Atrial fibrillation or A-fib is a condition with abnormal heart rhythm or arrhythmia. This irregular heart beat is caused by inconsistent electrical impulse in the upper chamber of the heart. Atrial fibrillation surgery involves many options that prevent blood clots, reducing the risk of stroke, restoring the rhythm of the heart, controlling heart rate, and treating any underlying disorders.
Doctors resort to surgery only if the condition is severe and, medications for treatment do not work. Many surgical options are available depending on the complications.
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Symptoms of A-fib
Listed below are the common symptoms but, in some cases, symptoms may not be noticeable at all.
- Heart palpitations
- Shortness of breath
- Chest pain
Causes of Atrial fibrillation
A-fib is typically caused by other conditions that affect the heart. At times, the cause may be unknown. It is triggered by factors like:
- Old age or family history of A-fib
- Heart diseases:
- Heart valve disease
- Heart failure
- Coronary artery disease
- Rheumatic heart disease
- Cardiomyopathy (weakened heart muscle)
- Heart birth defects
- Pericarditis (inflamed membrane or sac around the heart)
- Sick sinus syndrome
- Other health conditions:
- Lung diseases
- High blood pressure
- Obesity, diabetes and, metabolic syndrome
- Sleep apnea
- Viral infection
- Habits and lifestyle:
- Binge drinking
- Stimulant drugs
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Types of Atrial Fibrillation
There are various types of A-fib which could also change over time.
- Paroxysmal A-fib: spontaneously comes and goes for a short duration of time and may be asymptomatic. Changes in lifestyle may be recommended.
- Persistent A-fib: It also begins spontaneously but lasts for at least 7 days or so and may or may not end on its own. It needs medical intervention.
- Long-standing persistent A-fib: associated with heart damage,this can last a year without interruption. A medical invasive treatment may be needed.
- Permanent A-fib: Long-standing persistent A-fib can result in permanent A-fib when a normal heart rhythm or rate is not restored. The heart is always in a state of A-fib and treatment no longer work causing lower quality of life.
- Valvular A-fib: A-fib caused by an artificial heart valve problem.
- Non-Valvular A-fib: Caused by something other than an artificial heart valve problem.
Diagnosis and Tests
- Electrocardiogram (ECG) to reflect:
- Rhythm of your heartbeat
- Speed of your heartbeat
- Strength and timing of the electrical signals passing through your heart
- Holter monitor: A portable ECG to record prolonged heart activity for 24 – 48 hours.
- Event monitor: A portable ECG to record some abnormal activity or manually record when you experience:
- A fluttering or racing heart
- Echocardiogram; Sound waves to produce:
- An image of your heart.
- How the heart chambers and valves are working
- Where heart muscles are contracting the wrong way
- Areas of poor blood flow
- Previous injuries caused by poor blood flow
- Chest X-Ray: To check the condition of your heart and lungs
- Stress Test: tests on your heart while you are exercising
- Blood tests: To check infection, signs of heart attack, thyroid and kidney problems.
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Types of A-fib surgeries
Surgery for A-fib is dependent on the frequency of the A-fib and the area where the irregularity occurs. Various options are available.
- Ablation: It is a minimally invasive surgery. In a Catheter ablation, a catheter is inserted into your heart to burn the areas that cause abnormal beats. If the Catheter does not work, Atrioventricular node ablation (AVN) is resorted to destroy a larger area of your heart. The procedure is the same as the former surgery. A permanent pacemaker may be needed to keep the normal rhythm of the heart.
- Maze procedure: Small cuts are made at the top part of the heart. After the cuts are sewn, a scar tissue is formed which prevents further A-fib. A maze-like pattern is formed for the heart’s electrical signal to follow. Some may require a pacemaker after surgery.
- A cardiologist may take some physical examination that includes:
- Listening to your heartbeat's rate and rhythm
- Listening to your lungs
- Checking your blood pressure and pulse
- Checking for signs of heart valve or muscle problems
- A review of your medical history
- Review and discuss a treatment plan that includes:
- Your age
- Overall health
- Type of A-fib
- Any underlying cause that needs to be treated
- Diagnostic tests
- Avoid eating and drinking at least 8 hours before surgery
- Removing of hair in the area where the procedure may take place
- Do not smoke for at least 2 weeks prior to surgery.
- A general anaesthesia will be administered to you
- It takes about 2 – 4 hours to perform
- Patches of ECG electrodes will be put on your chest and back
- A respirator will be attached to help in breathing
- A catheter may be inserted in your bladder to collect urine
- For Catheter ablation, either from the neck or groin, a catheter will be inserted through your blood vessel and into your heart, and this procedure will be monitored by an ultrasound
- To create a scar tissue, surgeons may use certain methods such as radiofrequency waves, microwave, lasers or, cryothermy
- If you are having an Open-heart Maze procedure, the surgeon breaks the breastbone, opens the chest, and put you on a heart-lung machine to keep you alive during the procedure of making a scar tissue
- For a Minimally invasive maze surgery, the surgeon makes small incisions called keyholes into the heart
- Heat or cold energy will be used to make a scar tissue
- A tiny camera is used inside the heart to see the cuts and scars
- In case a Robotic-assisted maze surgery is performed, robotic tools slightly different from minimally invasive procedures are used.
- A Catheter ablation takes a shorter stay and the patient may be discharged on the same day itself after resting for 6-8 hours after surgery or an overnight stay
- A Maze procedure takes at up to 5 days stay in the hospital
- You may feel sore or uncomfortable for a few days and may need to rest more than usual
- You may not have a normal heartbeat until a scar tissue is formed
- You may be given blood thinners and other medications such as anti-inflammatory or diuretic drugs
- For about a month, avoid any hot showers, soaking in a bath, or whirlpool tub
- Do not use creams or lotions around the surgical wounds
- Follow-up will be scheduled on a regular basis for at least a year
- Avoid exercise or heavy weights for at least 3 weeks after surgery
- Another procedure may be necessary if the first surgery has not worked.
Post-surgery risks and complications
- Blood clots
- Accidental damage to the tissues in the body including heart puncture
- Organ failure
- Vein problems
Factors affecting costs of A-fib
- Choice of hospital
- Surgeon’s fee
- Cost for blood tests and diagnostic tests
- Type of treatment and surgery
- Medicinal costs
- Duration of stay
- Cost of post-surgery care