Atrial fibrillation is the most common form of abnormal heart rhythm, or arrhythmia, affecting more than 2.2 million Americans.
In atrial fibrillation, the upper chambers of the heart (the atria) pump too quickly, or quiver and twitch in an irregular and unpredictable way. As a result, blood can pool in the atria and form a blood clot that can break apart and travel to the brain, causing stroke. Atrial fibrillation also can lead to additional heart rhythm problems, as well as heart failure.
Generally speaking, atrial fibrillation is caused by abnormalities or damage to the heart muscle — possibly the result of high blood pressure, heart attack, abnormal heart valves or another condition. Because of this damage, the heart's pathway for conducting electrical signals, which controls the heartbeat, becomes disrupted. A short-circuit is created.
Atrial fibrillation treatment seeks to repair this electrical pathway, control the heart rate, restore normal heart rhythm and prevent blood clots.
At HonorHealth, you have a full range of atrial fibrillation treatments, including medication, minimally invasive surgery, open-heart surgery and reduced radiation procedures. The appropriate treatment can depend on how long you have experienced symptoms, the severity of symptoms and underlying causes of the condition.
Atrial fibrillation treatments include:
1. Atrial Fibrillation Treatment with Cardioversion
The initial approach for atrial fibrillation treatment is a procedure called cardioversion. That simply means resetting the heart rate to normal with medication and electrical therapy.
Anti-arrhythmic medications, which decrease and normalize the heart rate, are the first-stage treatment for atrial fibrillation, especially for patients who have just begun to experience symptoms.
- Interrupts and resets heart rhythm with an electrical charge, which is transmitted to the heart through paddles placed on your chest. Although the procedure is brief, several attempts may be required.
- Should not be confused with the emergency heart-shocking treatment seen on TV. Electrical cardioversion is planned in advance and performed in a carefully controlled setting, under general anesthesia.
- May be accompanied by a transesophageal echocardiogram (TEE). A tube s guided down your throat so that detailed, up-close ultrasound images can be taken of the heart. A TEE also can measure blood flow and check for blood clots.
2. Catheter Ablation
In catheter ablation, an electrophysiologist, a specialist in heart rhythm disorders, repairs the pathway that conducts electrical impulses through the heart by removing abnormal tissue. This normalizes the heart's electrical signals and restores normal heart rhythm.
Prior to the catheter ablation, a diagnostic procedure called an electrophysiology study (or EP study) is performed. In an EP study, a thin, flexible tube (catheter) is guided along a blood vessel, starting at the groin or the neck, to the heart. At the end of the catheter, tiny electrodes gather data on the heart's electrical signals. These electrodes also can send electrical impulses to heart tissue, triggering or disabling abnormal heart rhythms, to pinpoint the tissues that are transmitting incorrect electrical signals.
Once the EP study has confirmed the source of the atrial fibrillation, a catheter ablation destroys, or blocks, abnormal tissue by creating lesions (scarring). The catheter can heat the tissue by releasing high-energy radiofrequency electrical signals (radiofrequency ablation) or freeze it with extremely cold vapors (cryoablation).
Most cases of atrial fibrillation are triggered by abnormal electrical firing in the pulmonary veins, or areas where the pulmonary veins connect with the left atrium. A specialized catheter ablation procedure, called pulmonary vein antrum isolation, can target this area.
Two to three months after catheter ablation, small circular scars form at the source of the abnormal electrical signals, disconnecting or isolating them from the rest of the heart. The arrhythmia is corrected without need for medications or implantable devices.
3. Surgical Ablation: Mini-Maze Surgery
The leading surgical treatment for atrial fibrillation is "Maze" surgery, which includes open-heart and minimally invasive techniques (mini-maze surgery). In each technique, a maze-like pattern of small cuts, or burns, are made on the heart's atrium, isolating cells that produce abnormal electrical signals. Scar tissue eventually forms on the heart, repairing the heart's electrical pathway.
Classic open-heart Maze surgery, which requires a large chest incision and cutting of the breastbone (sternum), usually is performed only when a patient requires open-heart surgery for other reasons, such as coronary artery bypass surgery or valve repair. HonorHealth uses newer, minimally invasive mini-maze approaches whenever possible, for several reasons:
- The sternum does not to be cut open. Only small incisions between the ribs are needed.
- A heart-lung machine is not used. Maze surgery is performed on the beating heart.
- The heart itself is not cut. In Maze surgery, abnormalities in the heart tissue are corrected using high-frequency energy or extremely cold vapors (cryosurgery).
- Maze surgery enables surgeons to remove the left atrium's appendage, a tiny, ear-shaped area of the heart where blood clots most commonly form. Removing the appendage can reduce the long-term risk of stroke.
As a result, compared with conventional surgery, mini-maze approaches offer less pain, shorter hospital stays and less scarring. What's more, mini-maze can be performed using the newest robotic surgery technologies available.
Mini-maze surgery typically involves a "keyhole" approach. Keyholes are three small incisions made between the ribs and on the side of the chest, serving as entry points — or ports — that make way for a miniature camera and small instruments to access the heart.
The surgeon places a clamp-like tool on the left atrium near the pulmonary veins, isolating the heart tissue that causes the atrial fibrillation. Next, this tissue is rapidly heated with radiofrequency energy. A surgeon will ensure that the heart's abnormal tissue is properly deactivated, performing diagnostic tests as needed. The left atrial appendage, a fingerlike structure where clots form, also may be removed.