Guided Coagulation System Treats Persistent AF

A new epicardial ablation device helps treat long-standing persistent atrial fibrillation (Afib) in patients who do not respond endocardial catheter ablation alone.

The AtriCure (Mason, OH, USA) EPi-Sense Guided Coagulation System is intended for use in combination with an ablation catheter to treat persistent Afib when anti-arrhythmic drugs (AADs) are not working, or cannot be tolerated by the patient. The minimally invasive surgical device is video-guided to the epicardial surface of the posterior left atrium via a cannula inserted below the sternum. The device is then used to send intense pulses of radiofrequency (RF) energy to destroy the tissue.


At the same time, an ablation catheter inserted percutaneously through the femoral vein is guided towards the interior wall of the left atrium. The tip of the ablation catheter delivers concomitant RF energy to address lesion gaps to tissues inside the heart that are causing the abnormal heart rhythm. A recent study showed that when the two devices are used in unison, the hybrid procedure is 35% more efficient at 18 months than cardiac ablation alone, with a 37% reduction in Afib burden also evident.

“The long-standing persistent Afib population represents over three million patients in the United States alone, or nearly half of all diagnosed Afib patients. These patients are very difficult to treat with catheter ablation alone,” said Michael Carrel, President and CEO of AtriCure. “In addition to superior clinical results, the [EPi-Sense] procedure significantly improves electrophysiology lab efficiency by reducing endocardial ablation times by over 40 minutes, improving throughput, and enabling more patients to be treated.”

AF occurs when the heart's two upper chambers beat erratically, which can lead to serious adverse events such as thrombi travelling from the heart to obstruct arteries supplying the brain, causing stroke, or other parts of the body causing tissue damage. In one form, paroxysmal AF, patients have bouts of erratic beats that begin spontaneously and usually last less than a week. AADs can often control the heart rhythm and symptoms of AF, but many patients do not respond well, and require surgical treatment.

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