1 AnswerGraham M. Bundy, MD, Cardiothoracic Surgery, answered on behalf of Henrico Doctors' Hospital - HCA VirginiaPeople who have had the hybrid maze procedure for atrial fibrillation (AFib) are evaluated after the procedure at six- and 12-month follow-up intervals, and seen on an as-needed basis thereafter. Because the hybrid maze procedure is performed in a single setting and can fit within the normal practice requirements of catheter ablation, it avoids the downfalls of complex surgical procedures, including the pain associated with large chest incisions or ports. This demonstrates the ability to treat persistent and longstanding atrial fibrillation with minimally-invasive techniques, better outcomes and reduction of long-term recurrence.
1 AnswerGraham M. Bundy, MD, Cardiothoracic Surgery, answered on behalf of Chippenham Hospital - HCA VirginiaDuring the hybrid maze procedure for atrial fibrillation (AFib), after anesthesia, the surgical team first performs the epicardial ablation portion of the procedure, creating the lesions around the heart. This is performed through an endoscopic incision in the diaphragm using a radiofrequency technique, allowing the heart to continue its normal function throughout the operation. The opening in the diaphragm is sized specifically to facilitate the passage of the epicardial ablation device and an endoscope, allowing the surgeon to visualize both the atrial surface and the space around the heart during the procedure.
Upon completion of the epicardial ablation, a drain remains in place around the heart and the abdominal access site is closed. At this point, the electrophysiology team takes over the procedure to perform the endocardial ablation, creating any necessary lesions on the interior walls of the heart, using irrigated tip catheters to access the multiple sites. After the operation, the pericardial drain is left in place for 36-48 hours; the patient is observed for a further 24 hours post-drain removal.
1 AnswerGraham M. Bundy, MD, Cardiothoracic Surgery, answered on behalf of Johnston-Willis Hospital - HCA VirginiaThe hybrid maze procedure aims to help manage atrial fibrillation (AFib) without relying on repeat treatments. The endoscopic approach allows epicardial access and ablation to be accomplished without violating the chest or deflating the lungs. It also enables a single-setting procedure to be performed in the electrophysiology laboratory, potentially reducing post-procedure pain, decreasing length of hospital stay and improving recovery.
1 AnswerPenn Medicine answered
When medications do not work in the treatment of atrial fibrillation (AFib), there are alternatives:
- Electrical cardioversion. This is a controlled procedure and is conducted under light anesthesia in the hospital, and you usually go home the day of the procedure.
- Catheter ablation
- The Maze procedure. This often requires open heart surgery because the clinician must make precise, small cuts (or possibly catheter burns) in specific places on the atria. The procedure’s name comes from the mazelike pattern of incisions made in the atria. Usually, the Maze procedure is performed only when open heart surgery is required for other reasons.
If you suspect you have atrial fibrillation (AFib), set up an appointment with your doctor. A doctor will usually start by looking at your personal medical history as well as your family history. The information from you will help your doctor understand your specific symptoms and how severe they may be, as well as define your AFib clinically. The discussion should also reveal your AFib frequency, duration, precipitating factors and how it terminated (if it did).
If you received any treatment for AFib before seeing your doctor (for example, if paramedics administered a drug or defibrillation therapy), your doctor will want to review your response to such therapy.
There are a number of temporary (acute) that can cause atrial fibrillation (AFib). For the most part, when the temporary condition ceases or is treated, AFib usually is resolved. The acute conditions are:
- Lung disease, such as pneumonia
- Asthma attacks
- Extreme body stress
- The occurrence of a metabolic disorder, such as hyperthyroidism (overactive thyroid gland)
- An inflammation of the lining of the heart
- A heart attack, which also increases the risk of AFib
Many of the acute conditions listed can cause chemical imbalances that may lead to electrical imbalances in your heart, triggering AFib. However, once the necessary balance is restored, the AFib may disappear on its own.
1 AnswerHealthwise answered
Catheter ablation is a minimally invasive procedure to treat atrial fibrillation. It can relieve symptoms and improve quality of life.
During an ablation, the doctor destroys tiny areas in the heart that are firing off abnormal electrical impulses and causing atrial fibrillation.
You will be given medicine to help you relax. A local anesthetic will numb the site where the catheter is inserted. Sometimes, general anesthesia is used. The procedure is done in a hospital where you can be watched carefully.
Thin, flexible wires called catheters are inserted into a vein, typically in the groin or neck and threaded up into the heart. There is an electrode at the tip of the wires. The electrode sends out radio waves that create heat. This heat destroys the heart tissue that causes atrial fibrillation or the heart tissue that keeps it happening. Another option is to use freezing cold to destroy the heart tissue.
Sometimes, abnormal impulses come from inside a pulmonary vein and cause atrial fibrillation. (The pulmonary veins bring blood back from the lungs to the heart.) Catheter ablation in a pulmonary vein can block these impulses and keep atrial fibrillation from happening.
View a slideshow of catheter ablation to see how the heart's electrical system works, how atrial fibrillation happens and how ablation is done.Atrial Fibrillation: Should I Have Catheter Ablation? AV node ablation
AV node ablation is a slightly different type of ablation procedure for atrial fibrillation. AV node ablation can control symptoms of atrial fibrillation in some people. It might be right for you if medicine has not worked, catheter ablation did not stop your atrial fibrillation or you cannot have catheter ablation. With AV node ablation, the entire atrioventricular (AV) node is destroyed. After the AV node is destroyed, it can no longer send impulses to the lower chambers of the heart (ventricles). This controls atrial fibrillation symptoms.
After AV node ablation, a permanent pacemaker is needed to regulate your heart rhythm. Nodal ablation can control your heart rate and reduce your symptoms, but it does not prevent or cure atrial fibrillation. AV node ablation helps about 9 out of 10 people. 1 The procedure has a low risk of serious problems. 2
View a slideshow of AV node ablation to see how the heart's electrical system works, how atrial fibrillation happens and how AV node ablation is performed.
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1 AnswerScripps Health answered
A potential option for people with atrial fibrillation who do not want to take blood thinners is a minimally invasive surgery that blocks the heart’sleft atrial appendage, where blood is most likely to stagnate and clot.
One device used for this procedure, the Lariat, ties off the appendage from outside the heart. The procedure is done through small punctures, requires an overnight stay in the hospital and poses very little risk. Following the procedure, people with atrial fibrillation no longer need blood thinners.
The Lariat is available for people with atrial fibrillation who meet certain qualifications. People should consult their doctor for more information.