Atrial Fibrillation Ablation (Afib Ablation or AF Ablation) is an invasive procedure that involves removing the cells that give rise to atrial fibrillation, and/or the cells that help in its continuation. It is used when medications have failed to treat atrial fibrillation (Afib).
Ablation procedures mainly involve the left upper chamber of the heart (the left atrium), most often at the site, where the pulmonary veins open into the atrium. The pulmonary veins are blood vessels that bring oxygen-rich blood to the heart from the lungs. This is the most common origin point of the aberrant electrical impulses that give rise to atrial fibrillation.
Why an atrial fibrillation ablation surgical procedure is performed?
Atrial Fibrillation Ablation procedures are performed in individuals, when atrial fibrillation cannot be controlled with medication, or if they cannot tolerate the side effects of the drugs.
How an atrial fibrillation ablation surgical procedure is performed?
An Atrial Fibrillation Ablation procedure may be carried out via catheter or surgery.
- This is done by passing a flexible wire (catheter) through a vein, usually in the groin (or even neck/arm) and guiding it right up to the heart
- The tip of the catheter then uses, either radio waves/heat/intense cold/ultrasound waves to ablate the source of the atrial fibrillation, or block the conduction, once it has been guided into the heart
Cox Maze III procedure
- Two open heart procedures, Cox Maze III and Maze, help in Surgical Ablation of Atrial Fibrillation
- The open heart procedures are usually performed, when an individual needs another surgery, such as valve repair or replacement, or coronary artery bypass grafting
- The surgeon opens the chest cavity, enters the heart and scars the source of Afib, or blocks conduction, by making a series of “cuts and sews”
- Although, this is considered the gold standard for surgical treatment of Afib it is a very complicated procedure and hence, rarely performed
Mini Maze procedure (minimally-invasive surgical ablation)
- The surgeon opens the chest cavity, enters the heart, and creates a conduction block with an energy source
- In this procedure, the surgeon makes small incisions on the chest, places ports, to pass a camera (thoracoscope), surgical instruments, and an ablation device, into the chest
- Using the camera to visualize the inside of the chest and heart, the surgeon creates a conduction block, to treat atrial fibrillation
- To be a candidate for the mini maze procedure, no prior open chest procedures should have been performed
- During surgical ablation procedures, the surgeon may also remove/block a small flap of the left atrium, called the left atrial appendage, to reduce the risk of clots and strokes
Catheter ablations are performed by a cardiac electro-physiologist, while surgical ablations are performed by cardiothoracic surgeons
. Ablation for Atrial Fibrillation surgical procedure may take anywhere between 2-4 hours.
Preparations needed before an atrial fibrillation ablation surgical procedure
Diagnostic lab tests required before an atrial fibrillation ablation surgical procedure
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Some recent data, however suggests that carrying out the ablation procedure, while on blood thinners, reduces the risk of developing strokes
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Normally, local anaesthesia is not used however, do inform the physician, if you are allergic to any local anaesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range if not their diabetologist may have to control blood sugar by recommending insulin or a combination of oral medicines
Prior to the ablation procedure, the individual may have to undergo certain tests, such as:
Risks and complications during atrial fibrillation ablation surgical procedure
Risks and complications after atrial fibrillation ablation surgical procedure
- Puncture of the atrial wall, leading to rapid pooling of blood in the chamber around the heart, causing a serious condition called cardiac tamponade
- Puncture of the posterior wall of the atrium and entering the food pipe (oesophagus) forming an atrioesophageal fistula
- Damage to the heart or blood vessels, bleeding
- Heart attack
- Damage to nerves that results in paralysis of the diaphragm (the muscle that helps with breathing)
- During mini maze procedure, deflation of the lung could result in its collapse
- In some rare cases, death is a possibility
Post-operative care needed after atrial fibrillation ablation surgical procedure
- Narrowing of the pulmonary veins (pulmonary vein stenosis)
- New rhythm disturbances of the heart
- Inflammation of the covering of the heart (pericarditis) following mini maze
- Inflammation of the vein (phlebitis), due to catheter manoeuvring
- Once the catheter ablation procedure is over, the individual is transferred to a recovery room or cardiac care unit. For individuals undergoing surgical ablation, post-procedure ICU stay may be mandated - anywhere from a few hours, to a day or even more
- The heart rate, rhythm, and blood pressure, are constantly monitored
- Medications to manage pain are administered, as necessary
- Following catheter procedure, the individual is advised to lie still a few hours, to avoid any bleeding from the puncture site
- Other medications, such as drugs, to prevent infections, anti-nausea medications, are also administered
- Exercises to prevent fluid accumulation in lungs may be given, while recovering from general anaesthesia