Writes Stylianos E. Tzeis MD, PhD Director MITERA Adult Cardiology Clinic
Atrial fibrillation is the most common cardiac arrhythmia. It is estimated that about 250,000 Greeks suffer from atrial fibrillation, a number that is expected to increase in the coming years, mainly due to the aging population.
In atrial fibrillation, the atria (the two upward cavities of the heart) beat very fast, chaotically and completely arrhythmically, with the result that their organized and effective contraction is not achieved. Patients with atrial fibrillation may complain of symptoms, sometimes severely, but are mostly vulnerable to complications such as stroke and heart failure.
The treatment of patients with atrial fibrillation has two main objectives. The first is to prevent them from the risk of thromboembolism and especially stroke with the appropriate use of anticoagulants. The second is to reduce the recurrence of atrial fibrillation and maintain a normal sinus rhythm. The second goal is achieved either by administering antiarrhythmic drugs, or invasively by the method of ablation.
What is catalysis (ablation);
Atrial fibrillation ablation is an invasive treatment that attempts to isolate electrical “arrhythmogenic” areas of the heart (mainly the pulmonary veins) that are responsible for causing atrial fibrillation. The catalysis of the pulmonary veins is performed with special catheters in a procedure similar to that followed in coronary angiography or the “balloon”.
The catheters are inserted through peripheral veins and are painlessly advanced into the heart. The use of a catheter that emits high frequency current creates successive lesions (cauterization) with the aim of gradually creating more circular lesions around the pulmonary veins and the interruption of electrical communication between the left atrium and pulmonary veins. Similar results are achieved with the use of cryoablation balloon catheter.
Atrial fibrillation catalysis takes about 2 hours, with an even shorter duration on cryoablation. During the operation the patient is in hypnosis, while local anesthesia is used for vascular punctures. In a percentage of patients, a second operation of shorter duration may be required to cauterize additional foci. Patients are discharged from the hospital the day after surgery.
Which patients are suitable for catalysis (ablation) atrial fibrillation?
Suitable candidates for catalysis surgery are atrial fibrillation patients who remain symptomatic despite treatment with one or more antiarrhythmic drugs. In addition, according to the latest guidelines of the European Society of Cardiology, catalysis can be used as a first-line treatment, even before starting treatment with antiarrhythmic drugs, especially in highly symptomatic young patients with paroxysmal atrial fibrillation.
The following are considered ideal candidates:
- Patients with paroxysmal atrial fibrillation
- Frequent symptomatic episodes of atrial fibrillation
- Left atrium without stretching
- Absence of underlying heart disease
Success rates of catalysis surgery (ablation) atrial fibrillation
The results of many large studies have confirmed that ablation of atrial fibrillation is superior to treatment with antiarrhythmic drugs in controlling recurrences of atrial fibrillation. After catalysis surgery, approximately 70% of patients with paroxysmal atrial fibrillation remain free of recurrence.
What are the risks of catalysis surgery (ablation) atrial fibrillation?
About 1-2% of patients may experience some complication, such as collection of blood around the heart (occlusion), pulmonary vein stenosis, infection, hematoma in the peripheral vein puncture area, stroke. In the vast majority of cases the complications are treated after a short extension of the patient’s hospitalization. The results of studies have shown that the incidence of complications decreases with the cumulative experience, which suggests that the operation should be performed by specialized electrophysiologists experienced in this operation.
The article Invasive treatment of atrial fibrillation published in NewsIT .