Atrial fibrillation or A-fib is basically a disorganized rhythm of the upper chambers of the heart which are called the atria. So in intrinsically, A-fib is always been thought of as a benign rhythm. However, it’s been shown to people in A-fib live shorter than people that are not an A-fib what we call a normal sinuous rhythm.
And with A-fib you have various physiologic changes that can happen to cause problems, meaning, you can have low flow through the heart which can cause congestive heart failure which then causes you to be hospitalized more frequently.
You can also have stasis or again low flow which can cause blood clots to form in the heart which can then fire off to other parts of the heart meaning the brain or the body or the legs can cause clotting problems.
There’s a significant percentage of stroke patients in the country, has strokes due to embolic phenomenon from these clots that are formed in the heart due to atrial fibrillation and then gone up to the parts of the body. Symptoms of A-fib are varied, in fact, they can go from completely asymptomatic and people don’t even know they have it until maybe they’ve already had a stroke or they show up with some other problem or symptoms can go to a racing heartbeat, palpitations, shortness of breath.
Some people have this impending feeling of doom like they’re going to die. And that’s usually because of the– of a rapid response to the atrial fibrillation, a rapid heart rate. So the symptoms can really expand across the board, but what makes it so insidious and dangerous is often times it is asymptomatic, and you don’t know until you’ve already had a complication from it.
If A-fib is a stand-alone issue, often the first line of therapy is medication and there are anti-arrhythmic medications that are given often by the cardiologist and can handle the problem. With atrial fibrillation you also need to be on blood thinners, any coagulation to prevent those blood clots from forming.
Depending on the type of atrial fibrillation whether it’s been very short-lived or its been going on for years will depend– and if it’s managed by medications in and of itself will determine if you need to do a more invasive approach.
So cardiologist first-line invasive approach is usually with a catheter and they’ll take a catheter up through the [inaudible], snake it up to the heart and they can make burn marks on the inside of the hearth to basically try to ablate these areas of the heart that where this abnormal rhythm starts.
Patients that happen in large chart or have had A-fib for a much longer time have a much higher failure rate with catheter ablations.
So then that moves to the next step which is surgical ablation. Surgical ablation which is relatively new from a minimally invasive standpoint involves also making burn lesions on the outside of the heart and also getting rid of that left atrial appendage which is a little portion of the heart where the clot forms that then often can fire off to the body.
Historically, surgical ablation involved open chest, open sternotomy, cardiopulmonary bypass, big operation. These days we can do it with just a few little small port sites about a centimetre, three on each side and patient, it’s still until general anaesthesia, the patients have significantly less pain, recover very quickly afterwards and then has a higher success rate from the catheter ablations for A-fib.
We usually refer to it as a maze procedure ’cause you’re drawing lines that look like a maze on the outside of the heart to keep those electrical rhythms from propagating in the wrong direction.