Surgical Ablation For Atrial Fibrillation

What is Atrial Fibrillation?

Atrial fibrillation is the most common type of abnormal heart rhythm With atrial fibrillation, electrical impulses don't follow a normal pathway through the heart. As a result, the heart doesn't beat properly or pump blood correctly.

Atrial fibrillation can lead to:

  • Blood clots
  • Stroke
  • Heart attack
  • Heart failure
  • Chronic fatigue
  • Death

High Intensity Focused Ultrasound (HIFU) Ablation for Atrial Fibrillation can be performed as a stand alone procedure for treating atrial fibrillation. Dr. Peterson is a leading teacher in this area and recently completed a book: Minimally Invasive High Intensity Focused Ultrasound (HIFU) Cardiac Ablation that is widely used to help train other surgeons.

Ablation means to make a scar, separating the trigger points of atrial fibrillation from the rest of the heart.  

This technique involves making a small incision on the front of the right chest wall to treat atrial fibrillation.  While the procedure takes approximately one hour and the incision is about 2 1?2 inches in length, this is still an open-heart surgical procedure.

Once elected for minimally invasive HIFU surgery, you will be taken off your Coumadin (warfarin) for approximately seven days prior to surgery. 

About two days prior to surgery, laboratory data and blood type and crossing will be performed at the hospital.  You will meet with an anesthesiologist at that time to discuss the special anesthetic issues and pain management. 

You will be admitted to the hospital the same day of surgery.  In addition to routine procedures for surgery, an anesthesiologist will put in a spinal catheter for pain control.  This catheter is usually left in two days. 

Prior to surgery patients need to undergo a nuclear stress test to rule out the presence of blocked coronary arteries as well as an echocardiogram to look at heart function, to evaluate any heart valve disease and to measure the size of the heart collecting chamber (the left atrium). 

The procedure is performed under general anesthesia with the patient fully asleep and anesthetized in an open-heart room. 

As a precautionary measure, the heart/lung machine and heart/lung machine operator are available. 

The procedure is performed with the heart beating off the heart/lung machine. 

Once asleep, a special breathing tube will be placed, allowing us to deflate the right lung for 30-40 minutes during the surgery. 

The actual surgical ablation performed using the HIFU device and a computer generated algorithm lasts for less than ten minutes. 

First a small soft catheter is placed around the heart in a specific fashion.  After this, the device that creates the scar (ablation) is placed around the heart using the soft catheter as a guide

After the ablation procedure, all the devices are removed from around the heart.

Almost all patients have the breathing tube removed in the operating room prior to transfer to the Intensive Care Unit.  

After surgery patients will have two small drains in the right chest space.  These will be in for between two and four days on average. 

Patients spend one to two nights in the Intensive Care Unit.

Our target hospitalization is three days.  However, patients stay longer than that, often four or five days, depending on heart rhythm medicine management and chest tube drain management. 

We strive for aggressive pain management following surgery.  You will be discharged from the hospital with pain medication.

The procedure is not 100% effective.  In that this is a new procedure, the exact effectiveness in an individual case cannot be totally quantified. 

All open-heart surgery carries risks.  There is a risk of bleeding during the procedure, which may require the breastbone to be opened and even require open-heart bypass for repair.  Less common risks include the need for a pacemaker, infection, diaphragm nerve injury or death.

It is important for you and your family to know that the ablation procedure merely starts the scarring process.  It may take up to six months or even longer to tell if permanent treatment for your heart rhythm has been effective.  It is very common and even expected to have atrial fibrillation in the month or even a three month period following surgery.  Results continue to improve even after six months and possibly up to one year. 

You will be placed on heart rhythm control medicines after surgery.  While these are often similar medicines to your medications before surgery, there may be changes. 

Your cardiologist will be involved in management of your heart rhythm medications following surgery. 

You should expect to be on Coumadin medication for at least six months following surgery.  Sometimes Coumadin medication requirements are longer than six months. 

We will be available to answer any questions and to assist your cardiologist and primary care physician in management of your heart rhythm following your surgical procedure. 

These are only general guidelines. The specifics of your procedure may vary.

If you have further questions please call our office at any time.

What Are The Benefits of the Procedure?

Surgical HIFU ablation for atrial fibrillation offers the following benefits:

  • 70 to 86 percent cure rate of atrial fibrillation
  • Reduction in risk of blood clots and stroke
  • Fewer or no symptoms related to abnormal heart rhythms
  • Reduction or discontinuation of blood thinners such as Coumadin
  • Reduction or discontinuation of anti-arrhythmic drugs such as Amiodarone
  • Most patients who have had the procedure report an ability to exercise more frequently and for longer periods of time
  • In some cases, the procedure will reduce the size of the atria, therefore lessening the risk for other complications, such as heart failure
  • Additional benefits of the minimally invasive approach include:
  • No splitting of the breastbone (sternum)
  • Faster recovery than with a large chest incision
  • Less time spent in the hospital
  • Incisions are small
  • Minimal blood loss

Who is a candidate for surgical treatment of atrial fibrillation?

HIFU ablation for atrial fibrillation is an option if:

  • You have atrial fibrillation: Works best with intermittent atrial fibrillation and a smaller subset of chronic or continuous atrial fibrillation.
  • Your atrial fibrillation is not well controlled by medication
  • You have intermittent atrial fibrillation that is disabling
  • You require another type of heart surgery procedure, such as mitral valve surgery or coronary artery bypass surgery
  • You have a history of stroke or cannot take Coumadin

How is the HIFU approach better than the Maze procedure?

You may have heard about the Maze procedure, a surgical approach to treating atrial fibrillation that entails precise cutting of heart tissue to stop the abnormal heart rhythms. While this is an effective approach to treat atrial fibrillation, it does pose greater risks and complications than the HIFU approach.

In contrast to the Maze procedure, surgical HIFU ablation offers the following benefits:

  • Less scarring to heart tissue
  • No need to use a heart-lung machine
  • No cutting of heart tissue
  • Significantly shorter operative time
  • Faster recovery time

How is surgical ablation different from catheter ablation?

Catheter ablation is similar to surgical ablation in the sense that both procedures are performed for the same purpose to treat abnormal heart rhythms. Catheter ablation involves the use of a catheter that is threaded through the leg and into the heart. The catheter is equipped with a device that delivers HIFU waves to the source of the arrhythmia. An electrophysiologist performs this procedure in a catheterization lab.

The information provided on this website is provided for informational purposes only, and must not be used to diagnose or treat any health problem or disease. This information is not intended as a substitute for professional medical care, and is not intended to provide complete medical information. Only a doctor can diagnose and treat medical problems.

You must consult with us personally if you want more information on the procedures and tests that are described on this website.

This website created exclusively for Manatee Cardiac Surgery by: NetGain Promotions