Knowing Your Surgical Options for Resolving Atrial Fibrillation

1/23/2020

By Michael Bolanos, M.D.

Millions of people experience abnormal heart rhythms (arrhythmias), and not all of these conditions are life-threatening. But when they are dangerous and do not respond to medication or you cannot take the recommended medicine, knowing your surgical options becomes important.

Arrhythmias are caused by problems with the electrical system that regulates the steady heartbeat. The heart rate may be too slow or too fast; it may stay steady or become chaotic (irregular and disorganized). Some arrhythmias are very dangerous and cause sudden cardiac death, while others may be bothersome but not life threatening.

The most common arrhythmia -- atrial fibrillation (AFib) – affects millions of people in the United States. In AFib, disorganized signals from the heart’s electrical system cause irregular and rapid heartbeat. The upper chambers of the heart may beat about four times faster than normal.

AFib can present in many ways. It can lead to feeling tired all the time and even heart failure (with symptoms such as filling up with fluid, swelling of the hands, legs and feet, and shortness of breath). People with AFib are five times more likely to have a stroke than people without the condition.

Doctors often prescribe blood thinners (anticoagulants) to patients with AFib to reduce this higher risk of stroke. The medications do not always resolve the problem, and depending on other conditions, patients may not be candidates for blood thinners.

For patients whose AFib is not treated through medication, the cardiologist may recommend ablation. In this procedure, a tool applies electricity to ablate or terminate the areas where the heart’s electrical system is misfiring. By terminating the abnormal electrical pathways, a normal heart rhythm is restored.

Ablation procedures may be conducted through a catheter from inside the heart or on the outside of the heart through a small incision in the chest. Additionally, a surgical ablation procedure can be performed at the time of other cardiac surgical procedures, such as coronary artery bypass surgery or heart valve surgery.

The latest technique is to combine these approaches where a cardiothoracic surgeon performs an ablation procedure to the outside surface of the heart. Then, some weeks or months later, an electrophysiologist uses catheter-based techniques to perform an ablation procedure from inside the heart. (An electrophysiologist is a highly specialized cardiologist who deals with the heart’s conduction system.) Combining the techniques should resolve AFib in most patients.

While both techniques are much less invasive than opening up the chest, both require hospitalization for a few days.

Heart rhythm problems can be very complex, so it is important for cardiologists, cardiothoracic surgeons and electrophysiologists to collaborate closely on the proper diagnosis and treatment options for patients with AFib.

To learn more about surgical options for resolving AFib and other arrhythmias, call (941) 486-6770.

A cardiothoracic surgeon with the heart team at Venice Regional Bayfront Health, Michael Bolanos, M.D., specializes in surgical treatment options for atrial fibrillation.

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