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Atrial Fibrillation and Heart Disease

What Is a Permanent Pacemaker?

A pacemaker is a device that sends electrical impulses to the heart muscle to maintain a specified heart rate. Pacemakers may be implanted in people with AF who have a slow heart rate. The pacemaker has a pulse generator (which houses the battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to the heart muscle, as well as sense the heart's electrical activity.

Newer pacemakers have many sophisticated features designed to help with the management of arrhythmias and to optimize heart rate-related function as much as possible.

What Surgeries Are Performed?

Patients with chronic atrial fibrillation not relieved by medication or procedures, or patients who have other conditions requiring heart surgery, may be candidates for surgical treatment of AF. These procedures are types of open-heart surgery that require general anesthesia (you are put to sleep) and a hospital stay.

During the Maze procedure, a series of precise incisions are made in the right and left atria to confine the electrical impulses to defined pathways to reach the AV node.

Surgical pulmonary vein isolation is a modification of the Maze procedure in which the surgeon uses alternative energy sources instead of incisions to create lesions. The alternative energy sources used during surgical pulmonary vein isolation include: radiofrequency, cryothermy, microwave, and laser. The goal of all four energy sources is to produce lesions and ultimately scar tissue to block the abnormal electrical impulses from being conducted through the heart and to promote the normal conduction of impulses through the proper pathway.

Many of these approaches can be performed with minimally invasive (endoscopic or "keyhole") surgical techniques.

  • Radiofrequency ablation: A special radiofrequency energy catheter is used to heat the tissue and produce lesions on the heart similar to the lesions of the Maze procedure. There are a variety of surgical techniques related to the type of catheter used, the dose of energy, and the types of lesions created.
  • Cryothermy (also called cryoablation): Very cold temperatures are transmitted through a probe (called a cryoprobe) to create lesions. This technique is used commonly during arrhythmia surgery to replace the incisions made during the Cox Maze procedure.
  • Microwave technology: A special wand-like catheter is used to direct microwave energy to create several lesions on the heart. The lesions block the conduction of abnormal electrical beats and restore a normal heartbeat.
  • Laser: Lasers rapidly create the lesions or lines of conduction block. Laser technology offers promise for the development of additional minimally invasive approaches.

Some patients may have atrial fibrillation in addition to other heart problems (such as valve or coronary artery disease) which require surgery. In these cases, the surgeon may combine the surgeries to correct the atrial fibrillation and the coexisting heart condition at the same time.

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WebMD Medical Reference

Reviewed by James Beckerman, MD, FACC on December 19, 2013

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