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Multidisciplinary Clinic Offers a New Model for Complex AFib Care
When patients with refractory AFib fall into a treatment gap, a collaborative new multidisciplinary clinic from Keck Medicine of USC gives them a way out.
In longstanding persistent AFib, fibrosis and scarring may create self-sustaining electrical loops beyond the pulmonary veins. The article reports that data indicate endocardial measures alone are less successful than a hybrid approach that also includes minimally invasive epicardial techniques.
Target Population
Patients with complex or longstanding persistent AFib, including those with multiple unsuccessful catheter ablations, advanced heart failure, or a need for concurrent cardiac procedures.
Care Setting
Keck Medicine of USC’s advanced multidisciplinary AFib clinic in Pasadena, where cardiac electrophysiologists, cardiac surgeons, and a nurse practitioner jointly evaluate patients and develop care plans.
Key Highlights
The clinic combines cardiac electrophysiology and cardiac surgery expertise in a single multidisciplinary visit.
Treatment options include endocardial approaches, minimally invasive convergent maze or totally thoracoscopic maze (TT-maze), and combinations of these approaches.
The surgical maze procedures described are combined with left atrial appendage exclusion.
The clinic provides postsurgical electrophysiologic evaluation using RF and PR technologies and follows patients with long-term rhythm monitoring.
Care plans also address risk-factor modification and comorbidities such as heart failure or valvular disease.
Guideline-Based Recommendations
Diagnosis
Management
Monitoring & Follow-up
Risks
Patient & Prescribing Data
The article identifies patients with longstanding persistent AFib, multiple unsuccessful catheter ablations, advanced heart failure, or a need for concurrent procedures such as CABG or valve repair as potential candidates for the clinic’s specialized services.
Treatment is tailored after joint evaluation by a cardiac electrophysiologist, cardiac surgeon, and nurse practitioner; options may include endocardial treatment, minimally invasive surgery, or both.
Clinical Best Practices
The clinic reviews prior AFib treatments and failures, risk factors, cardiac abnormalities, and comorbidities when developing a care plan.
The clinic coordinates electrophysiology and cardiac surgery expertise for patients whose AFib may require a hybrid approach.
The clinic includes long-term rhythm monitoring and management of risk factors and comorbidities in follow-up.
Pulmonary vascular disease is a rapidly evolving field, with emerging therapies, new diagnostic approaches and ongoing research reshaping how patients with pulmonary hypertension are evaluated and treated.
