When treatment with medicine and lifestyle modifications fails, a doctor may suggest surgery to treat arrhythmia. The goal of all arrhythmia surgery procedures is to get the heart back to its normal rhythm.
A disorder that alters your heartbeat’s rhythm or pace is referred to as an arrhythmia. Your heart may beat erratically, quicker, or slower than usual if you have an arrhythmia. According to experts, between 1.5% and 5% of persons experience arrhythmias.
Arrhythmias are frequently treated with a mix of medicine and lifestyle modifications. Your doctor might advise surgery if these don’t work to relieve the symptoms of your arrhythmia.
Are you wondering what goes into arrhythmia surgery? As we examine three different arrhythmia surgery options, continue reading.
Cardiac ablation for arrhythmia
Problems with the electrical system of your heart cause arrhythmias. This could happen, for example, if a cell type other than the native pacemaker in your heart begins to produce electrical signals. This may disrupt the heart’s normal rhythm.
Physicians can utilize ablation to kill these cells with heat or cold if they know where they are. This may assist in resolving the arrhythmia.
Most frequently, a thin, flexible tube known as a catheter is used by doctors to accomplish ablation. This treatment involves little invasiveness.
Physicians may also conduct ablation as an open procedure. Although it’s rare, if a doctor is unable to properly access your heart with a catheter, they may choose to do it.
A Maze operation is a particular kind of open ablation surgery that physicians perform to treat atrial fibrillation (AFib). The following section will cover that one in further detail.
Preparation
Your physician will want to make sure you’re in good enough health to have the surgery. They’ll order several tests to do this, including:
- an electrocardiogram (EKG)
- blood tests, such as metabolic panels, full blood counts, and assessments of kidney and liver function
- imaging, such as X-ray and echocardiogram
Particular preparation guidelines will also be sent to you in the days preceding your treatment. These are probably going to be:
- advice on which prescription and over-the-counter medications to change and when to do so
- information about when to begin fasting the night before the procedure
- what supplies to pack on your procedure day at the hospital
It’s critical that you attentively follow each of these guidelines to guarantee that your process can go forward on time.
Procedure
The following actions are involved in catheter ablation:
- Your doctor makes a tiny incision, usually in your groin, to implant a catheter into a blood vessel.
- To guide the catheter through your blood vessels and into your heart, they use imaging.
- Your doctor locates the region producing abnormal electrical impulses using electrodes attached to the catheter.
- Your doctor destroys the cells by applying heat or cold once they have located the spot.
- They next take out the catheter and seal the tiny cut.
When doing catheter ablation, doctors usually employ conscious sedation or general anesthesia. This implies you won’t experience any discomfort during the process but will remain awake. You might, however, experience some pressure or tugging.
Recovery
After your catheter ablation, you might be able to go home that same day. However, your doctor might want you to spend the night in the hospital for monitoring, depending on how the procedure went.
After a few days, most people can resume many of their usual activities, however, you might be restricted from doing some things for a longer period. For instance, your physician might suggest avoiding:
- driving
- bathing
- strenuous activity
- heavy lifting
- swimming
Risks and side effects
Following an ablation operation, the risks and adverse effects may include:
- a reaction to the anesthesia
- excessive bleeding
- blood clots, which may result in a stroke or a heart attack
- infections
- damage to the heart or blood vessels
- kidney damage
- Vascular constriction in the lungs and heart, known as pulmonary vein stenosis
- an uncontrollable pre-existing arrhythmia or a new one
- paralysis of the phrenic nerve, which is important in breathing and regulates your diaphragm
- damage to your esophagus
The radiation used during catheter ablation has a small risk of cancer as well. A single ablation surgery is estimated to have a lifetime risk of 1 in 21,700 cases of cancer, according to a 2017 study.
Maze procedure for arrhythmia
The most prevalent arrhythmia, AFib, is treated via open surgery such as the Maze operation. It is estimated by researchers that between 3 and 6 million Americans suffer from this kind of arrhythmia.
The heart’s top chambers, or atria, are scarred by the surgeon during the Maze treatment. The irregular electrical impulses linked to AFib can then be disrupted by these scars, aiding in the restoration of a normal cardiac rhythm.
Preparation
The Maze procedure requires comparable preparation as ablation. Make sure you’re well enough for the procedure, according to your surgeon. They will need several blood and imaging tests in addition to an EKG.
You will receive instructions from your surgeon on what to do in the days leading up to surgery. This covers things like which medications to change when to begin fasting, and what to pack for the hospital.
Procedure
General anesthesia is used by surgeons during the Maze operation. That implies you won’t experience any discomfort and will be unconscious during the procedure.
The following fundamental steps are included in the Maze procedure:
- An incision is made across your breastbone by your surgeon.
- They attach a heart-lung machine to you. This maintains blood flow to your heart while your surgeon works on your stopped heart.
- Using heat or ice, your surgeon creates many precisely positioned scars on the tissue of your atria. This produces a “maze” that lets your heart’s normal electrical signaling pass through but prevents abnormal electrical signaling.
- Your surgeon will restart your heart and remove the heart-lung machine once all the scars have been made.
- Your chest incision is closed by your surgeon.
A Maze operation can also be performed by a surgeon using a minimally invasive technique. This entails a right mini-thoracotomy, in which your surgeon makes tiny incisions on the right side of the rib cage to do surgery.
To get better outcomes, physicians may also employ a novel technique known as “hybrid convergent” procedures, in which catheter ablation is done in addition to the Maze treatment.
Recovery
Several days will pass while you are in the hospital following your Maze surgery. Your hospital stay might have been a little bit shorter if you got a minimally invasive surgery.
After your operation, you can also discover that your AFib symptoms are still present. This is normal and is brought on by the surgery’s resulting discomfort and inflammation. As a result, you might need to continue taking your AFib medicine for a short duration.
In around six weeks, you can return to all of your regular activities. For around three months following an open surgery, you can still be restricted from engaging in intense activities or lifting heavy objects.
Risks and side effects
The Maze procedure carries several dangers and adverse consequences. These could consist of:
- a reaction to the anesthesia
- excessive bleeding
- blood clots, which may result in a stroke or heart attack
- infections
- damage to the heart or surrounding tissue
- kidney failure
- an uncontrollable pre-existing arrhythmia or a new one
- the need for a pacemaker
Implantable devices for arrhythmia
An implanted gadget can be suggested by a physician to assist in controlling your arrhythmia. One of two kinds of implanted devices may be suggested by them.
A pacemaker helps your heart beat at a consistent rhythm and rate by delivering regular electrical signals to it. For patients with bradycardia, an arrhythmia that causes a sluggish heartbeat, doctors frequently advise getting a pacemaker.
When you experience arrhythmia symptoms, an implanted cardioverter defibrillator (ICD) delivers electrical signals to your heart to get it back to a regular rhythm. For patients with potentially fatal arrhythmias such as ventricular fibrillation and tachycardia, doctors usually advise them.
If your heart suddenly stops, as can happen in people with potentially fatal arrhythmias, an ICD can also restart it. Certain ICDs have pacemaker capabilities as well.
Preparation
The Maze process and cardiac ablation preparation are comparable to that of pacemaker or ICD implantation. To make sure you can have the treatment, your doctor will run tests.
Along with giving you advice on what to bring to the hospital, how to take your medications, and what to eat and drink, they will also go over the specifics of the process with you.
Procedure
A pacemaker or implanted cardiac device is frequently performed under local or general anesthesia. A transvenous technique is usually used to insert an ICD or pacemaker:
- A little incision is made by your physician beneath your left collarbone.
- They put the device’s cables into a vein.
- To precisely guide the wires and implant them into one or more heart chambers, they employ imaging.
- The gadget is inserted by your doctor into a pocket that is made beneath the skin of your chest.
A catheter is used by surgeons to implant certain wireless pacemakers. Usually, they use imaging to carefully guide the catheter into the heart after inserting it into a blood vessel in the groin area.
Finally, a pacemaker can be affixed directly to your heart by a surgeon. This is less common and is referred to as an epicardial pacemaker. A cut below your ribcage is made during this surgery, which is done under a general anesthetic.
Recovery
After having an ICD or pacemaker put in, you might need to spend the night in the hospital for monitoring. You can occasionally return home on the same day.
Similar to previous surgery, you will receive instructions from your care team on self-care and when you can resume your regular activities. After your operation, you can usually resume most of your regular activities four to six weeks later.
Risks and side effects
When an implanted device is used to treat an arrhythmia, some potential risks and adverse effects include:
- a reaction to the anesthesia
- excessive bleeding
- blood clots, which may result in a stroke or heart attack
- infections
- scarring around the device
- a new arrhythmia
- malfunction of the device
- damage to the heart or blood vessels
- trapped air or fluid in the chest
- pacemaker syndrome
- interference from objects or processes near powerful magnetic fields
Takeaway
Arrhythmia is a widespread ailment that impacts millions of individuals globally. While lifestyle modifications and medication are often helpful forms of treatment, if these don’t work, a doctor may suggest surgery.
There are several kinds of arrhythmia operations accessible. All seek to assist in reestablishing a regular cardiac rhythm.
Every kind of surgery for arrhythmias is unique. Make sure to have an honest discussion regarding the ins and outs of the suggested operation, as well as its advantages and disadvantages, the process itself, and the expected length of recuperation.