What to know about Surgery for Atrial Fibrillation

Cardiac catheter ablation procedures are minimally invasive surgeries, usually lasting about two hours in a hospital. The surgeon inserts a catheter through a vein and uses radio waves to create heat at the tip, destroying and scarring heart tissue to prevent misfiring electrical signals.

Radiofrequency ablation is the most common type of ablation used. A 2024 review found that the success of ablation depends on many factors, including age, atrial size, and the duration of atrial fibrillation. The long-term success rates range from 50% to 80%. Half to one-third of people may not require antiarrhythmic drugs after ablation.

Atrioventricular node ablation

In some cases, you may need a more extensive type of ablation, known as atrioventricular node ablation (AVN).

This procedure is similar to the catheter ablation surgeries described above, but it destroys a larger area of your heart, known as your atrioventricular node. This node is responsible for relaying electrical signals from the top to the bottom chambers of the heart.

During this procedure, the surgeon uses a catheter to destroy the node with radiofrequency energy, correcting your irregular heartbeat. Afterward, you will need to have a pacemaker implanted to maintain a regular heart rhythm.

Risks of ablation

While any medical procedure carries risks, complications from ablation surgeries are rare.

Side effects include:

• mild pain
• bleeding
• bruising
• vein problems
• infection
• blood clots
• heart damage
• blood vessel or other surrounding tissue damage

More serious complications include stroke or abnormal fluid collection around your heart, but these complications are rare. Your healthcare team will closely monitor you after your procedure to watch for signs of problems.

A pacemaker is a device implanted in the body to regulate heart rate. It is often used for AFib when it causes a slower heart rate.

According to a 2020 study, certain factors make people with AFIb more likely to need a pacemaker. These are:

• over age 60
• male
• congenital heart defect
• heart failure before the age of 60
• previous episodes of fainting
• AFib caused by a heart valve issue
• high blood pressure (hypertension)
• history of heart disease
• diabetes

In addition, if you undergo AVN, you will also need a pacemaker.

Risks of pacemaker insertion

While pacemaker insertion is a minor surgical procedure, it still carries risks.

Doctors insert traditional pacemakers through the veins into the heart chambers with the generator placed under the skin of the chest. Alternatively, epicardial placement involves placing electrodes on the heart’s surface. Some pacemakers are wireless and contained within one device inside the heart.

Some insertions lead to same-day discharge, while others may require an overnight hospital stay. Potential complications include infection, blood clots, and scarring or stiffness of tissue around the device.

The pacemaker may also malfunction, but this is rare. According to a 2018 case report study, the leading cause of pacemaker malfunction is lead fractures, occurring in approximately 0.1% to 4.2% of patients per year.

These fractures are often the result of physical strain during activities such as weightlifting or chest trauma. The best way to reduce the chance of malfunction is to have it checked by your cardiologist regularly.

AFib is common in patients who have other heart conditions. If you have a condition that requires open-heart surgery, such as coronary bypass surgery, your surgeon can use the maze procedure to treat AFib at the same time.

During the maze procedure, your surgeon will make incisions in your heart to create scar tissue. This blocks erratic signals from being conducted in the heart. The procedure is named after the mazelike pattern it creates for the signals to follow.

Risks of the maze procedure

The maze procedure involves greater risks than ablation because it involves open-heart surgery. Risks include:

• stroke
• kidney failure
• other organ failure
• death

You may also require a pacemaker after undergoing the maze procedure.

While it poses risks of serious complications, the maze procedure also has a high success rate. To lower your risk of complications, look for an experienced surgeon and center to achieve success and minimize your chance of developing complications.

If your cardiologist recommends one of these procedures to treat your AFIB, you’ll have to consider whether the benefits outweigh the risks.

Some questions you might want to ask your doctor include:

1. What complications are possible, and how likely are they to occur?
2. How many of these procedures have you performed?
3. How do I prepare for the procedure?
4. What can I expect during recovery?

The more information you have about what to expect, the easier it will be to make the best decision for your health.

How serious is heart ablation surgery?

Cardiac ablation is usually a minimally invasive procedure. However, it can also be done as part of open heart surgery, making it a more significant operation. As with any medical procedure, cardiac ablation carries risks. Risks for ablation include bleeding, infection, blood clotting, and damage to surrounding tissues.

What is the recovery time for atrial fibrillation surgery?

This depends on the type of surgery. After an ablation procedure, you may stay overnight for observation. You may need to avoid exercise and lifting more than 10 pounds for a period of time. Discuss with your cardiologist when you can drive, lift, exercise, and resume normal activities. After pacemaker insertion, you may have chest soreness, bruising, and swelling for 1-2 weeks. With an open-chest maze procedure, it can take a few months to heal.

How many years does an ablation last?

This may depend on the type of ablation and your particular case. Overall, the long-term success rates of ablation procedures range from 50% to 80%.

AFib can be a potentially uncomfortable and dangerous health problem. Fortunately, there are many options available to treat it. If lifestyle changes and medications aren’t enough, your doctor may recommend surgery.

Open heart surgery is more invasive and involves higher levels of risk. When possible, your doctor may recommend ablation surgery. This minimally invasive procedure involves a low level of risk and a high success rate.

Ask your doctor about your specific condition, treatment options, and outlook. They can help you understand the potential benefits and risks of undergoing surgery to treat AFib.