Treating heart rhythm problems
What is it?
Every beat of your heart is triggered by an electrical impulse. This impulse starts in a node within your heart's right atrium, then travels through the rest of your heart. In some people, that electrical impulse starts traveling on the wrong pathway. This can cause heart rhythm problems like an arrhythmia, otherwise known as palpitations.
Ablation is a procedure used to treat many rhythm problems, including atrial fibrillation and ventricular tachycardia. Atrial fibrillation is a "fluttering" of the heart's upper chambers. Ventricular tachycardia is rapid heart beat is the lower chambers that is potentially life threatening.
An arrhythmia can often be treated with medications. If medications aren't working for you, there are three major approaches to consider: catheter ablation, maze procedure, and minimally-invasive maze (mini maze) procedure. These procedures can frequently cure an arrhythmia completely, so patients no longer have any symptoms or need medications.
- Catheter ablation. An electrophysiologist creates tiny scars in a few of the cells of your heart. These scarred cells create a "roadblock" for the electricity in your heart, forcing the impulses to travel on the right path. This is the least invasive of these procedures.
- Maze procedure. Is an open-heart surgery done by a cardiothoracic surgeon using an energy source to scar the tissue (Radiofrequency ablation). It is typically combined with other heart surgery.
- Mini maze procedure. Is a minimally-invasive surgical ablation that uses an energy source to scar the tissue. It doesn't require opening the chest, so it has a shorter recovery time. It is less invasive than maze surgery, and is slightly more invasive than catheter ablation.
Having both the electrophysiologist and the surgeon collaborate in the operating suite has led to the latest trend, the hybrid ablation procedure. It incorporates both catheter ablation and a mini maze procedure in a single operation, so it is important to know about both types of atrial fibrillation treatments in order to find the procedure that is right for you.
How is it done?
Catheter ablations are performed in one of the electrophysiology labs at Lee Health. Patients remain awake during this procedure.
You first receive a medication through an IV to help you relax. A small incision is made in your groin area. Thin tubes called catheters are then inserted into this incision.
With the help of x-ray images, the catheters are threaded up to your heart. Your electrophysiologist uses the catheters to detect the faulty electrical pathways that are causing your arrhythmia.
Electrodes on the end of the catheter are then used to create tiny scars on the wall of your heart. These scars act as roadblocks to keep your heart's electrical impulses traveling in the right direction.
Catheter ablations typically take from 3-6 hours, depending on complexity. After your ablation procedure, you need to wait several hours in the recovery area.
Most patients who have ablation procedures go home the same day, while some patients need to stay overnight in the hospital.
Maze and Mini Maze Procedures
Mini maze ablations are similar to the maze ablation, except that the surgeon reaches the heart through small incisions on each side of the chest and does not require that the heart be stopped.
You first receive a medication through an IV to sedate you during the procedure. The surgeon accesses the heart by making three small incisions between the ribs, through which a tiny camera and video-guided instruments are inserted.
As in the open chest maze procedure, the surgeon uses an energy source to make precise scars, or ablations, on the heart to block the irregular electrical impulses that cause AF and removes or closes off the left atrial appendage where stroke-causing blood clots often form.
The mini maze procedure takes just a few hours, usually 2–4 hours.
The major benefits of not having to open up the whole chest is that it makes recovery much easier and reduces the average hospital stay to around four days.
Even with minimally invasive ablation proceduress, there are several risks that patients should know about:
- Bleeding at site of incision
- Puncture of the heart
- Damage to blood vessels
- Blood clots
- Worsened arrhythmia symptoms
- Heart tissue inflammation (pericarditis)
- Collapsed lung from deflating the lung in surgery, which is correctable with a chest tube (mini maze and maze procedures)
Technology and expertise at Lee Health
Lee Health offers the most advanced and effective heart rhythm treatments to our patients. We perform more treatments for heart rhythm disorders than any other hospital in the area. In many cases, the treatments we provide are not available at any other hospitals in the region.
Lee Health has two fully equipped electrophysiology labs for ablation procedures and two dedicated implant room for device implants. They are staffed by nurses and technicians who work exclusively on heart rhythm disorders.