Catheter Ablation – A Treatment for Atrial Fibrillation

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The Need for Pulmonary Vein Isolation Ablation- What Is It?

Atrial fibrillation can be treated through a procedure called pulmonary vein isolation ablation.

This procedure, pulmonary vein isolation ablation, is an option for treating atrial fibrillation and may be the right choice for certain patients who:

  • Display the symptoms of continued atrial fibrillation in spite of being given medications
  • Have a low tolerance for antiarrhythmic drugs or suffer complications from their use

Atrial Fibrillation Explained

In this medical condition, the heart rhythm that has its origin in the heart’;s top chambers is abnormal.

In cases of atrial fibrillation, the heart's electrical rhythm is not directed by the SA node. In its place, there are many other impulses that by firing rapidly at once, cause a fast and chaotic rhythm inside the atria. The electrical impulses are chaotic and fast, and as a result, the atria are unable to contract or squeeze the required blood through the ventricle, that’s where the term fibrillation comes from.

Treatment for Atrial Fibrillation

Doctors use many options when they need to treat atrial fibrillation, among which are changes in lifestyle, the use of medicines, procedures using catheters, and surgery.

The objective of these treatments is to:

  • Regain the normal sinus rhythm
  • Heart rate control
  • A reduction of symptoms
  • Risk reduction of strokes and blood clots

The treatment that is recommended to you as a patient can depend on the severity of symptoms, previous treatments, and a judgment of other medical conditions that can increase the risk of treatment.

To start with, a doctor may use medications to treat atrial fibrillation, and these can include:

  • Medications to slow the heart rate
  • Antiarrhythmic drugs that control heart rhythms
  • Blood thinners or anticoagulants like Coumadin that lessens the risks of strokes and blood clots

Ablation Procedure

The tissue that is targeted for ablation receives energy through the tip of a catheter, the energy can be either a burning or freezing type of energy. This energy is directed at the left atrium and its application is done in a circular fashion in the area that connects the left atrium and the pulmonary veins.

Monitoring During an Ablation Procedure

Defibrillator/Pacemaker/Cardioverter: A sticky patch is used to attach any of these devices to the center of the back as well as to an area on the chest. These devices allow doctors and nurses to increase the pace of the heart if it is slow, or to deliver energy to the heart if the heart rate is too fast.

Electrocardiogram/EKG/ECG: The device is attached to the chest and inside the heart with sticky electrode patches. They provide images on the monitors that display how the electrical impulses are going through the heart.

Blood pressure monitor: Connection is made through a blood pressure cuff placed on the arm. It checks the blood pressure during the procedure.

Oximeter monitor: A small clip on the finger helps to check the oxygen level in the blood.

Fluoroscopy: An X-ray machine is positioned above the patient, and allows doctors to monitor the leads throughout the procedure by viewing their images on X-ray screens.

Three Dimensional Mapping system: Technology that is state-of- the-art, is used to help doctors to locate the area in the heart that is arrhythmic.

Intracardiac ultrasound: A catheter transducer is introduced into the heart to help in this monitoring. Throughout the procedure, this ultrasound is used to view the heart’s structures and the contact made by the catheter with the lining of the heart.

Post Procedure – What Can You Expect

Once the procedure is completed the doctor will discuss its results with the patient and the patient;s family.

You are typically required to stay overnight for observation in the hospital that you are admitted to. The hospital room will have a telemetry monitor that can evaluate the heart rhythm and rate during the period of recovery. This telemetry is a small box that uses sticky electrode patches to connect to the chest. This box displays the heart rhythm on various monitors placed throughout the nursing unit.

Once the doctor removes the catheters, a pressure is applied to the insertion points to stop bleeding, and no stitches are required. The risk of bruising and bleeding is reduced by the application of pressure bandages to the sites where catheters were introduced on the neck and leg.

The patient needs to be in bed and keep the legs still for several hours, as this helps to prevent bleeding.

Most patients receive their discharge from hospital on the following morning. Patients are advised to have themselves driven home by other responsible adults.

Health After the Procedure

The area of the catheter insertion may feel uncomfortable for a few days after the procedure is completed. Doctors will often prescribe pain relievers that can help.

Recovering patients can also feel fatigued, some discomfort in the chest and a shortness of breath. There will be underlying inflammation in the chest which causes pain and is noticed in certain positions when lying down but is alleviated by sitting up. After a few days, all these symptoms should go away.

Heart Rhythm

For a few weeks after the procedure, the patient may still have a racing heart, extra heartbeats, skipped heartbeats and atrial fibrillation. Inform the doctor of this. In some cases, a heart monitor may be recommended.

These symptoms are common and will go away after a few weeks.

In rare cases, the atrial fibrillation can become worse after the procedure, but this is more a result of inflammation of the lesions created during the procedure.

Medication

It is advisable to take an anticoagulant for at least a month after the procedure so the risks of a stroke and blood clots are reduced. Depending on individuals, this medication may be continued for three
months or more.

It may be necessary to take medication for arrhythmia for several months following the procedure, in order to control the abnormal beating of the heart.

Insertion Site Care

Showers are permitted. Extreme temperatures of the water are best avoided. For ten days after the procedure, it is best to avoid the taking of a bath, a swim or soaking in water, as this period will allow the incisions to heal.

Important:

  • Keep the incision sites clean and dry
  • Never scrub that area
  • There is no need to cover the area with a bandage
  • Ointments, lotions, and creams are best avoided on the area of incision
  • Examine the area every day and observe its healing. Call the doctor if you notice any infection.

Activity Guidelines

One week after the procedure, the patient can go back to any normal routine or exercise.

During this week:

Avoid lifting things that weigh more than 10 pounds
Do not push or pull heavy objects
If any activity tires you, stop it

Ask your doctors advice on:

When you can resume driving
When you can start lifting heavy weights or other strenuous activities
When you can start working again

The Process of Pulmonary Vein Isolation Ablation

During this procedure, a doctor will insert catheters into blood vessels through the neck or leg and
guide them into the atrium.

The tip of the catheter that is inserted is energized and this energy is delivered to the tissue that requires ablation, the energy delivered may be a burning or freezing energy. Other areas that maintain or trigger atrial fibrillation will also be targeted.

The ablation causes small circular scars that then prevent the signals that cause the atrial fibrillation. These scars are formed 2 to 3 months after the procedure.

The formation of the scars blocks any impulses that fire inside the pulmonary veins, and this disconnects them from the heart. The SA node then starts directing the heart rhythm and you have the required sinus rhythm restored.

As there is a time of a couple of weeks before the scars are formed in the created lesions, atrial fibrillation is commonly experienced during recovery periods. In rare cases, the atrial fibrillation may worsen for a few weeks after the procedure, but this is due to inflammation in areas where the lesions have been created. In most cases, these subside within one to three months.

Events Before the Procedure

The patient is made to lie on a bed and the nurse starts an IV in the vein of the arm. Medication given through this IV will cause drowsiness. Areas of the neck, the upper chest, arm and the groin are cleaned with an antiseptic solution. The site for the catheter insertion is shaved. The patient is draped with sterile drapes from neck to feet.

During the Procedure

Medication given will help in relaxation and can cause the patient to fall asleep while the procedure is being carried out. Many ablation procedures are also performed with an anesthesiologist.

There will be a burning sensation at the site of the catheter insertion, as a medication is injected. When the catheter is energized, there can also be some burning sensation or discomfort in the chest.

Patients need to be still, keep quiet and breathe shallowly. Ask the doctor or nurse for medication if you are feeling pain.

Events During the Procedure

Once the patient is drowsy, the doctor will inject a medication in the catheter insertion sites to numb the area. The doctor then inserts several catheters in your large veins that are in the neck or the groin. These catheters are then advanced towards the heart.

A small hole is made with a needle in the wall between the right and left atria and two catheters are positioned in the left atrium. This is called a transeptal puncture, a very routine part of the procedure.
One of the catheters has a transducer that allows intracardiac ultrasound to be performed. This allows the doctor to view the heart structures and know the position of the catheters throughout the procedure.
The catheter in the left atrium maps the abnormal impulses that are radiating from the pulmonary veins.

The second catheter is used to deliver the required radiofrequency or freezing energy both around and outside of the pulmonary veins.

Time For the Procedure

The procedure of pulmonary vein ablation can last for anything between 4 to 6 hours, but this can depend on the patient.

Families of patients must be made aware that preparation and recovery time for the procedure can require several hours, and it is best they plan to attend the hospital for the entire day of the procedure.

In addition to being known as a cardiologist, I am also known as a cardiac electrophysiology specialist. I do answer my emails and my Facebook questions.  If you need answers to live more compatibly with your AFib, I’m here to help you.

There’s no reason to feel like you’re alone in this disease. I gladly answer questions about atrial fibrillation.  Join my Facebook page. Ask me any question about AFib on my AFib Friday’s feature.

Dr. Morales: NEW PATIENT APPOINTMENT: 281.446.3645

Click here to make an appointment: https://www.vitalheartandvein.com/physician/percy-francisco-morales/