Heart Surgery (Ablation Therapy for Arrhythmias)

An arrhythmia is an abnormal heart rate. The type of abnormal heart beat depends greatly on whether or not you have another heart problem. Other heart problems you may have will determine whether or not ablation therapy is the right treatment for you and whether it should be preformed surgically or non-surgically. Since there is a serious difference in the way the procedure is performed, both methods are explained here.

Surgical Ablation

This is typically used to treat atrial fibrillation. It can be completed as either an open procedure or a closed, also called minimally invasive. An open procedure is typically combined with a second procedure such as bypass surgery, valve repair, or valve replacement.

An atrial fibrillation is typically caused by a malfunction of the atrioventricular node. To understand why this should be repaired you must first understand how the heart works. The atria are the top two open areas, or chambers, of the heart. The purpose of the atrioventricular node is to delay impulses and allow the atria to complexly fill and properly contract to empty the contents. This must be timed right since the atria must empty before the ventricles, or the lower two chambers of the heart, are able to empty. If this is not timed right, it triggers an abnormal heart beat.

There are different approaches to this procedure. Here are the three most popular approaches.

The Maze Procedure: This is considered an open heart surgical procedure. The surgeon makes small cuts in the heart to interrupt the abnormal beat and direct normal impulses. This procedure is aimed at the atrioventricular node, or the section of the heart where the atria merge. As the heart heals, scar tissue builds around the muscles that are triggering early preventing them from sending triggering the urge to beat excessively.

During this surgery, the patient is hooked to a machine that does the job the heart typically does. The heart is then stopped so that there are no accidents in the procedure caused by accidently nicking other areas of the heart.

Minimally Invasive Surgical Ablation: There is not a large opening into the chest wall and the heart is not stopped in this procedure as it is in a surgical procedure. An endoscope is run into the heart. This endoscope has a light, a camera, and small instruments attached to it. The incisions are still made into the atrioventricular node; however the cuts are smaller and heal much faster.

The Modified Maze Procedure: During this procedure, the surgeon uses a special catheter, or tube, to send energy into the heart that will build scar tissue. This is done through a small incision in the left atrium. The scar tissue works the same as the original maze procedure and blocks the abnormal electrical impulses. There are many several different energies that can be used for this procedure, radiofrequency, microwaves, laser, and cryotherapy (freezing).

Non-surgical Ablation

This is used for many different types of arrhythmias. It is done in a special lab known as the electrophysiology laboratory. In this procedure, a small catheter is inserted into the specific area of the heart that is causing the problem. Energy such as the one’s mentioned in the Modified Maze Procedure is sent into specific muscles in that portion of the heart to interrupt the cause of the abnormal rhythm.

Why You Need Ablation Therapy

If your doctor has recommended ablation therapy to treat your abnormal heart beat, it means that they believe the benefits to you outweigh the risk of the procedure. Typical reasons that doctors recommend ablation therapy are an atrial fibrillation, atrial flutter, Ventricular tachycardia, Av Nodal re-entry tachycardia, or accessory pathways. These are explained in further details below.

Atrial fibrillation – atrial fibrillation means that the abnormal rhythm of your heart beat is not allowing your body to get enough blood flow. It is caused by impulses that are sent out by your heart muscles to beat chaotically. This is typically not life threatening but can lead to the need for emergency treatment and later complications.

Atrial flutter – an atrial flutter can be extremely scary for the person experiencing it. Your heart rate can go up to between 240 and 400 beats per minute. Even though you heart is beating fast, it does not push enough blood through your body. This can lead to low blood pressure and can be very life threatening.

AV Nodal re-entry tachycardia: most people have one pathway that takes blood out of the atria. This is a healthy blood flow. However, people who develop AV nodal re-entry tachycardia have two pathways that blood flows out of the atria, a fast path and a slow path.

Ventricular tachycardia: ventricular tachycardia is a condition that is caused by a very fast heart beat. This is considered to be more than 100 beats per minute. To be considered a tachycardia, there must be at least three abnormal heart beats in a row. It is typically a complication that is developed after a heart attack, but can develop years after the heart attack occurred due to scar tissue.

What to Expect From the Procedure

During non-surgical ablation therapy, you will be helped to get ready by the nurse. You will lay on the bed and the nurse will start an IV. This is so that you can get fluids and medications while the procedure is being done. Depending on the type of ablation surgery that is being done, you may be awake or under general anesthesia. You will then be hooked up to several monitors so that the team knows what your body is doing at all times.

Your groin will be shaved. Your neck, chest, and arm will be washed with antiseptic. You will then be covered with paper sheets, also known as sterile drapes. The doctor will then numb the site where they will insert the catheter, which will contain wires in it. This will monitor your heart rate and let the doctor know if you are experiencing any stress. The doctor will then begin the ablation procedure.

This procedure could take between four to eight hours depending on the severity of your condition and the location that is causing the issue.


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