Surgical Treatment for Atrial Fibrillation

WebMD Live Events Transcript

Atrial fibrillation (AF) is the most common form of irregular heartbeat and affects about 2.2 million Americans. People with atrial fibrillation are at increased risk for life-threatening strokes. In addition, AF can damage the heart and lead to heart attack and heart failure. Cleveland Clinic heart surgeon A. Marc Gillinov, MD, joined us on Feb. 1, 2005 to discuss the latest surgical techniques for treating AF and restoring normal cardiac rhythm.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live Dr. Gillinov. Please begin by telling us about the Cleveland Clinic Heart Center.

GILLINOV:
The Cleveland Clinic is the largest cardiac surgery and cardiology surgery program in North America. We treat all forms of cardiovascular disease and have particular expertise in the treatments of atrial fibrillation (AF) and heart valve disease.

MEMBER QUESTION:
I have had persistent atrial fibrillation for one year, no other health problems and I am 81 years old. I do not like the effects of the medications. Does my age present a barrier to having the procedure (ablation, minimally invasive)?

GILLINOV:
Ablation is occasionally indicated in people over the age of 80. Such an individual should consider ablation only if the atrial fibrillation is very symptomatic or the patient has suffered a stroke from the atrial fibrillation.

"The natural history of untreated atrial fibrillation is that it becomes more frequent until it is present all the time."

MEMBER QUESTION:
What are the risks of ablation, and rates of occurrence?

GILLINOV:
Ablation is a general term used to describe a procedure to cure atrial fibrillation. The procedure may be performed with minimally invasive surgery or in some cases, with a catheter. The ablation procedure creates areas of conduction block in the heart. The success rate in people with intermittent atrial fibrillation is about 80%. The success rate for people who are in continuous atrial fibrillation is about 70%.

MEMBER QUESTION:
I am a 45-year-old male with occasional atrial fibrillation. I have had it for about 10 years. If it is occasional do I need to get it fixed surgically? I take no medicines for it.

GILLINOV:
If the atrial fibrillation only occurs occasionally and does not cause severe symptoms and has not caused a stroke, then it does not require an intervention like ablation. However, it would generally be wise to take aspirin in this instance.

MEMBER QUESTION:
Does atrial fibrillation get worse over time?

GILLINOV:
Yes. The natural history of untreated atrial fibrillation is that it becomes more frequent until it is present all the time. Atrial fibrillation decreases heart function and it is associated with a risk of stroke. The longer a person is in atrial fibrillation the greater the cumulative risks of decreased heart function and stroke.

MEMBER QUESTION:
When does a person decide that surgery is necessary to correct AF?

GILLINOV:
Surgery, which is usually minimally invasive surgery, should be an option when medical therapy has failed. So, if a person continues to have symptomatic atrial fibrillation or has a stroke on good medical therapy, it's time to think about other options. Another reason might be if a person does not wish to take lifelong medications. As we all know, these medications can have serious side effects, and it is often undesirable to be on such medicines for decades.




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