Health Care Professionals

The Atrial Fibrillation Ablation Center does not stand alone. Our team specializes in arrhythmia management and is dependent upon you, the primary health care provider, internist, cardiologist, surgeon, intensivist, etc. who refer to us. We are grateful to the army of nurses, technicians, physician assistants and other health care workers who support the practice of medicine and electrophysiology.

We are a resource to you as a specialty service, much like other specialty services, and need you to partner with us in the care of the arrhythmia patient.

Aurora's Standards

We follow the guidelines developed, endorsed or approved by the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the European Society of Cardiology, the Society of Thoracic Surgeons and the Heart Rhythm Society.

Our goals in the treatment of patients with atrial fibrillation (AF) have evolved as basic scientific discoveries have revealed information about genetic, cellular, anatomical and electrical mechanisms of normal atrial fibrillation, and with the advent of newer medications and technology. We continue to evolve and grow but believe we now have the tools to help stop the progression of AF from paroxysmal AF to continuous, chronic AF with interventions aimed at rhythm control.

Continuing Medical Education

Announcing registration now open for the 2011 AF, VT, VF Summit
Dec. 2-3, 2011
Fairmont Hotel, Chicago, IL

Download the 2011 AF, VT, VF Summit brochure. (PDF, 609 KB)

The Rate Control vs. Restoration of Normal Rhythm Debate

The following is extracted from ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation:

"Quality of life is considerably impaired in patients with AF compared with age-matched controls. Sustained sinus rhythm is associated with improved quality of life and better exercise performance than AF in some studies.

For many individuals, restoring normal rhythm may be the best initial approach. Often, medications that exert both antiarrhythmic and rate-controlling effects are required. Catheter ablation should be considered to maintain sinus rhythm in patients who failed to respond to antiarrhythmic drug therapy.

Depending upon the symptom profile and general health of older, elderly patients, rate control may be reasonable initial therapy if AF is persistent, chronic and accompanied by hypertension or associated with heart disease."

Establishing a Treatment Plan

The type of AF ablation or medical therapy is dependent upon the type and the stage of the AF. We can help you make this decision and can provide a second opinion or consultation. We will not turn away any patient from an evaluation, even if the patient with chronic AF may be considered a candidate.

Catheter Ablation may be helpful for a patient with chronic or persistent AF; however, the procedure may be more extensive and a repeat procedure may be needed. AF may occur in isolation or in association with other arrhythmias, most commonly atrial flutter or atrial tachycardia. Atrial flutter may arise during treatment with antiarrhythmic agents prescribed to prevent recurrent AF. Atrial flutter may degenerate into AF and AF may convert to atrial flutterFocal atrial tachycardias, AV reentrant tachycardias and AV nodal reentrant tachycardias may also trigger AF. Ablation of these arrhythmias can be done at the same setting when they are induced or documented spontaneously.

Indications for Catheter AF Ablation

The guideline statement (below) suggests ablation is for the symptomatic patient. The patient may present with unusual or vague symptoms. In some cases, patients cannot correlate their symptoms to AF episodes. At other times, patients’ overall health is affected by AF with increased heart failure or fatigue.

"The primary clinical benefit from catheter ablation of AF is an improvement in quality of life resulting from elimination of arrhythmia-related symptoms such as palpitations, fatigue, or effort ...thus, the primary selection criterion for catheter ablation should be the presence of symptomatic AF refractory or intolerant to at least one antiarrhythmic medication."

  • Symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication
  • In rare clinical situations, AF ablation may be a first line therapy
  • Selected symptomatic patients with heart failure and/or reduced ejection fraction
  • The presence of a left atrial thrombus is a contraindication to catheter ablation of AF

Surgical AF Ablation

Surgical ablation of AF is an alternative for patients who are having open chest or heart surgery, although atrial flutters or other concomitant-organized arrhythmias cannot be addressed at this setting. Subsets of patients who have AF also have flutters or tachycardias that may recur after surgery and require subsequent electrophysiologic mapping.

Preventing Thromboemboli

Antithrombotic therapy with vitamin K agonists is universally recommended for all patients with AF to prevent thromboemboli except in a few circumstances.
Following a catheter ablation:

  • Warfarin is recommended for all patients for at least two months following an AF ablation procedure
  • Decisions regarding the use of warfarin more than two months following ablation should be based on the patient’s risk factors for stroke and not on the presence or type of AF
  • Patients may have asymptomatic episodes of AF or may have different arrhythmias such as atrial flutters in the post ablation period. Positive evidence of arrhythmia absence on repeated long term ambulatory monitors will be used to determine when and if anticoagulation can be stopped
  • Discontinuation of warfarin therapy post ablation is generally not recommended in patients who have a CHADS score greater than or equal to 2

Fuster,V., Ryden, L., Cannom, D., et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. JACC Vol. 48, No. 4, 2006, August 15, 2006:e149–246

Calkins, H., Brugada, J., Packer, D., et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up. Heart Rhythm, Vol 4, No 6, June 2007

Publications and Research

Cardiac Image Registration. Sra J. J Afib 2008;1(3);145-160.

Atrial fibrillation ablation complications. Sra J. J Interv Card Electrophysiol 2008;22:167-172.

Cardiac image integration: implication for atrial fibrillation ablation. Sra J. J Interv Card Electrophysiol.2008;22(2);145-154

Cardiac image registration of the left atrium and pulmonary veins. Sra J, Ratnakumar S. Heart Rhythm 2008;5:609-617.

Periprocedural anticoagulation for atrial fibrillation ablation. Mortada ME, Chandrasekaran K, Nangia V, Dhala A, Blanck Z, Cooley R, Bhatia A, Gilbert C, Akhtar M, Sra J. J Cardiovasc Electrophysiol 2008;19:362-366.

Mapping techniques for AF ablation. Sra J, Akhtar M. Curr Probl Cardiol 2007;32:663-768

CT-Fluoro registration-guided ablation of the left atrium in atrial fibrillation. Mortada ME, Krum D, Sra J. J Interv Card Electrophysiol 2007;Oct 17 Epub

Computed tomography fluoroscopy image integration-guided catheter ablation of atrial fibrillation. Sra J, Narayan G, Krum D, Malloy A, Cooley R, Bhatia A, Dhala A, Blanck Z, Nangia V, Akhtar M. J Cardiovasc Electrophysiol 2007;18:409-414.

Registration of 3D computed tomographic images with interventional systems: implications for catheter ablation of atrial fibrillation. Sra J, Narayan G, Krum, Akhtar M. J Interv Cardiac Electrophysiol 2007;16:141-8.

Pulmonary vein isolation and linear lesions in atrial fibrillation ablation. Sheikh I, Krum D, Cooley R, Dhala A, Blanck Z, Bhatia A, Nangia V, Akhtar M, Sra J. J Interv Card Electrophysiol 2006;16:103-109.

Posterior left-atrial esophageal relationship throughout the cardiac cycle. Sra J, Krum D, Malloy A, Bhatia A, Cooley R, Blanck Z, Dhala A, Anderson AJ, Akhtar M. J Interv Cardiac Electrophysiol 2006;16:73-80.

Combined use of 1C and III agents for highly symptomatic, refractory atrial fibrillation. Narayan G, Akhtar M, Sra J. J Interv Cardiac Electrophysiol 2006;15:175-178.

Common ostium of the inferior pulmonary veins in a patient undergoing left atrial ablation for atrial fibrillation. Sra J, Malloy A, Shah H, Krum D. J Interv Cardiac Electrophysiol 2006;15:203.

Cardiac Activation and Motion Propagation - Next Step in Catheter Navigation? Sra J. Heart Rhythm Editorial Commentary 2006;3:789-90.

Atrial tachycardia arising from the coronary sinus musculature: electrophysiological characteristics and long-term outcomes of radiofrequency ablation. Badhwar N, Kalman JM, Sparks PB, Kistler PM, Attari M, Berger M, Lee RJ, Sra J, Scheinman MM. J Am Coll Cardiol 2005;46:1921-30.

Registration of 3D left atrial computed tomographic images with projection images obtained using fluoroscopy. Sra J, Krum D, Malloy A, Vass M, Belanger B, Soubelet E, Vaillant R, Akhtar M. Circulation 2005;112:3763-3768.

Registration of three-dimensional left atrial images with interventional systems. Sra J. Heart 2005;91: 1098-1104.

Localization of left atrial esophageal anatomical relationship using CT-fluoro registration. Sra J, Krum D, Malloy A, Bloomgarden D. J Cardiovasc Electrophysiol EP Images 2005;16:1-2.

Registration of 3-D left atrial computed tomographic images with fluoroscopy. Sra J, Krum D, Belanger B, Vaillant R. HeartRhythm Images: Cell to Bedside 2005;2:1020.

Absent left inferior pulmonary vein in a patient undergoing atrial fibrillation ablation. Arora V, Nangia V, Krum D, Sra J. EP Images from Cell to Bedside- J Cardiovasc Electrophysiol 2005;16:924-5.

Catheter location, tracking, cardiac chamber geometry creation, and ablation using cutaneous patches. Krum D, Goel A, Hauck J, Schweitzer, Hare J, Attari M, Dhala A, Cooley R, Akhtar M, Sra J. JICE 2005;12:17-22.

Feasibility and validation of registration of three-dimensional left atrial models derived from computed tomography with a noncontact cardiac mapping system. Sra J, Krum D, Hare J, Okerlund D, Thompson H, Vass M, Schweitzer J, Olson E, Foley WD, Akhtar M. HeartRhythm 2005;2:55-63. (Cover article)

Pulmonary vein narrowing following atrial fibrillation ablation. Sra J, Krum D, Fung M, Okerlund D. J Cardiovasc Electrophysiol Images 2004;15:969.

Endocardial imaging of the left atrium in patients with atrial fibrillation. Sra J, Krum D, Okerlund D, Thompson H. J Cardiovasc Electrophysiol Images 2004;15:247.

Noncontact and electroanatomic mapping of atrial flutter in surgically repaired sinus venosus atrial septal defect and rerouting of anomalous pulmonary venous drainage. Kumaraswamy N, Kumbar C, Dhala A, Sra J. Pacing and Clin Electrophysiol 2004;27:526-9.

Pulmonary vein narrowing following atrial fibrillation ablation. Sra J, Krum D, Fung M, Okerlund D. J Cardiovasc Electrophysiol Images 2004;15:969.

Endocardial imaging of the left atrium in patients with atrial fibrillation. Sra J, Krum D, Okerlund D, Thompson H. J Cardiovasc Electrophysiol Images 2004;15:247.

Visualization of remnants of the left atrial appendage following epicardial surgical removal. Krum D, Olson DL, Bloomgarden D, Sra J. Heart Rhythm - Images: from Cell to Bedside 2004;1:249. (Cover article)

Endocardial imaging of the left atrium in patients with atrial fibrillation. Sra J, Krum D, Okerlund D, Thompson H. J Cardiovasc Electrophysiol Images 2004;15:247.

Radiofrequency ablation of atrial fibrillation during mitral valve surgery. Kress D, Sra J, Krum D, Goel A, Campbell J, Fox J. Semin Thorac Cardiovasc Surg 2002;14:210-8.

Validation of a left atrial lesion pattern for intraoperative ablation of atrial fibrillation. Kress D, Krum D, Chekanov V, Hare J, Michaud N, Akhtar M, Sra J. Ann Thorac Surg 2002;73:1160-8.

New technologies for mapping cardiac arrhythmias. Sra J, Thomas JM. Indian Heart J 2001;53(4):423-444.

Correlation of spontaneous and induced premature atrial complexes initiating atrial fibrillation in humans: Electrophysiologic parameters for guiding therapy. Sra J, Zaidi S, Krum D, Georgakopoulos N, Ahmad A, Akhtar M. J Cardiovasc Electrophysiol. 2001; 12:1347-1352.

Noncontact mapping for radiofrequency ablation of complex cardiac arrhythmias. Sra J, Bhatia A, Krum D, Akhtar M. J Intervent Card Electrophysiol 2001;5:327-355.

Atrial Fibrillation Detection and R-Wave Synchronization by Metrix Implantable Atrial Defibrillator:Implications for Long-Term Efficacy and Safety, Hung-Fat Tse, MB, BS; Chu-Pak Lau, MD; Jasbir S. Sra, MD; Herry J. G. M. Crijns, MD; Nils Edvardsson, MD; Salem Kacet, MD; D. George Wyse, MD, PhD; for the Metrix Investigators, Circulation 1999 Mar 23;99(11):1446-51