How Can Atrial Fibrillation Be Treated?
Treating AF with Medications.
Restoring your normal heart rhythm, controlling your heart rate and preventing clots from forming are the goals of treament. You may be on medication to maintain normal heart rhythm, these are called anti-arrhythmics. Controlling heart rate is usually done with beta-blockers or calcium channel blockers. Additionally, blood-thinners such as coumadin are used to prevent clots and strokes. These are the medical options; however, these do not work all the time and many patients have continued symptoms and are unable to tolerate the medications. Fortunately, there are other new and innovative ways to treat Atrial Fibrillation.
Treating Atrial Fibrillation with Catheter Ablation.
This is a technique also known as pulmonary vein ablation/pulmonary vein antrum isolation or PVI.
During pulmonary vein ablation, the electrophysiologist will insert catheters through the groin that go to the left atrium. This technique is similar to what occurs during cardiac catheterization. Then these catheters are placed near blood vessels called the pulmonary veins. Research has shown that almost all atrial fibrillation signals come from the four pulmonary veins. Ablation of the tissue near these blood vessels causes a lesion (scar), and prevents the chaotic electrical signals from traveling throughout the heart. Other areas of the heart may also receive ablation lesions, such as near the superior vena cava.
Treating Atrial Fibrillation with Surgery.
You may benefit from surgery to treat your Atrial Fibrillation if:
- You have symptoms and your medications aren’t working
- You are at risk for forming clots and stroke
- You are having a heart operation already
It may be time to consider a surgical option often referred to as the MAZE procedure, or Mini MAZE or surgical ablation.
Surgeons at the Nebraska Heart Institute have performed hundreds of procedures for AF. Recently, a new minimally invasive technique has been used successfully for the treatment of AF. Benefits include no sternal incision, less blood loss, and quicker recovery.
A major part of the surgical procedure, for AF, includes removal of the left atrial appendage, which is the likely source of stroke in patients with AF. Removing the appendage may reduce the risk of stroke and in many patients allow discontinuation or reducing the need for coumadin.
The MAZE procedure is a surgical intervention that cures Atrial Fibrillation by interrupting these extra electrical beats that are fired from the atria of the heart. Traditionally, the MAZE procedure, done by cutting and sewing of the heart, has been very successful. Recently, alternative energy sources have been used to replace cutting and sewing of incisions with linear lines of ablation (lesions) to stop the abnormal impulses. The surgeon uses a highly selective and safe device which creates lesions in the top portion of the heart to stop the conduction of the extra beats while channeling the normal impulse from the top of the heart to the bottom to form a normal beat. The scar tissue forms where the lesions were made and the abnormal beats are now unable to form. Your heart will beat normally again and provide the body with the blood supply it needs.
If you are already having an open heart surgery procedure and you are a candidate for surgical treatment of Atrial Fibrillation, the surgeon will be able to access your heart through the same incision.
If you are not having an open heart surgery procedure but may be a candidate for surgical treatment of Atrial Fibrillation, you may be a candidate for Minimally Invasive Surgery where your operation will be done with small incisions and without the heart-lung machine to cure your Atrial Fibrillation.
What are the Side Effects and Benefits of Having Either Catheter-Based or Surgical Treatment?
You have a very good chance of having short-term Atrial Fibrillation right after heart surgery. This is very common and will likely cease in about 3 months as the heart heals. During this time, you will continue to be on medications until your heart is fully healed.
These procedures, when successful, maintain the normal regular rhythm of the heart and prevent stroke. Additionally, long-term medications such as coumadin may no longer be required.
You and your electrophysiologist or surgeon will make the final decision if you are a candidate for treatment of Atrial Fibrillation. Your doctor will discuss the risks of both procedures with you, as well as any questions you may have. You will also have close follow up after your procedure and access to a nurse for any questions or concerns.