Physician discussing treatment options with middle-aged woman

 How is AF treated?

How is AF treated?

There are different ways to treat AF depending on your symptoms and the information gathered from your diagnostic tests. Your doctor will discuss the options with you and help you decide what treatment is the most appropriate for your condition and your lifestyle.

Healthy lifestyle

Whatever treatment plan is chosen, you should support it with good lifestyle choices that are well recognised to have a positive impact on heart health and general wellbeing.1

Having a healthy lifestyle doing a regular exercise.

EXERCISE REGULARLY

Eat a healthy diet and maintain a healthy weight

EAT A HEALTHY DIET AND MAINTAIN A HEALTHY WEIGHT

restrict and eliminate alcohol and caffeine.

RESTRICT/ELIMINATE ALCOHOL AND CAFFEINE

Stop smoking to have a healthy life.

STOP SMOKING

For more information on what you can do to improve your heart health and overall wellbeing, download our guide to healthy living.

Cardioversion

Cardioversion can be a scheduled procedure or used in emergencies.

Cardioversion can be a scheduled procedure or used in emergencies.
It involves delivering low-energy shocks to the heart in order to quickly restore a normal heart rhythm. Cardioversion can also be conducted with medication. While the risks are low, cardioversion is not generally a long-term solution. 

 Drug treatments

Drug therapy is often the first course of treatment for AF. A variety of different drug treatments are available, which fall into two main types:
 

  • Anti-arrhythmia drugs, such as sodium channel blockers and beta blockers, intended to control the rhythm and speed at which your heart beats
  • Blood-thinning drugs intended to reduce the risk of stroke by limiting the blood’s ability to clot

Your doctor will assess how well you tolerate the drugs, how they impact your lifestyle and how well they are controlling your AF and risk of stroke. This will help determine if they are a satisfactory treatment for you or if a different approach should be considered. 

Left atrial appendage closure (LAAC)

Blood is pumped from the left upper chamber of the heart (left atrium) to all parts of the body, including the brain. The left atrial appendage is the part of the heart where blood can pool and clot if the upper chambers (atria) of the heart are not contracting properly. By closing off this „clot-making reservoir“, the risk of stroke is significantly reduced and the need for long-term blood-thinning drugs can be avoided. 

Learn more abour LAAC with Watchman FLX.
Learn more about LAAC with WATCHMAN FLX

Cardiac ablation*

Cardiac ablation aims to treat the cause of AF by neutralising the locations in your heart that are transmitting the random or abnormal electrical signals that are disrupting its rhythm.
These problem signals often reach the heart via the joining points where the four pulmonary veins delivering blood from the lungs enter the left atrium.
A common form of cardiac ablation called pulmonary vein isolation (PVI) targets these specific joining points to stop them being able to transmit abnormal signals from the veins to the left atrium. Cardiac ablation is a minimally invasive procedure performed by advancing long thin tubes called catheters through blood vessels into your heart from a small incision in your groin. Once in position, a catheter is used to deliver energy to targeted points in your heart to "neutralise" the problem tissue so it will no longer be able to transmit the electrical signals that are causing your AF.

7-8 out of 10 patients with paroxysmal (intermittent) AF are free from AF for the first year after their cardiac ablation.2, 10-13 As AF is a chronic disease, the recurrence rate increases through 5 years and repeat ablation procedures might be needed.9

Ablation technology has evolved over the years to increase the precision and efficiency of the procedure and to minimise the risk of damage to healthy heart tissue or nerves. The latest innovation in cardiac ablation is pulsed-field ablation (PFA).2

INCREASING PRECISION, SAFETY AND EFFECTIVENESS2, 7

When were radiofrequency, cryoablation and PFA first used to treat AF

1991: First use of radiofrequency ablation for treatment of AF3

When were radiofrequency, cryoablation and PFA first used to treat AF

Introduction of 3D mapping systems for cardiac electrophysiology4
2005: First use of cryoablation for the treatment of AF5

When were radiofrequency, cryoablation and PFA first used to treat AF

2021: FARAPULSETM Pulsed* Field Ablation System approved for use in Europe after positive clinical trial results.6-8

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) uses high-frequency energy to create extreme heat to neutralise target tissue

Cryoablation

Cryoablation uses extreme cold to neutralise target tissue

Pulsed field ablation (PFA)

Pulsed field ablation uses microsecond electrical pulses to neutralise target tissue

 FARAPULSE™ Pulsed Field Ablation (PFA)* 

The FARAPULSETM PFA system has been specifically developed to offer a next-generation ablation method with excellent precision and accuracy. The "petals" of the distinctive flower-shaped catheter tip are straightened out while the catheter is being advanced through your veins to your heart. Once in position, they are opened up and adjusted to different shapes to fit the anatomy of the entrance from your pulmonary veins. Unlike radiofrequency and cryoablation, PFA works with pulsed, high-energy electrical fields and is therefore a non-thermal ablation method. Because cardiac cells are more sensitive to this electrical field, surrounding structures, such as the oesophagus or the phrenic nerve are usually not affected. PFA aims at selectively targeting and neutralising the tissue responsible for your AF.

Discover FARAPULSE PFA system and how it works.
Discover FARAPULSE PFA system and how it works.
Discover FARAPULSE PFA system and how it works.

Extensive studies have shown PFA with FARAPULSE™ to be safe, with minimal side effects.2, 8, 14-16 Patients have also reported minimal pain and fast recovery after their FARAPULSE™ PFA procedure.17, 18 

 *Not all types of atrial fibrillation are suitable for treatment with cardiac ablation or with the FARAPULSE™ Pulsed Field Ablation System. Your doctor will be able to advise you if it could be a suitable treatment for you according to diagnostic and treatment guidelines.
**Study showed 78% of patients free from paroxysmal AF in the first year post cardiac ablation were still free from AF after 4 years.9


REFERENCES:

1.Isabelle C. Van Gelder et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal (2024) 00, 1–101 https://doi.org/10.1093/eurheartj/ehae176.
2.Reddy VY, Gerstenfeld EP, Natale A, et al. ADVENT: Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation New England Journal of Medicine (August, 2023)
3.Ghzally Y, Ahmed I, Gerasimon G. Catheter Ablation. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470203/. Accessed July 2024.
4.Sebag FA, Wright M. Cardiac Electrophysiology: Evolution of the technique over the last decade. e-journal of Cardiology Practice 2022 12 Jan;21(15). Available at https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-21/cardiac-electrophysiology-evolution-of-the-technique-over-the-last-decade. Accessed July 2024
5.Yang H, Xiang J, Shen J, et al. Global Research Trends of Cryoablation for Atrial Fibrillation from 2002 to 2022: A Bibliometric Analysis. Anatol J Cardiol. 2023 Dec 1;27(12):688-696. doi: 10.14744/AnatolJCardiol.2023.
6.Cardiac Rhythm News. 29 January 2021. Available at: https://cardiacrhythmnews.com/farapulse-gains-ce-mark-for-its-pulsed-field-ablation-system/. Accessed July 2024.
7.European Society of Cardiology press release marking release of international consensus statement on how to treat AF with ablation. Press release available at: https://www.escardio.org/The-ESC/Press-Office/Press-releases/International-experts-agree-on-standards-for-catheter-ablation-of-atrial-fibrillation. Accessed July 2024.
8.Reddy et al., Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1-Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II JACC: Clinical Electrophysiology 7.5 (2021): 614-627.
9.Ngo L, Lee XW, Elwashahy M, et al. Freedom from atrial arrhythmia and other clinical outcomes at 5 years and beyond after catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2023 Aug 7;9(5):447-458. doi: 10.1093/ehjqcco/qcad037
10.Mont L, Bisbal F, Hernandez-Madrid A, Perez-Castellano N, Vinolas X, Arenal A, et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J 2014;35:501–7.
https://doi.org/10.1093/eurheartj/eht457
11.Wazni OM, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S, et al. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med 2021;384:316-24. https://www.nejm.org/doi/10.1056/NEJMoa2029554
12.Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med 2012;367:1587–95. https://doi.org/10.1056/NEJMoa1113566
13.Kuniss M, Pavlovic N, Velagic V, Hermida JS, Healey S, Arena G, et al. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace 2021;23:1033–41. https://doi.org/10.1093/europace/euab029
14.Schmidt B, Bordignon S, Tohoku S, et al. 5S Study: Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation. Circ Arrhythm Electrophysiol. 2022 Jun;15(6):e010817. doi: 10.1161/CIRCEP.121.010817.
15.Turagam MK, Neuzil P, Schmidt B, et al. Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry. Circulation. 2023;148:35–46. DOI:10.1161/CIRCULATIONAHA.123.064959
16.Ekanem, E., Neuzil, P., Reichlin, T. et al. Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study. Nat Med (2024). https://doi.org/10.1038/s41591-024-03114-3.
17.Füting A, Neven K, Howel D et al. Patient discomfort following pulsed field ablation for paroxysmal atrial fibrillation – an assessment of chest and groin pain using the Numeric Rating Scale. Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
18.Patient testimonials from FARAPULSE™ PFA WAVE DocuSeries​ Archives - Arrhythmia Academy


CAUTION:
This material is for informational purposes only and not meant for medical diagnosis. This information does not constitute medical or legal advice, and Boston Scientific makes no representation regarding the medical benefits included in this information. Boston Scientific strongly recommends that you consult with your physician on all matters pertaining to your health. 
 

FARAPULSE™ Pulsed Field Ablation System:
The FARAPULSE Pulsed Field Ablation (PFA) System is intended for the isolation of the pulmonary veins in the treatment of paroxysmal atrial fibrillation by rendering targeted cardiac tissue electrically non-conductive to prevent cardiac arrhythmia initiation or maintenance. With all medical procedures there are risks associated with the use of the device. The risks include but are not limited to pain or discomfort, electric shock, hypotension, infection/inflammation, allergic reaction, anesthesia risk, radiation injury/tissue burn, heart failure, renal failure, respiratory distress, arrhythmia, nerve injury (such as phrenic nerve or vagal nerve), gastrointestinal disorders, vessel trauma, cardiac trauma (such as perforation), injury related to adjacent structures (esophageal injury, atrio-esophageal fistula, pulmonary injury), pulmonary vein stenosis, surgical and access complications, muscle spasm, injury due to blood clot or air bubbles in the lungs or other organs, heart attack, TIA, stroke, and/or damage to red blood cells. In rare cases, cardiac arrest or death may occur. Be sure to talk with your doctor so that you thoroughly understand all of the risks and benefits associated with the implantation and use of the device.
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