintain the high cure rate offered by the Maze-III.

Much of the lack of progress can surely be blamed on the paucity of basic science models in which this disease is studied. Even the classification system for this disease is confusing and antiquated. It has only recently been concluded that AF is probably not one disease, but more likely two or three, depending upon the stage at which the patient presents, how long they have had the arrhythmia, and what is the predominant rhythm disturbance. Accordingly, AF has now been divided into three classes - paroxysmal, persistent, and permanent.5-9

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