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Atrial fibrillation is the most common cardiac arrhythmia and mainly appears with age. The heart is completely out of synch: the atria and ventricles beat at different rhythms. Treatment with a minimally invasive surgical procedure can significantly improve patients' quality of life. Disconnecting the auricle should also prevent a much-feared complication – stroke.
Depending on the presentation, duration and reversibility of the condition, we talk about paroxysmal, persistent or permanent atrial fibrillation.
1. Paroxysmal atrial fibrillation
Paroxysmal atrial fibrillation is self-limiting and is sometimes scarcely noticeable. It generally comes and goes on its own. Patients usually have a sinus rhythm and the atrial fibrillation only appears sporadically. However, it may also be highly symptomatic.
2. Persistent atrial fibrillation
Persistent atrial fibrillation is more complex in its development and does not generally return to a sinus rhythm on its own. However, it can be brought back to a sinus rhythm with a so-called conversion using various drugs or interventions.
3. Permanent atrial fibrillation
Permanent atrial fibrillation can no longer be reversed. Only the complications are treated: blood thinning is used to prevent strokes and frequency monitoring to prevent excessive heart rate.
Minimally invasive procedure for atrial fibrillation
Ablation is an effective treatment for atrial fibrillation, particularly if rhythm control is the aim. Ablation is a locally applied energy dose that causes a scar. This scar leads to electric insulation of the waste tissue. Since the pulmonary veins are responsible for triggering atrial fibrillation, pulmonary vein isolation is performed on patients with paroxysmal atrial fibrillation. Here, a catheter is used to treat the posterior wall of the left atrium. Catheter ablation has variable results and very often a second or third procedure is needed to eliminate the atrial fibrillation completely. This procedure is carried out by an electrophysiologist in electrophysiology.
For refractory patients, an endoscopic procedure can be used. The operation is performed with special instruments and a mini-camera, which is introduced through a small incision in the skin. This type of surgical procedure is also known as keyhole surgery. The camera sends the images from inside the body to a monitor, which the surgeons use as an orientation tool. Three small skin incisions on the left and right sides of the chest are enough for the procedure on the beating heart. This new method combines the high surgical success rate of more than 90% with a gentle, minimally invasive procedure, and is therefore a good alternative to catheter ablation, which is not problem-free.
A hybrid procedure is also possible as an extension of the treatment. In this case, ablation and removal of the left atrial auricle are first performed by thoracoscopy. Then there is a wait of a three-month ‘blanking period’; if atrial fibrillation recurs, the electrophysiologist can perform a further investigation using a catheter. The success rate for patients with persistent atrial fibrillation is more than 90% after one year.