Atrial fibrillation (AFib), also called arrhythmia, is a disruption of the normal beating of the heart. In normal sinus rhythm, the upper and lower chambers of the heart beat in unison to pump blood. But in AFib, the electrical signals that coordinate the two chambers of the heart don’t work together as they should. This causes the heart to contract in erratically. In AFib, the heart beats either too fast, two slow, or irregularly.
AFib can happen on a single occasion. If you have a single arrhythmia, you will likely never need treatment. However, AFib can become chronic and lead to dangerous problems. According to the Cleveland Clinic, AFib can double your risk of death and increase your risk of stroke sevenfold.
In AFib, blood can pool in the atria and not pump out regularly. This can cause clots to form, which can lead to stroke. Heart tissue may also become damaged, which can eventually lead to heart failure. AFib can cause pain, palpitations, fatigue, and other discomfort, but sometimes it isn’t noticeable.
There are many ways to control AFib, starting with lifestyle changes. If you have AFib, you should quit smoking and follow a heart-healthy diet. Medications can help the heart function more efficiently. More severe cases that can’t be controlled by these methods may require surgery.
Ablation procedures are minimally invasive surgeries that are typically performed in hospitals in about two hours. There are many types of ablation surgery for AFib. The type of ablation you receive depends on the area of the heart where the electrical misfiring begins. It also depends on whether your AFib occurs frequently or not.
In general, ablation is a procedure that uses a catheter (a small tube) inserted through a vein in the groin or neck. A doctor then threads the catheter to the upper and lower chambers of the heart. The catheter has an electrode at the tip, which sends radio waves that create heat. The heat will destroy and scar the area of tissue that’s causing the problem. (The misfiring electrical signals can’t cross scar tissue.) Radio waves are the most common method, but other types of energy can create this scarring. Other types of ablation include sonar, microwave, and cryoablation (freezing).
According to the American Heart Association, catheter ablation techniques can cure irregular heartbeats in 95 percent of patients. However, some patients will still require medication after the procedure.
Atrioventricular node ablation (AVN) is another type of ablation surgery to control AFib. This method is similar to the catheter ablation surgeries, but it destroys a larger area of the heart called the atrioventricular node. A permanent pacemaker is necessary to establish a normal rhythm after this surgery.
Any medical procedure carries risks, but problems in catheter ablation surgeries are rare. Problems occur in only five percent of people, according to the American Heart Association. AVN surgery also has a high success rate. According to one study, the procedure was successful in 84 out of 100 people.
Side effects of ablation include:
- mild pain
- vein problems
More serious, but rare problems include stroke or abnormal fluid collection around the heart. A patient will be monitored closely after these procedures to watch for these side effects.
Atrial fibrillation is common in patients who have other heart conditions. If you need a different surgery, such as a bypass, your surgeon may also want to perform an AFib surgery at the same time.
If this is the case, your doctor will treat your AFib with a surgery called the MAZE procedure. This is performed during open heart surgery, which requires a patient to be put on a heart-lung bypass. A surgeon makes a number of incisions within the heart and then sews them together during the procedure. Just like in catheter procedures, the electrical signals can’t cross scar tissue. This surgery reroutes signals so they function normally.
This surgery is called MAZE because it creates a mazelike pattern that the heart’s electrical systems follow.
MAZE risks are greater than those for ablation because it’s an open heart surgery. Risks include:
- kidney failure
- other organ failure
Some patients will require a pacemaker after the surgery. Despite the risks, the MAZE surgery is successful at restoring normal heart rhythm in over 80 percent of cases, according to the Society of Thoracic Surgeons. However, choosing an experienced provider is important when deciding on any open heart surgery.
Although AFib can be an uncomfortable and nerve-wracking health problem, advancements in medical technology have led to less invasive and better treatments. They also come with shorter recovery times.
Catheter ablation has become an important tool in treating AFib. And the MAZE procedure may be an effective option for those who have a more complicated heart condition.