Atrial Fibrillation Ablation Center

Jasbir Sra, MD, with Aurora Cardiovascular Services at Aurora St. Luke’s Medical Center explains why awareness is key and how Aurora can help diagnose, manage and treat this disorder.

The Atrial Fibrillation Ablation Center of Aurora Health Care in Milwaukee, Wisconsin, is a health care delivery system of physicians and nurses in our clinics and hospitals who are specially trained and dedicated to the care of patients with atrial fibrillation (AF).

The Atrial Fibrillation Center is one of a few centers in the world where the services of cardiac electrophysiologists, cardiovascular (heart) surgeons have combined technologies since the 1980s in a world class hospital center to provide advanced treatment to eliminate atrial fibrillation.

Contact Us | Patient Comments | Doctors | Services | Technology | Why Aurora?

Patient Comments

Joseph S. commented about his life after hybrid (convergent) ablation procedure:  “I’m very pleased – back working out, back on yoga … doing the things I like to do.”

 

 

 

Dan T.:“When I was first diagnosed with Atrial Fibrillation it was a frightening experience.  It confirmed what I feared, that something was not right with my heart.  Prior to seeing Dr. Sra I had been very active.  I was 47 years old and wanted to continue my active lifestyle.  I had been a runner (an occasional marathon) and also enjoyed biking and lifting weights. 

When I saw Dr. Sra he was very informative.  He took the time to answer all of my questions (I am an attorney; I had a lot of questions).  Dr. Sra explained all of my options.  He told me about the medications that I could take and about their side effects.  He told me about the ablation procedure, the risks, and the statistics regarding the likely outcomes. 

I opted for the ablation.  I did not want to take meds for the rest of my life.  The procedure was just as it was explained.  Everyone was great.  I was able to run again five days after the procedure.  I did have some skipped beats right after the procedure but nothing like the afib episodes prior to the procedure.  Those skipped beats have now subsided.  I am taking it slow but it is great to have my life back.  I am so grateful for Dr. Sra and his staff. 

I know that the decision regarding what to do when you are suffering with Atrial Fibrillation can be almost as agonizing as the episodes themselves.  However, I would not hesitate for an instant if I again had to make the decision to have an ablation to treat my atrial fibrillation. “ 

Why Choose the Atrial Fibrillation Ablation Center?

The Atrial Fibrillation Ablation Center is an arm of the electrophysiology division, Aurora Cardiovascular Services.  Historical highlights of the center include:

  • Aurora's cardiac electrophysiology program was the first in Wisconsin and among the first in the country, established in 1977 by Dr. Masood Akhtar
  • Catheter ablation was first applied in 1982, and we performed our first catheter ablation in 1983, performed the first radiofrequency ablation in the Midwest in 1990, and began using ablation for atrial fibrillation in 1999
  • Dr. Jasbir Sra was the first clinical investigator in the United States to implant the first implantable automatic defibrillator for atrial fibrillation

We’ve strived to be at the forefront of technological innovation and treatment of cardiac rhythm disturbances (arrhythmias). Positioned in a medical facility of this caliber, the Atrial Fibrillation Ablation Center has physicians from all specialties at its disposal whenever necessary. The expertise of our staff includes:

  • The Atrial Fibrillation Ablation Center physicians and staff have been performing atrial fibrillation ablations since the 1980s, increasing experience and technologies
  • Our doctors are board-certified cardiac electrophysiologists with faculty affiliations at the University of Wisconsin School of Medicine and Public Health
  • With over 30 years of experience in electrophysiology (EP), our service and physicians have performed thousands of procedures at St. Luke's Medical Center, an accredited, high-volume tertiary care center
  • We are proud to have expert physicians on our staff who train other cardiologists and electrophysiologists visiting us from all over the world
    • They actively teach and mentor in our ACGME-accredited electrophysiology fellowship training program
    • We offer additional important mentoring for fellows' development and enough experience for their learning

AF Ablation CenterAF ablation is the most complex of ablation procedures and requires use of multiple catheter-imaging and navigation systems in order to adequately evaluate AF and perform ablation safely. The AF Center has access to and uses the most advanced technologies in every AF ablation we perform.

Many AF patients also have other supraventricular tachycardias that are more organized. These tachycardias are usually the ones we call atrial flutter. Ablation of atrial flutters observed during AF ablation is important for the AF patient, as the rapid heartbeats of the flutters can be responsible for AF episodes or cause significant symptoms. We use three-dimensional electroanatomical mapping and diagnostic pacing techniques to identify these circuits. 

Services Provided at the Atrial Fibrillation Ablation Center 

The AF Ablation Center physicians are fully qualified and experienced in all the aspects of cardiac electrophysiology. We provide a comprehensive electrophysiology service, including:

  • Catheter ablation and medical management of supraventricular tachycardias, such as atrioventricular nodal reentry, atrial flutter, Wolff-Parkinson-White syndrome or other accessory pathways, and of course, AF
  • Catheter ablation and medical management of ventricular tachycardias
  • Implantation of permanent pacemakers and implantable cardioverter defibrillators (ICD)
  • Long-term follow-up for pacemakers and ICDs using remote, computerized, automatic monitoring
  • Implantation, follow-up and management of the new heart failure (biventricular) pacemakers and defibrillators

Techniques

  • Pulmonary Isolation Catheter Ablation Procedures is performed in all AF Ablations. Both cryo (freezing) and radiofrequency (RF, heat) energy technologies are available destroy abnormal electrical activity.
    • Candidates for ablation procedure are patients with:
      • Symptomatic AF who have failed initial medical therapy
      • Side effects from arrhythmia medicines
      • A preferences to avoid stronger medication therapy
  • Hybrid or Convergent Ablation Procedures: Only a few centers in the USA are capable of performing these non-open chest procedures combining technologies of electrophysiology (catheter {endocardium, inside of the heart]) with surgical (epicardium, inside of the heart) ablations without need for open heart or chest surgeries
    • Candidates for the hybrid procedure are patients with:
      • Long standing, persistent AF and/or larger hearts (large left atrial heart chambers) when standard ablation are not recommended
      • Failed prior standard catheter ablation procedure
  • Left Atrial Appendage Closure Devices prevent clots formed in the pouch (appendage) of the left atrium (upper left heart chamber) or filter clots to prevent stroke. Filter (Watchman™) and lasso (Lariat™) types are both available. Left atrial appendage closure devices are used in treatments for the reduction of strokes.
    • Candidates for closure devices are patients
      • Who cannot take anticoagulation medicines because of allergies or other reactions
      • Poor control of bleeding complications of anticoagulation medications.

Technology

The technologies available at our Atrial Fibrillation Ablation Center allow us to plan the ablation procedure to the patient's specific needs. The use of a combination of several newer technologies is usually necessary to achieve a successful outcome. Types of technology used at the Atrial Fibrillation Ablation Center include:

  • Three-dimensional imaging: Three-dimensional image integration with electrical monitoring is used for most AF ablation procedure to give real-time data on three-dimensional maps with real-time tracking of catheter location, allowing for safe and accurate diagnosis. This technology now permits us to integrate the patient's previously acquired CT or MRI of the left atria to improve and guide navigation of recording and ablation catheters. With fluoroscopy, we can create live, motion picture of the heart, and color-coded three-dimensional maps to reflect timing of electrical impulse impulses, as well as the voltage of the electrical signal separating out areas of healthy heart muscle from scarred or abnormal areas
  • X-ray: used during the procedure is modified to decrease exposure levels. The fluoroscopy moving X-ray pictures is created with digital enhancement from pictures taken at reduced frames per second and reduced exposure levels. This technique is possible because the ablation catheter movement is continuously tracked and displayed continuously on the three-dimensional electroanatomical mapping computer
  • BiPlane X-ray: this X-ray system can create two simultaneous images of the heart with its integrated two fluoroscopy (moving pictures of the heart) systems. This can help our doctors see how the catheters are moving through the heart in two dimensions (front to back and right to left) without moving the X-ray equipment
  • Electrocardiogram (EKG): Careful review of all electrocardiogram strips from continuous (21-30 day) outpatient monitors or standard EKG to define the burden of atrial fibrillation and discover if the patient has more than one type of heart rhythm problem.
  • Electrogram (EGM) and anatomically guided ablation: Standard, long establish techniques of ablation include creating lines of ablated ares to "block" abnormal electrical circuits of the heart. More recently, ablation of electrically abnormal areas has shown to be a necessary additional step in reducing recurrence of AF. This requires catheters that touch the heart to allow the IGM to be recorded on specialty monitors that can determine the characteristics of the signal, for example its amplitude, frequency or oscillations, and its duration or episodic continuity.
  • Tranesophageal echocardiography (TEE) shows us the left atria very clearly using ultrasound waves. The probe placed into the esophagus (swallowing or food tube) can be positioned to see the left atrium. The TEE is used to look for clots in the heart that would become a danger to you if we performed the left atrial ablation. The TEE helps us see the transseptal instruments, position them at the correct location in the right atrium and cross to the left side
  • Intracardiac echocardiography (sometimes called ICE): is a thin tube or catheter with tiny ultrasound probes that can be slipped into the vein and moved to the heart to show us the structures from the inside. The intracardiac echo is used at times to help with the transseptal procedure (much like the TEE) and to help guide positioning of the catheter during ablations
  • Cooled tip catheters: reduce heat loss and reduce the complications of clot formation on the catheter surface during ablation and help deliver the deeper lesions. These are important in creating continuous lesions to avoid any new rhythm problems
  • Cryo and radiofrequency energies: can be used in certain heart areas instead of heat for ablation
  • Robotics: robotic system for catheter is available to help steer the catheters within the heart. We use the robot to steer and hold catheters during selected procedures
  • Thermometer: esophagus temperature is watched very closely for elevations that might mean we are at an area of the heart overlying the esophagus
  • Computerized medical records and databases: the computer provides us with unique ability to have information at the right time in the right place. A good example of this is the medication prescribing error reduction possible when your allergies are listed clearly or the computer automatically notes a dose that is incompatible with the medicine
  • Surgical ablations: The American Heart Association, American college of Cardiology and the Heart Rhythm Society continue to recommend open chest surgery for AF if the patient needs surgical procedure for another reason such as coronary artery bypass or valve replacement. Our surgeons have extensive experience in these procedures that have good outcomes. Robotic surgical instruments are available if considered appropriate. The AF Ablation Center can help you determine if surgery is for you.

There are also additional technologies available through hybrid/convergent procedures. Candidates for this procedure have recurring episodes of persistent long lasting and/or permanent atrial fibrillation resistant to the standard catheter ablation procedure.  In these patients, a combination of the catheter and surgical techniques can provide a good outcome.

The Hybrid ablation procedure is a truly minimally-invasive treatment solution with the surgeon creating a comprehensive bi-atrial lesion pattern on the outside of a beating heart without the need for chest incisions. The energy used is similar to radiofrequency ablation energy. An Electrophysiologist then uses an ablation catheter to complete the lesion pattern and check that all reentrant circuits have been interrupted.

  • Subxiphoid surgical approach: The instrument for the hybrid ablation is passed under the breast bone using a small incision. The lining around the lungs is undisturbed and chest re-inflation may not be necessary. Some air and fluid do accumulate as the surgeon washes away body fluids and chest drain may be used to eliminate any from accumulating around the heart.
  • Optical visualization using instruments to see the actual heart surface similar to the technology used for colonoscopy. This permits careful application of ablations avoiding delicate structures on the heart such as coronary arteries.

Staff and Physicians

The physicians performing atrial fibrillation ablation must adhere to strict criteria for privileging at our center. In addition to being board-certified electrophysiologists (board-certified cardiologists with additional years of study in arrhythmias), they must demonstrate considerable proficiency with ablations, and specifically adequate proficiency for AF ablation, to ensure our center's high skill level. 

Jasbir S. Sra, MD, FACC, FHRS
Clinical Professor of Medicine, Electrophysiologist & Atrial Fibrillation Ablation Center Director
Board Certifications: Internal Medicine, Cardiovascular Diseases, Clinical Cardiac Electrophysiology

Dr. Sra has been an electrophysiologist in our health care system since 1990. He performed his first atrial fibrillation (AF) ablation in 1999. In 1995, he was the first doctor in the United States to implant the atrial defibrillator for atrial fibrillation. He is board-certified by the American Board of Internal Medicine in Internal Medicine, Cardiovascular Disease and Cardiac Electrophysiology.

In 1999, he was appointed Professor of Medicine, Cardiovascular Disease Section, University of Wisconsin School of Medicine and Public Health. Dr. Sra is the Atrial Fibrillation Center Medical Director. He has been honored as a Fellow by the American College of Cardiology and a Fellow by the Heart Rhythm Society, as well as listings in The Best Doctors in America for a number of years.

Ryan Cooley, MD
Clinical Assistant Professor of Medicine, Electrophysiologist
Board Certifications: Clinical Cardiac Electrophysiology, Cardiovascular Disease, Internal Medicine

Dr. Cooley has been an electrophysiologist in our health care system since 1999. He is board-certified by the American Board of Internal Medicine in Internal Medicine, Cardiovascular Disease and Cardiac Electrophysiology. In 1999, he was appointed Clinical Assistant Professor of Medicine, Cardiovascular Disease Section, University of Wisconsin School of Medicine and Public Health.

Masood Akhtar, MD, FACC, FACP, FAHA, FHRS, MACP
Clinical Professor of Medicine, Electrophysiologist
Board Certifications: Internal Medicine, Cardiovascular Diseases, Clinical Cardiac Electrophysiology

Dr. Akhtar is considered one of the world's preeminent electrophysiologists. In 1977, he came to what is now Aurora Sinai to develop the electrophysiology program. The program today has more full-time electrophysiologists than any other program in the U.S., and enjoys a national reputation for innovation, quality and service. Dr. Akhtar also developed the electrophysiology laboratory at Aurora St. Luke's Medical Center.  He has been honored as a Pioneer in Cardiac Electrophysiology by the Heart Rhythm Society. 

Atul Bhatia, MD, FACC
Clinical Assistant Professor of Medicine, Electrophysiologist
Board Certifications: Clinical Cardiac Electrophysiology, Cardiovascular Disease, Internal Medicine

Indrajit Choudhuri, MD
Clinical Assistant Professor of Medicine, Electrophysiologist
Board Certifications: Internal Medicine, Cardiovascular Diseases, Clinical Cardiac Electrophysiology

Anwer Dhala, MD, FACC, FHRS
Clinical Associate Professor of Medicine
Clinical Professor of Pediatrics
Board Certifications: Internal Medicine, Cardiovascular Diseases, Clinical Cardiac Electrophysiology

Mohamed Djelmami-Hani, MD, FHRS
Electrophysiologist
Dr. Hani is Board certified in Clinical Cardiac Electrophysiology. He received advanced fellowship training in complex interventional EP procedures including atrial fibrillation and ventricular tachycardia ablation. He has been honoroed as a Fellow by the Heart Rhythm Society.
Board Certifications: Clinical Cardiac Electrophysiology, Cardiovascular Disease, Internal Medicine

Warren M. Jackman, MD, FHRS
Visiting Clinical Professor of Medicine, Electrophysiologist
George Lynn Cross Research Professor 
University of Oklahoma Health Sciences Center
Senior Scientific Advisor, Heart Rhythm Institute 
Board Certifications: Internal Medicine, Cardiovascular Diseases, Clinical Cardiac Electrophysiology

Dr. Jackman has been honored as a Pioneer in Cardiac Electrophysiology by the Heart Rhythm Society, the youngest person so honored in the history of the society, for his work in the development of catheter ablation techniques. He was recipient of the 2006 Mirowski Award. He has been cited in Best Doctors in America continuously since 1992.

David Kress, MD
Cardiovascular Surgeon
Board Certifications: Surgery: General, Thoracic and Cardiac Surgery-General

Dr. Kress was an initial user of the hybrid technologies. He teaches others in the US how the procedure is performed.

M. Eyman Mortada, MD
Clinical Assistant Professor of Medicine, Electrophysiologist
Board Certifications: Clinical Cardiac Electrophysiology, Cardiovascular Disease, Internal Medicine

Vikram Nangia, MD
Clinical Assistant Professor of Medicine, Electrophysiologist
Board Certifications: Clinical Cardiac Electrophysiology, Cardiovascular Disease, Internal Medicine

Imran K. Niazi, MD, FACC, FHRS
Electrophysiologist
Board Certifications: Clinical Cardiac Electrophysiology, Cardiovascular Disease, Internal Medicine

Dr. Niazi is a fellow of the American College of Cardiology, American College of Physicians, American Heart Association and the Heart Rhythm Society. In 2012, he earned the National Board of Cardiology’s Award of Excellence and has been appointed consultant to the National Academy of Medicine.

Mohamed S. Rahman, MD
Electrophysiologist
Board Certifications: Cardiovascular Disease

Contact Us

Call us:  1-888-649-6892 or fill in a contact form.    

For more information, please contact us at:

Atrial Fibrillation Ablation Center
Aurora Cardiovascular Services, Aurora Medical Group
2801 W. Kinnickinnic River Parkway
St. Luke's Physician Office Building, Suite 777
Milwaukee, WI 53215-3669