How to perform atrial fibrillation surgery

Anyone who has some understanding of atrial fibrillation should know that atrial fibrillation mainly refers to the fact that patients often experience symptoms of irregular heartbeat. And the treatment methods for each type of atrial fibrillation symptoms are different, but fundamentally speaking, if you want to quickly treat atrial fibrillation symptoms, you need to undergo atrial fibrillation surgery, and atrial fibrillation surgery has certain risks. Patients who want to undergo atrial fibrillation surgery must be familiar with the steps of atrial fibrillation surgery.

For paroxysmal atrial fibrillation, radiofrequency catheter ablation can indeed be considered, but according to my experience, the success rate is generally only 60%-70%. And there are certain risks.

The mechanism is generally as follows:

Generally speaking, paroxysmal atrial fibrillation is caused by the presence of abnormal pacemaker cells similar to the sinoatrial node in the pulmonary veins, which can also emit rhythms and cause atrial fibrillation. So most of our current work is to electrically isolate the pulmonary veins, use radiofrequency ablation between the pulmonary veins and the left atrium, and prevent the abnormal potential activity in the pulmonary veins from entering the left atrium. Wouldn't this solve the problem of atrial fibrillation?

People generally have four pulmonary veins, so most current methods use electrical isolation of all or most of the pulmonary veins. What's more, I might as well do linear ablation on the left atrium around the pulmonary vein orifice, which seems to be more thorough.

But the actual situation is that your abnormal potential may not be in the pulmonary veins, or there may be many tiny reentry loops in your atria. These are the reasons why the above-mentioned ablation methods for atrial fibrillation are unsuccessful.

In foreign countries, there is also ablation of the place where the most chaotic potential of the atrium is generated. Where is the most chaotic potential activity in your atrium? In other words, I will ablate the most serious source of atrial fibrillation. However, this is only done by Dr. Nademanee with a higher success rate, and no one else can replicate it. Because we must first find the ablation site, the current positioning system is still relatively difficult.

The above briefly describes the treatment mechanism of radiofrequency catheter ablation for atrial fibrillation. Generally, only a few cardiac centers can do this. First, it requires high-end equipment, and the key is a three-dimensional electroanatomical positioning mapping system, such as CARTO and EnSite3000, because this makes positioning relatively easier. Second, it requires highly skilled experts in electrophysiological examinations/radiofrequency catheter ablation. Both conditions are indispensable. But even so, only a few heart centers in Beijing, Shanghai and other places in China have the conditions and do a better job.

There are also surgical operations. Currently, Maze III is a maze operation that can be performed. Mini Maze (minimally invasive maze operation) appeared in the United States at the beginning of this century. This is a minimally invasive surgery combined with thoracoscopic surgery technology. The principle is similar to radiofrequency catheter ablation, which also includes pulmonary vein ablation, linear ablation in the left atrium, partial denervation of the epicardium, and left atrial appendage resection. Some domestic hospitals, such as Beijing Anzhen Hospital, have also performed this surgery. The highest success rate reported abroad is 90%. However, I personally think this is not very reliable.

In fact, both radiofrequency catheter ablation and minimally invasive surgical maze surgery have certain risks. For example, if you ablate the pulmonary veins, it may cause pulmonary vein stenosis. Moreover, most of the current ablations are performed on the majority of pulmonary veins (3 or even all 4 pulmonary veins). Once pulmonary vein stenosis occurs, the consequences are quite unpleasant.

In addition, many other serious situations such as heart perforation also occur from time to time.

Another thing is that the success rate is not that high. As far as I know, many of the so-called successful patients did not succeed immediately on the spot. They often continued to take amiodarone for a period of time after the operation, and only succeeded after about 3-4 months. In fact, it also reflects that we do not fully understand many situations such as the formation mechanism of atrial fibrillation, and our positioning is not always so accurate.