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Surgery and Other Procedures for AFib

Medically Reviewed by James Beckerman, MD, FACC on March 01, 2021

Atrial fibrillation (AFib) is an irregular heart rhythm that can lead to serious problems and may need treatment. That will depend on what’s causing your Afib, your age, your symptoms, and other medical conditions you have. Some medications can control your heart rate or can convert your heart’s rhythm back to normal, but you might also have surgery or another kind of procedure to correct or maintain it.

Cardioversion

A cardioversion procedure can reset your heart to its normal rhythm. There are two types:

Electrical cardioversion. Your doctor gives your heart an electrical shock through paddles or patches on your chest. The shock stops your heart for a quick moment to reset it.

Your doctor will do this in a hospital. The procedure takes only about 5 minutes. But the entire process, including recovery, will probably take 30 to 45 minutes.

Your doctor puts you to sleep with a sedative before the procedure so that you don’t feel the shock. They might give you medications called anti-arrhythmics before your cardioversion. These will also help your heartbeat go back to normal.

Cardioversion with drugs. Your doctor gives you anti-arrhythmics to restore your heart’s rhythm. You might get these medicines through a vein (intravenous or IV) or in pills that you swallow, depending on your heart condition.

This procedure also usually happens in a hospital. Your doctor continuously watches your heart rate during your cardioversion. If the rhythm goes back to normal, the doctor usually gives you the same or a similar anti-arrhythmic drug so that you can avoid future AFib episodes.

Your doctor will do all they can to make your cardioversion safe, but as with other procedures, there are risks.

  • Blood clots. During an electric cardioversion, blood clots from your heart can become dislodged and move to other parts of your body. This could cause serious issues like a stroke or a clot in your lungs. Your doctor will check for clots before the procedure. They might also prescribe a blood thinner for several weeks beforehand to lower the risk. If your AFib episode lasted longer than 48 hours, your doctor may have you take one of these medications for at least a month after cardioversion, too.
  • Unusual heart rhythm. It’s rare, but the procedure could lead to other heart rhythm problems. If this happens, it’s usually during or right after the procedure. Your doctor can give you more electrical shocks or extra medication to fix it.
  • Skin burns. This is also rare, but you could get a slight burn from the electrodes on your skin.

Your doctor will have you stay in a recovery room for about an hour after the procedure. They’ll closely watch for any complications. You’ll usually be able to go home the same day. But someone else will have to drive you.

Cardiac Ablation

Doctors can do this procedure in a hospital to correct an uneven heart rhythm. It works by scarring or getting rid of tissue in your heart to stop faulty electrical signals caused by AFib.

Cardiac ablation is usually not the first choice of treatment for AFib. Doctors often use it if medications or other procedures haven’t worked.

Cardiac ablation usually improves symptoms of AFib such as fatigue and shortness of breath. There are three types:

Catheter ablation. This is the most common method for cardiac ablation. Your doctor puts long, thin tubes called catheters through a vein and into your heart, where they apply extreme heat or cold to cause small scars.

After the procedure, you go to a recovery room to rest for 4 to 6 hours. This will help avoid bleeding from the catheter site. Your doctor watches your blood pressure and heartbeat while you rest.

Most people can go home the same day. Someone else will need to drive you home. You might feel slightly sore, but this shouldn’t last more than a week.

Maze procedure. Your doctor does this type of ablation during open-heart surgery. They use cuts, extreme cold, or radiofrequency to make a maze pattern of scar tissue in your heart’s upper chambers. This might be a good option if you’re already having heart surgery for another reason.

You are put under general anesthesia for this type of surgery and might also get a sedative beforehand to help you relax. A maze procedure usually lasts 2 to 4 hours, but you have to stay in the hospital for 5 to 7 days after surgery.

After the procedure, your doctor watches you in an intensive care unit (ICU). They monitor your heart’s activity with a test called an EKG and give you pain medication to help you stay comfortable.

AV node ablation. Atrioventricular (AV) node ablation uses catheters to make scars in the AV node. This is the part of your heart that connects the upper and lower chambers. After the procedure, you need to use a pacemaker to keep a regular heart rhythm and to take blood thinners to lower the risk of stroke.

AV node ablation and pacemaker insertion takes about 3 hours. You usually stay in the hospital for 2 nights after the surgery.

After your surgery, you shouldn’t have any major pain. You might feel some chest discomfort because of inflammation from surgery, have a sore throat from the tube used with anesthesia, or have bleeding at the wound site. Your doctor watches for these side effects and treats them if necessary.

The risks of cardiac ablation include:

  • Damage to your heart, blood vessels, heart valves, or heart electrical system
  • Blood clots in your legs or lungs
  • Bleeding or infection
  • Heart attack or stroke
  • Narrowing of the veins between your lungs and heart

Rarely, these procedures can be deadly.

Left Atrial Appendage Closure

The left atrial appendage (LAA) is a small area on your heart’s left atrium. Blood usually flows into and out of this area, but AFib can lead to blood clots there. This can cause serious issues like a stroke. Usually, your doctor will give you medication to prevent clots. But if you’re not able to use long-term blood thinners, your doctor will do a procedure to close your LAA.

A left atrial appendage closure seals off your LAA to keep clots from getting out, so you have a lower risk of stroke and won’t need to take blood thinners.

There are a couple of ways that your doctor can close your LAA. They’ll talk with you about which one they recommend.

Watchman. The Watchman is a parachute-shaped device that your doctor puts in place through a catheter in a vein near your groin. You won’t need surgery, but you might have general anesthesia to put you to sleep during the procedure. You’ll stay in the hospital overnight and take aspirin and warfarin until a 45-day follow-up appointment.

AtriClip. An AtriClip is put on the outside area of the LAA to close it at its base so that blood doesn’t get in. Your doctor does this through a small cut in the left side of your chest. You don’t need to be on a blood thinner before or after this procedure.

Amplatzer plug. Doctors have used this device in Europe since 2008, but it’s still being tested in the United States. In a procedure like the one to place a Watchman, your doctor puts a catheter into the vein at your groin and up to your LAA, where they put the plug.

LARIAT device. This procedure uses a loop stitch around the base of the LAA to seal it off from the rest of your heart. It blocks any blood clots from getting to your brain and causing a stroke.

Not many centers offer the LARIAT device. It’s not for people who’ve already had cardiac surgery, whose LAA is too large, or whose LAA is in an unusual spot.

It’s rare, but a procedure to close the LAA carries the risk of a stroke, blood clots, or fluid buildup around the heart.

WebMD Medical Reference

Sources

SOURCES:

Mayo Clinic: “Atrial Fibrillation,” “Cardioversion,” “Atrial Fibrillation Ablation.”

University of Utah: “Left Atrial Appendage Closure: Watchman Device & Atriclip,” Maze Procedure (Atrial Fibrillation Surgery).”

Cleveland Clinic: “Left Atrial Appendage & Closure.”

Stanford Health Care: “What Is Left Atrial Appendage Closure.”

Johns Hopkins Medicine: “Left Atrial Appendage Closure Procedures.”

Penn Medicine: “Ablation Recovery: What You Should Know.”

University of Michigan: “AV Node Ablation,” “Atrial Fibrillation: Should I Try Electrical Cardioversion.”

Journal of Cardiothoracic and Vascular Anesthesia: “Anesthesia for elective cardioversion: a comparison of four anesthetic agents.”

Upstate University Hospital: “Maze Procedure.”

SecondsCount.org: “Your Electrical Cardioversion Procedure: What to Expect.”

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