Surgical ablation for Atrial Fibrillation
With this procedure atrial fibrillation can be treated very effectively, even in complex situation after failed catheter ablations or persistent atrial fibrillation. Medications can thus be reduced, and the risk of heart failure and stroke sink drastically. It is a surgical procedure under general anaesthesia. Catheter ablation is usually the first in the line of treatment – but not always.
Highly effective in regard to freedom of Atrial Fibrillation
What is surgical ablation
For stubborn cases, we apply a unique method. Surgical ablation, also called thoracoscopic ablation, is a minimally invasive operation. It is performed by cardiac surgeons (Prof. Salzberg & Dr. van Boven) under general anaesthesia. Small incisions on the chest wall allow us to insert camera and instruments in order to gently perform the ablation procedure on the surface of the heart. We perform a pulmonary vein isolation and a complete box with bipolar radio-frequency, and close the left atrial appendage with a clip. The procedure usually takes less than 90 minutes.
For whom is surgical ablation
If you are planning to undergo a cardiac surgery – and you have symptoms of atrial fibrillation – you should be treated by a surgeon (Class I Indication). This includes surgical ablation and closure of the left atrial appendage.
If you only suffer from stand-alone or isolated atrial fibrillation, then the symptoms determine whether a minimally invasive procedure should be done. We make this decision within the HeartTeam. The operation is done to free patients from medication and to improve their quality of life. Patients who have already had a catheter ablation or are not eligible for a catheter ablation can be evaluated by our team for the procedure. But the desire or the need to stop taking blood thinners can also qualify patients.
Pulmonary vein isolation
Where the pulmonary veins flow into the heart, “misfires” (lat. Foci) arise, which can then cause the entire atrium to atrial fibrillation. At this point, it is important to make a scar and through that create an electrical barrier. This barrier prevents the "misfire" from spreading to the heart. The ablation performed with energy leads to tissue denaturation, which then over time (days-weeks) develops into a scar. This scar is the electrical insulation. That is why we speak of pulmonary vein isolation. The pulmonary vein isolation is the cornerstone of all atrial fibrillation ablation therapies.
Here a short animation depicting the procedure (without LAA closure).
Minimally Invasive technqiue
Keyhole access is used to get to the heart. We use "state of the art" bipolar radio frequency instruments. Our ablations are done on the hearts surface under direct vision in a controlled, effective and safe manner. In addition to the pulmonary veins we create a complete box lesion of the back of the left atrium. At the end of the procedure, the left atrial appendage is clipped off so that it no longer poses a danger through formations of clots. Before the ablation and after the ablation we carry out an epicardial 3D mapping to document the effects of the electrical isolation. The intervention usually lasts less than 90 minutes. The patients leave the clinic after 3-5 days to go back home.
On this picture you can see the 1cm small incision that are necessary to get to the heart. Pain is rather rare after such a procedure. Complications can occur. The doctor will educate you about all of this.
Pros and cons of the surgical ablation
There are many studies that provide results for surgical ablation. This method has already found its way into the most recent guidelines of the European Society for Cardiology. This technique has advantages, particularly for patients with more complex diseases. Many studies are currently underway, and the results that are presented to us are indeed promising. We would be happy to inform you.
Impressions from the operating theater
Well-rehearsed team during the approx. 90-minute intervention. All our procedures are performed in modern operating theatres for cardiac surgery. We have been doing these procedures together for over 10 years. The procedure is done under general anaesthesia without opening the chest. With our instruments, we can apply radio frequency specifically to the heart surface and thus ensure a sustainable result. By closing the left atrial appendage with a clip, discontinuation of the blood thinner can be discussed after the procedure.
Illustrations surgical ablation