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, unpredictable way. As a result, blood can pool in the atria and form a blood clot, which 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.
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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, to control the heart rate, restore normal heart rhythm and prevent blood clots.
At John C. Lincoln Hospitals, patients are offered a full range of atrial fibrillation treatments, including medications, minimally invasive surgery and open-heart surgery. The appropriate treatment option can depend upon how long a patient has experienced symptoms, the severity of symptoms and underlying causes of the condition.
Reduced Radiation Heart Procedures
John C. Lincoln North Mountain Hospital offers reduced radiation procedures for atrial fibrillation. Learn more.
Atrial fibrillation treatments include:
Atrial Fibrillation Treatment with Cardioversion
The initial approach for atrial fibrillation treatment is a procedure called cardioversion, which simply means to reset the heart rate to normal. Cardioversion can be performed 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.
Electrical cardioversion interrupts and resets heart rhythm with an electrical charge, which is transmitted to the heart through paddles placed on the patient's chest. Although the procedure is brief, several attempts may be required. Electrical cardioversion should not be confused with the emergency heart-shocking treatment seen on TV. This procedure is planned in advance and performed in a carefully controlled setting, under general anesthesia.
Electrical cardioversion may be accompanied by a transesophageal echocardiogram (TEE), in which a tube is guided down the patient's 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.
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In catheter ablation, the pathway that conducts electrical impulses through the heart is carefully repaired by removing abnormal tissues. Doing so normalizes the heart's electrical signals and restore normal heart rhythm. The procedure is performed by an electrophysiologist, a specialist in heart rhythm disorders.
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 (PVAI), 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.
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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. As in catheter ablation, 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), is usually performed only when a patient requires open-heart surgery for other reasons, such as coronary artery bypass surgery or valve repair. At John C. Lincoln, we employ 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 entail 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, in a way very similar to catheter ablation. A surgeon will work collaborate closely to ensure that 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.
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