Surgical Ablation to Treat Atrial Fibrillation

Surgical ablation treats atrial fibrillation with epicardial ablation (treating the outside of the heart). A surgical ablation is very similar to the first part of Hybrid AF Therapy. The main differences are:

Hybrid AF Therapy is a minimally invasive surgery (MIS). MIS uses small incisions. It does not include a sternotomy, or cutting the breastbone, to access the heart. This may allow for a shorter hospital stay and faster healing time. Hybrid AF Therapy can be performed by itself, and not just if you have another heart surgery at the same time.
Surgical ablation is done during surgery to treat another heart problem. A surgical ablation involves open-heart surgery. In order to treat that other heart problem, open-heart surgery often requires a larger chest incision compared to Hybrid AF Therapy. It can take about 4-6 weeks to heal.

Common reasons for someone to need open-heart surgery include:

Coronary artery bypass graft (CABG) surgery for clogged heart arteries
Heart valve repair or replacement surgery

During surgical ablation, the doctor uses medical devices to make lesions on both the outside and inside of the heart. As noted earlier, lesions do not carry electrical signals through the heart. So a surgical ablation can stop erratic electrical signals and, therefore, stop atrial fibrillation. Surgical ablation is used to treat persistent and long-standing persistent atrial fibrillation when a surgeon is already operating on the heart. The overall surgery is more invasive, but the surgical ablation lesions are very durable.¹

Are There Other Things to Know About Surgical Ablation?

Recall that the left atrial appendage (LAA) is one of the areas of the heart where atrial fibrillation often begins. The LAA is a small, finger-like piece of tissue in the left atrium. During surgical ablation, the surgeon might close the LAA with a clip or with other devices. This prevents blood from moving between the LAA and the left atrium. Cutting off blood flow from the LAA can reduce the risk of a stroke in the future. See the areas of the heart where atrial fibrillation begins.

What Could I Expect with Surgical Ablation During Another Heart Surgery?

Remember that the ablation is being done surgically because you need another type of open-heart surgery.

Your health care provider will advise you about what you can eat or drink before the surgery. You might also be asked to stop taking certain medications before the surgery. When you get to the hospital, you will have an IV (intravenous) line put into your forearm or hand. You will receive needed fluids and medications through the IV.

When you are in the operating room, the surgical team will do the following:

Make about a 4-inch incision in your chest
Perform the other heart surgery that’s needed (for instance, a coronary bypass or a valve replacement)
Use an ablation catheter to treat the heart tissue with heat or cold

After the surgery, you will be in the intensive care unit (ICU) for about 1-2 days. You will then be moved to a regular hospital room. Your total hospital stay may be less than 1 week. Many people can resume exercise and return to work in 4-6 weeks, but always follow your doctor’s advice about activity. Your health care provider will explain what you need to do during your recovery.

The risks of any open-heart surgery include:

References

McCarthy, P.M., Gerdisch, M., Philpott, J., Barnhart, G.R., Waldo, A.L., Shemin, R., Andrei, A.C., Gaynor, S., Ndikintum, N., Calkins, H. (2020). Three-year outcomes of the postapproval study of the AtriCure Bipolar Radiofrequency Ablation of Permanent Atrial Fibrillation Trial. Journal of thoracic and cardiovascular surgery, S0022-5223(20)32702-1. doi: 10.1016/j.jtcvs.2020.09.099

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