Atrial Fibrillation Paper

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A systematic review of the literature on…
Radio Frequency Cardiac Ablation Therapy as First Line Treatment for Paroxysmal Atrial Fibrillation vs. Anti-Arrhythmic Drug Therapy.

The Capstone Project
Presented to
The Faculty of the Division of Physician Assistant Studies
Long Island University
In Partial Fulfillment of the Requirements for the Master of Science Degree in Physician Assistant Studies

Boris David Fuzaylov

Introduction Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance in the United States, affecting over 2 million individuals with over 150,000 new cases of AF being diagnosed each year. Approximately 4% of the population over the age of 65 is affected. As a person ages, …show more content…

A website for the American Heart Association (AHA) and the American College of Cardiology Foundation showed guidelines as to how to treat all classifications of atrial fibrillation. This article mentioned recommendations for which procedure/treatment was appropriate for each classification of AF and if the benefit was greater than the risk. Another search was done and was geared towards certain medical websites such as the Journal of the American Medical Association (JAMA), and the New England Journal of Medicine (NEJM), which prompted a search for the topic that led to the discovery of a few articles that are presented in this paper. The last tool that was used was Long Island University’s library online database that is available to all students to help locate articles when working on a research paper. The databases that were primarily used were Medline: PubMed and Medline: Ebsco created by the National Library of Medicine and it was found to be quite helpful in finding copious articles relevant to the topic. In the search bar, keywords such as: “atrial fibrillation”, “catheter ablation”, and “paroxysmal”, were used which resulted in many articles. The filters were set to human subjects, the English language, full text articles, and articles published since 2005. Results that did not include atrial …show more content…

Most focal AF is initiated by premature beats from the orifices of the pulmonary veins or from the myocardial sleeves inside the PV’s, and radio frequency catheter ablation of triggered foci has been shown to cure AF. 14 Experts in catheter ablation have acknowledged that pulmonary vein isolation is the primary approach for patients with AF. It has been noted that pulmonary vein ostial ablation may result in pulmonary vein stenosis, which is why most conductors have discussed going away from the ostium and towards the antrum of the pulmonary vein.14 The antrum blends into the posterior wall of the left atrium and to be able to include most of the pulmonary vein, ablation must be performed around the entire antrum along the posterior left atrium wall.14 A recent meta analysis of 31 studies including 2,800 patients found that the single procedure success rate of pulmonary vein isolation of all types of AF without anti arrhythmic drugs was 57%.14 An analysis of 34 studies enrolling a total of 3,481 patients show that the success rate without anti arrhythmic drugs increased to 71% after multiple procedures.14 However, examining data from 6 pioneering centers with greater experience in AF ablation, the success rate without anti arrhythmic drugs was 81% in 1,039 patients followed up for a period of 6 months to 2.4 years.14 Recently, two 5 year follow up studies reported that single procedure success rates without

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