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AFib Treatment

Atrial fibrillation (AFib) treatment aims to reduce your symptoms and lower your risk of stroke and heart failure. The Washington University and Barnes-Jewish Heart & Vascular Center in St. Louis offers a complete array of AFib treatments. Our care includes many noninvasive approaches to correct heart rhythm with a shorter recovery period.

AFib Treatment: Why Choose Barnes-Jewish Hospital?

At the Heart & Vascular Center, you’ll work with an arrhythmia team of world-renowned experts in AFib care. In fact, a Washington University doctor developed the revolutionary Cox-Maze procedure for AFib. We continue to serve as a center of research and innovation for atrial fibrillation.

AFib Treatments We Offer

Our highly experienced arrhythmia team tailors treatment to your needs. We make sure you understand your options and are comfortable with the plan before you start treatment. Your options may include:

Medications for AFib

Medications such as beta blockers and calcium channel blockers can control and restore regular heart rhythm. Other medicines, such as anticoagulants and antiplatelets (blood thinners), can prevent clots that can lead to stroke. 

Electrical cardioversion

This procedure delivers a controlled shock to the heart to restore normal heart rhythm. You’ll be asleep under anesthesia during the shock, so you won’t feel any discomfort. Most people can resume normal activities soon after cardioversion.

Catheter ablation

An ablation procedure is a minimally invasive AFib treatment that uses catheters (thin, flexible tubes) to deliver heat or cold energy to your heart. The energy creates scars that cut off abnormal electrical impulses. 

Our team performs complex ablations to treat atrial fibrillation and ventricular tachycardia. Patients come to us from across the Midwest because of our expertise. Learn more about cardiac electrophysiology.

During an ablation procedure, we use advanced mapping technologies to identify disordered electrical patterns in your heart. By locating the precise area of the abnormal heart rhythm, we can perform a tailored, patient-specific treatment. We may use:

  • Rotor mapping: Traditional ablation technologies can be less than exact in identifying patterns in complex arrhythmias. Using rotor mapping, we can see the disordered patterns and find the precise source of the arrhythmia.
  • Stereotaxis Magnetic Navigation System: Washington University electrophysiologists helped develop this system. It enables us to guide the catheter with precision using computer controls and magnetic fields. As a result, we can access difficult-to-reach locations within the heart.
  • ECGI imaging: ECGI mapping is noninvasive. You wear a specialized vest with electrodes that allows us to locate the trouble spots in your heart.

Surgical ablation (Cox-Maze procedure)

The Cox-Maze procedure, developed at our hospital, is the gold standard for treating AFib. We train doctors from around the world to perform this complex procedure for AFib or AFib combined with other conditions. 

We can complete the Cox-Maze procedure without opening your chest. We access your heart using a minimally invasive procedure called right minithoracotomy (RMT). RMT involves an incision about 3 inches long between your ribs.

Your surgeon uses radiofrequency energy (heat) or cryoablation (cold) to make a series of small scars on your heart. These scars interrupt faulty electrical impulses and stop AFib. The procedure has excellent long-term success, ending AFib events for more than 90 percent of our patients. 

Pacemakers and ICDs

In some cases, we recommend pacing devices to help your heart maintain a steady rate. A pacemaker for AFib sits under your skin, near your heart. When it detects a slow heart rhythm, it sends a signal to speed up the heartbeat.

If you are at high risk of arrhythmia stopping your heart, an implantable cardioverter defibrillator (ICD) may be an option. This device, about the size of a pocket watch, sits in your chest, under the skin. When the ICD detects an abnormal electrical signal, it can correct the rhythm within seconds. 

Our cardiac electrophysiologists are experts in placing and setting pacemakers and ICDs. 

AFib and Stroke Risk

AFib raises your risk of having a stroke because it prevents the heart from completely emptying of blood with each pump. When blood pools, it can form a clot. If the clot breaks loose, it can travel to the brain and cause a stroke.

Blood most often pools in one of the heart’s upper chambers, in an area called the left atrial appendage (LAA). The LAA, also called the "stroke sac," is a thumb-size pouch extending off the chamber. Preventing blood clots and performing procedures to reduce your likelihood of having a stroke are crucial parts of AFib treatment.

Stroke-reducing procedures

If you are at high risk for stroke but cannot take blood-thinning medication long-term, your doctor may suggest a procedure.

For years, surgeons have removed the LAA to reduce stroke risk. By removing the LAA, blood can no longer pool there. We use new developments in stroke-reducing procedures that allow us to close off the LAA instead of removing it. By closing it off, the blood cannot move into the sac and form a clot.

As a national leader in AFib treatment, we offer two different procedures to close the LAA. Both have rigorous evidence proving their effectiveness. We perform both of these minimally invasive stroke-reducing procedures without having to open the chest:

  • WATCHMAN: We use a percutaneous (catheter-based) procedure to place a plug-like device in the LAA. The device sits at the base of the stroke sac, blocking blood from entering. You take blood thinners temporarily after the procedure to keep you safer as your body adjusts.
  • AtriClip: During minimally invasive surgery, we make three small incisions in your left chest, under the armpit. We place a small clip outside the LAA. The clip closes the entrance to the LAA, blocking blood from flowing in where it might clot. The AtriClip may provide a good option if you are also having other heart surgery or a Cox-Maze procedure for AFib.

Contact Us

We invite you to complete our atrial fibrillation treatment options form so our doctors can create your personalized treatment plan.  

Or, to make an appointment with a Washington University AFib specialist at Barnes-Jewish Hospital in St. Louis, call 314-747-1518.