What is atrial fibrillation (A-fib)?
Atrial fibrillation (AF or A-fib) is the most common heart rhythm disorder (arrhythmia), in which the heart beats at an irregular and often rapid pace. During atrial fibrillation, multiple electrical impulses travel through the heart's two upper chambers, causing it to “quiver” rather than contract. This causes the upper chambers, known as the atria, to beat at a much faster pace than the two lower chambers, known as the ventricles. This irregular heart beat results in poor blood flow to the body. Complications of atrial fibrillation can be life-threatening, including stroke and heart failure.
If you have A-fib, you have a significantly higher risk of stroke than those without the arrhythmia. If you have A-fib and have suffered a stroke, you have two times the risk of being bedridden than a patient who has suffered a stroke without the disorder.
As a patient at The Heart Institute, you'll have access to the most advanced treatments for atrial fibrillation. Your cardiologist will help you determine the best procedure for you.
Types of atrial fibrillation treatments
Lariat (left atrial appendage occlusion) surgery is an innovative catheter-based percutaneous procedure that uses sutures to tie off the left atrial appendage (LAA). This process helps to prevent blood clots that can lead to stroke in patients with A-fib. This procedure is the only minimally invasive treatment option for patients who have A-fib but cannot take blood thinners due to an underlying medical condition.
The Watchman device is a permanent implant designed to close the left atrial appendage in the heart in an effort to reduce the risk of stroke.
This treatment can be conducted two ways, by sending an electric current to the heart or by using anti-arrhythmia medication. Some patients may need to take blood-thinning medication before and after cardioversion.
In some cases, when heart rate cannot be converted, a combination of medications may be prescribed to slow the heart rate down.
The maze procedure uses a scalpel to make several precise incisions that create a pattern of scar tissue, blocking the abnormal electrical impulses that cause atrial fibrillation. Radiofrequency and cryotherapy can also be used to create the scars, as these are variations of the surgical maze technique. Generally, this procedure is reserved for those who don’t respond to other therapies or when it can be done during other heart surgery. Some people may require a pacemaker insertion.
Cryoballoon ablation is a balloon-based technology that blocks the conduction of the arrhythmia in cardiac tissue through the use of a coolant rather than heat, by way of a catheter. This freezing technology allows the catheter to adhere to the tissue during ablation, enabling greater catheter stability.
AV node ablation
AV node ablation applies radiofrequency energy to the pathway connecting the upper and lower chambers. When applied, the atria are prevented from sending electrical impulses to the ventricles. The atria will continue fibrillating and will require anticoagulation medication. A pacemaker will also be inserted to establish normal rhythm and to regulate the heart rate. This type of ablation is typically reserved for patients with serious symptoms or when other treatments have failed.
Radiofrequency catheter ablation directs radiofrequency energy through a catheter to the areas of heart tissue that cause erratic electrical signals. Scarring the tissue will correct the arrhythmia. In other cases, catheters that freeze the heart tissue, known as cryotherapy, can be used to get the same result.
PVAI (pulmonary vein antrum isolation)
Pulmonary vein ablation, also called pulmonary vein antrum isolation, is another procedure in which energy is delivered through the tip of the catheter to tissue that is targeted for ablation. The energy is applied around the connection of the pulmonary veins to the left atrium. Small circular scars are formed within two to three months blocking any impulses firing from within the pulmonary veins and isolating them from the heart. If successful, PVAI eliminates the need for medications.
After cardioversion, your heart rate and blood pressure are monitored.
Additional drugs to help prevent heart rhythm problems from recurring (antiarrhythmic drugs) may also be given before and after the procedure. If antiarrhythmic drugs are not used after cardioversion, your heart may be at greater risk of going back into a fast heart rate.
After cardioversion, you may take a blood-thinning medicine for a few weeks to prevent dangerous blood clots.
Recovery from catheter ablation is usually quick. Some people may be hospitalized for 1 to 2 days after the procedure so doctors can monitor heart rate and rhythm. Many people go home the same day.
Recovery from a maze procedure depends on how your surgery was done. For example, recovery will likely be longer for an open-heart procedure than for a less invasive procedure.
You may have to stay in the hospital for about seven to ten days. Most people spend the first two or three days after surgery in an intensive care unit (ICU) where they can be closely watched. You will be encouraged to walk within one to two days of your surgery.
Discomfort in the chest, ribs and shoulders is common within the first several days following surgery. Your doctor will order pain medicines to help control this discomfort.
Medicines, called diuretics, are used to control fluid buildup right after surgery. Your doctor may have you take a diuretic at home for several weeks following surgery.
You may need to take a medicine (called a blood thinner) that prevents blood clots, after the procedure. But this is usually determined on a case-by-case basis.
Recovery is typically complete within six to eight weeks following surgery. Some people have discomfort at the chest incision for several months after surgery.
You will be able to get back to your normal activities within three months. You may feel more tired than usual, but most people are back to normal within months.