Pros And Cons Of Ablation For Atrial Fib
In the United States, there are nearly 3 million people who are living with atrial fibrillation right now. This is often a difficult condition to treat because it causes the heart to begin beating in an irregular way. The symptoms of atrial fib when it happens can be quite debilitating: fatigue, shortness of breath, and weakness are common. Instead of taking drugs to manage symptoms, a procedure called abalation may be recommended.
Should those with atrial fib choose ablation as their first treatment option? Here are some pros and cons to consider before deciding if the procedure is the best available option to find relief.
How Do You Prepare For Ablation
Your medical team will probably tell you to:
- Stop eating or drinking the night before the procedure.
- Stop taking medications to treat arrhythmia several days before.
- Ask the doctor if you should stop any other medications.
- Ask the doctor about precautions if you have a pacemaker or implanted defibrillator.
The doctor will give you any other specific instructions.
Why Does Atrial Fibrillation Occur
In the majority of people who develop Atrial Fibrillation the cause is not known. Usually, the heart is otherwise sound. In some people, Atrial Fibrillation can develop due to other conditions such as high blood pressure, prior heart attack or leaky heart valves. Increasingly newer risk factors for the development of Atrial Fibrillation are emerging.
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Hybrid Ablation Procedures For Atrial Fibrillation
Hybrid ablation is a minimally invasive dual approach. First, a cardiac surgeon performs a mini maze surgical ablation procedure on the outside of the heart. Then, an electrophysiologist does a catheter ablation on the inside of the heart. Hybrid techniques may improve success and minimize risks as they combine the strengths of catheter ablation and a mini maze procedure and minimize any limitations of either alone.
A hybrid ablation is an emerging treatment for patients with more severe atrial fibrillation. This combined approach is investigational, with clinical trials being conducted to determine the safety and effectiveness for persistent and longstanding persistent afib. Combining both procedures may enhance the prospects that ablation lines fully penetrate all layers of the cardiac tissue, which is crucial to stopping afib. In addition, higher success rates and fewer complications may be possible as each specialist treats areas of the heart best suited to each of their approaches. This could improve success for those with persistent or longstanding persistent afib who want a minimally invasive approach.
As described below, the hybrid procedure and the convergent procedure are similar as they both combine surgery and catheter ablation. However, each uses a different entry point into the body and a different type of radiofrequency device.
What Are The Risks For Ablation
You may have specific risks based on your specific medical conditions. Be sure to discuss all your concerns with your healthcare provider before your ablation. Most people who have atrial fibrillation ablation have a successful outcome. There are some risks associated with the procedure, however. Although rare, there is the risk of death. Other risks include:
- Bleeding, infection, and pain from the catheter insertion
- Damage to the blood vessels from the catheter
- Puncture to the heart
- Damage to the heart, which might require a permanent pacemaker
- Blood clots, which might lead to a stroke
- Narrowing of the pulmonary veins
- Radiation exposure
You are more likely to have complications if you are older or if you have certain other medical and heart conditions.
Another risk is that the procedure may not permanently eliminate atrial fibrillation. Sometimes atrial fibrillation will come back shortly after the procedure or several months later. You might be more likely to have this problem if you are older, have other heart problems, or have a longer duration of atrial fibrillation. Performing the ablation again can permanently eliminate atrial fibrillation in some of these people.
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How Safe Are Cardioversion And Cardiac Ablation
Both procedures can cause serious complications, although the risks are low if youâre in overall good health. Either procedure can dislodge a blood clot, which can lead to a stroke or a pulmonary embolism.
Cardioversion can also cause:
Other possible complications of cardiac ablation include:
- Bleeding, infection, or pain from the catheter insertion
- Damage to the heart, blood vessels, or esophagus
- Narrowing of the pulmonary veins
During Catheter Ablation For Atrial Fibrillation
Catheter ablation for atrial fibrillation is performed in a hospital. Before your procedure, a specialist will insert an intravenous line into your forearm or hand, and you’ll be given a sedative to help you relax. In some situations, a general anesthetica may be used instead to place you in a sleep-like state.
After your sedative takes effect, your doctor or another specialist will numb a small area near a vein on your groin, neck or shoulder. Your doctor will insert a needle into the vein and place a tube through the needle.
Your doctor will thread catheters through the sheath and guide them to several places within your heart. Your doctor may inject dye into the catheter, which helps him or her see your blood vessels and heart using X-ray imaging. The catheters have electrodes at the tips that can be used to send electrical impulses to your heart and record your heart’s electrical activity. This process of using imaging and other tests to determine what’s causing your arrhythmia is called an electrophysiology study.
Next your doctor uses the catheter tips to apply heat or cold to the target area to destroy tissue and cause scarring.
The procedure usually takes three to six hours. Complicated procedures may take longer.
During the procedure it’s possible you’ll feel some minor discomfort when the dye is injected in your catheter or when energy is run through the catheter tips. If you experience any type of severe pain or shortness of breath, let your doctor know.
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What Happens During A Radiofrequency Ablation Procedure
During and after the procedure, blood thinning medication will be administered. During the procedure the heart will be monitored with a special ultrasound probe that is inserted into the oesophagus . This is called a Transesophageal Echocardiogram. This takes clear pictures of the heart before, during and after the procedure. It will be removed before you wake up.
What Are The Risks Of Catheter Ablation
The risks of catheter ablation are low. Complications after catheter ablation are rare. Possible risks include:
- Damage to the vein from the sheath or catheter.
- Damage to heart tissue or heart valves.
- Infection or bleeding.
- The need for a permanent pacemaker.
You do receive some radiation during radiofrequency catheter ablation. If you are pregnant, consult with your provider about whether you can safely wait to have the procedure after your baby is born.
How Successful Is This Procedure
Itâs also possible for the tissue in your pulmonary veins â which doctors tend to target during ablation â to change in the upper left chamber of your heart over time. If that happens, electrical signals might start to move across the lines of scar tissue your doctor created during the procedure. And that, too, could cause AFib to come back.
If your AFib does return, you might need a second ablation â in general, these work very well. Or your doctor may be able to treat it with medications.
If your problems continue, your doctor might implant a pacemaker to control your heartâs electrical signals.
What To Expect After Cardiac Ablation
What is recovery like?
It depends on the type of procedure you have:
Catheter ablation. You may need to spend a night in the hospital, but most people can go home the same day. If so, you’ll rest in a recovery room for a few hours while a nurse closely watches your heart rate and blood pressure. You need to lie flat and still to prevent bleeding from where your skin was cut. Plan to have someone drive you home.
The doctor will prescribe a medication to prevent blood clots and another to prevent AFib. Youâll probably take them for 2 months. A shower is OK once youâre home, but keep the water on the cooler side. Donât take a bath, swim, or soak for 5 days or until the cuts have healed.
For the first week:
- Donât lift more than 10 pounds.
- Skip activities that make you push or pull heavy things, like shoveling or mowing the lawn.
- If you get tired, stop and rest.
- Donât exercise. You can go back to normal in week two.
Maze procedure. Youâll probably be in the hospital about a week. Youâll spend the first couple of days in an intensive care unit and then move to a regular room before you go home. Full recovery takes about 6 to 8 weeks, but you should be able to return to normal activities within 2 or 3 weeks. You should start to feel better in about 4 weeks. Youâll probably take a blood thinner for about 3 months.
Mini maze. You’ll be in the ICU for a few hours to a day. Youâll probably stay for 2 to 4 days, total.
Life after cardiac ablation
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What Happens After Catheter Ablation
You may have to stay in the hospital overnight after your ablation so your doctor and nurses can keep an eye on you while you recover. Youâll rest in bed after the procedure. Some people leave the hospital the same day, while others go home the next morning.
Your doctor will tell you how well the procedure went and how good a job it should do to treat your AFib.
What Are The Risks Of Heart Ablation
Side effects of heart ablation are more common after surgical ablation than after catheter ablation. Possible risks of heart ablation include:
- Damage to the vein from the sheath and catheter.
- Damage to your heart, like a puncture or damaged valves or conduction.
- Narrowing of the veins that carry blood between your lungs and heart .
- Exposure to radiation during catheter ablation.
- Infection or bleeding.
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How Do I Prepare For An Ablation
Talk with your doctor about what you should do to prepare for your atrial fibrillation ablation. Avoid eating or drinking anything before midnight of the day of your procedure. Follow your doctors instructions about what medicines to take before the procedure. Dont stop taking any medicine unless your doctor tells you to do so.
Your doctor might order some tests before your procedure. These might include:
- Electrocardiogram , to analyze the heart rhythm
- Echocardiography , to evaluate heart structure and function
- Stress testing, to see how the heart responds to exercise
- Cardiac catheterization or coronary angiography, to get more information about the coronary arteries
- Cardiac CT or MRI, to further evaluate your heart anatomy
Let your doctor know if you are pregnant before having the procedure. Ablation uses radiation, which may be a risk to the fetus. If you are a woman of childbearing age, your doctor may want a pregnancy test to make sure you arent pregnant.
Someone will shave your skin above the area of operation . About an hour before the operation, you will be given medicine to help you relax.
If Ablation Fails What Next
There are many options available when patients have recurrent AFib even after an ablation. Some patients can do very well with a combination of medications, such as anti-arrhythmic medication, even after an ablation procedure. My usual approach for patients who have recurrent AFIb after an ablation is to adjust medical therapy and place on an anti-arrhythmic medication, such as flecainide. In addition, there any many patients who will do very well with an additional ablation procedure. Up to 30% of patients who undergo an ablation procedure may need additional procedures to get very good control over AFib. In redo procedures, the electrophysiologist can touch up any areas that did not get thoroughly ablated in the first case or uncover additional areas that were not abated the first time. In addition, patients who have recurrent AFib after a traditional ablation procedure should also consider surgical ablation procedures for AFib, such as a mini-maze procedure. These procedures are more extensive than a traditional AFib ablation and with higher risks.
In addition there are many patients that can overcome recurrent AFib after an ablation with lifestyle modifications. Getting to the root cause of atrial fibrillation can help with recurrences after an ablation. For many people, this would involve weight loss, but also treating sleep apnea when applicable and cessation of alcohol can also help.
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Risks Of Cardiac Ablation
Any procedure has risks. Problems with cardiac ablation can include:
- Bleeding or infection where the catheter went in
- Damaged blood vessels if the catheter scrapes them
- Arrhythmias caused by damage to your heartâs electrical system
- Blood clots in your legs or lungs
- Heart damage, like punctures or damaged valves
- Stroke or heart attack
What To Expect Before And During The Maze Procedure
At the hospital, your nurse may test your blood or urine, or give you a chest X-ray to make sure you donât have any infections or problems that may hurt your surgeryâs success. You may be given medication to help you relax before the surgery.
Youâll have electrocardiogram electrodes attached to your chest and back to keep track of your heartbeat. You will get anesthesia to put you to sleep during the surgery.
After you are asleep, your doctor will connect you to a respirator that has a tube that goes down your throat. This will help you breathe during the operation. You may have a tube inserted into your throat to help collect fluid or air in your stomach during the operation. You may also have a catheter inserted in your bladder to collect urine during the operation.
Your surgeon will cut into your chest during your operation, and they will insert instruments to make the small interior cuts or make lesions on your heart tissue. Depending on the type of maze procedure you have, your surgeon may use tiny video cameras or robotic arms to help perform the operation.
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The Pros Of Ablation For Atrial Fib
1. There is a greater chance of reducing symptoms with this procedure. Ablation works by destroying the abnormal heart tissues that are causing the muscle to beat in an irregular way. Through the use of radio frequencies, the tissue is either burned or frozen. This means it is very possible for someone to feel much better almost immediately after the procedure has been completed.
2. The procedure has a high success rate. When all patients are considered, the success rate of ablation falls between 70-80% for reliving symptoms. When only patients who are younger and have no heart disease that could be causing the issue are considered, the chances of success rise to at least 95%. Older patients with heart disease may have a success rate as low as 40%. Experienced doctors who perform this procedure on a regular basis tend to see the best success rates.
3. There are few complications that result from ablation. Fewer than 5% of people who undergo this procedure develop any problems after it has been completed. A catheter is used to reach the heart so the abnormal tissue can be destroyed, so the most common issue is to have vessel damage occur. This may cause bleeding or an infection. The chances of heart failure or stroke are listed as being lower than 1% during the procedure.
Isolation Of Other Thoracic Veins
While the pulmonary veins are recognised to be the main source of electrical activity that initiates and maintains Atrial Fibrillation, the other veins that lead into the heart can also be involved. This is increasingly recognised as potential sites that maintain longer episodes of Atrial Fibrillation, particularly in those with other heart diseases. These veins are the coronary sinus , the superior vena cava and infrequently the inferior vena cava . These veins can be isolated in a similar manner to the pulmonary veins, effectively insulating these regions from the heart. These steps are performed if we observed extra beats from these structures or if you have longer episodes of Atrial Fibrillation or have other heartabnormalities.
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What Is Ablation And How Does It Work
Ablation involves the destruction of abnormal tissue using heat. To achieve this, the catheter emits RF or radiofrequency waves that create heat and ablate the tissue in the area causing the improper electrical impulses. Cooling liquid that circulates within the catheter allows us to precisely regulate the amount of heat needed. The destruction of tissue effectively ends the arrhythmia and the tissue is slowly absorbed into the body. Because we receive real-time images from the catheter, we can evaluate the area treated to be sure no further improper electrical impulses are being generated. If necessary we can retreat the area.
The procedure is most often performed under twilight IV sedation although some patients may need general anesthesia. A typical catheter ablation can last from one to four hours depending on the complexity of the case and the number of sites that need to be treated. Touch-ups, or follow-on procedures, are sometimes needed within a few to several months of the initial ablation to reinforce results.
Patients rarely require an overnight hospital stay and can often go home on the same day as the procedure. They should avoid driving for at least 48 hours and can be back at work and performing normal activities within a few days.