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Published on May 28, 2019

Ablation at Gundersen can improve or eliminate atrial fibrillation

Do you have a patient with atrial fibrillation (AF) for whom medication or cardioversion are not effective or tolerated? If so, you and your patient should consider a referral to electrophysiologist David Ludden, MD, at Gundersen Health System. Dr. Ludden is fellowship trained in cardiovascular disease and clinical cardiac electrophysiology (EP).

David Ludden, MD

David Ludden, MD

Dr. Ludden offers diagnostic EP studies, rhythm monitoring and assessments, as well as minimally invasive ablation procedures for many arrythmias including catheter-based ablation for AF.

According to Dr. Ludden, AF ablation may prove to be the best option for a wide range of patients including:

  • People for whom rhythm control medications are ineffective or poorly tolerated
  • People who do not want to take anti-arrhythmic therapy due to potential side effects
  • Those who have heart failure or a reduced ejection fraction
  • Those with tachy-brady syndrome—it may eliminate the need for a pacemaker
  • As a first-line treatment in younger people with minimal co-morbidities

But Dr. Ludden notes, "Ablation is not clinically indicated if the sole purpose is to stop blood thinners."

"AF activity is generally focused in the pulmonary vein region for most patients with paroxysmal atrial fibrillation," Dr. Ludden reports. "For these patients, pulmonary vein isolation (PVI) is most effective. As AF progresses, more than one catheter ablation procedure, medication or a pacemaker may be needed as well."

"Early referral, especially in highly symptomatic patients, is key," Dr. Ludden encourages. "Atrial fibrillation is a progressive disease and will become more frequent. If it goes uncontrolled too long it can lead to longstanding persistent atrial fibrillation which stresses the atrium, causes remodeling and ultimately a cardiomyopathy. There is a point of no return when AF has gone on for so long, and the chamber so enlarged, that successful treatment with ablation is very low and may not be worth the risk."

The main aim of a rhythm control strategy in AF is to provide symptomatic relief. The link between AF and potentially life-threatening stroke or heart failure is clear, while there is also data linking AF with dementia and mortality.

"There are modifiable factors that you and your patient should address including high blood pressure, diabetes, sleep apnea, obesity, thyroid problems, electrolyte abnormalities, and too much caffeine and alcohol," says Dr. Ludden. "By modifying risks, we may be able to eliminate the need for aggressive AF treatment. If ablation is necessary, addressing these factors will improve success."

If you have a patient who may benefit from an electrophysiology assessment or ablation, consider a referral to Dr. Ludden for an evaluation. To schedule an appointment for your patient or to consult with Dr. Ludden, call via MedLink at (800) 336-5465 or in La Crosse at (608) 775-5465.

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