Does atrial fibrillation require surgery?

Surgery is a method of treating human diseases, and is mainly performed on more serious diseases in the human body. Whether it is a major or minor surgery, patients must pay attention to the recovery of surgical wounds and a recovery period. Atrial fibrillation is a heart disease with irregular heartbeat. Patients with atrial fibrillation often experience symptoms such as shortness of breath and chest tightness. Atrial fibrillation must be treated in time to recover, but does atrial fibrillation necessarily require surgery to treat it?

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1. Treatment principles

(1) Restoring sinus rhythm Only by restoring sinus rhythm (normal heart rhythm) can the goal of completely curing atrial fibrillation be achieved. Therefore, treatment methods to restore sinus rhythm should be tried for any patient with atrial fibrillation.

(2) Controlling rapid ventricular rate For patients with atrial fibrillation who cannot restore sinus rhythm, drugs can be used to slow down the faster ventricular rate.

(3) Preventing thrombosis and stroke If sinus rhythm cannot be restored during atrial fibrillation, anticoagulants can be used to prevent thrombosis and stroke.

For atrial fibrillation caused by certain diseases such as hyperthyroidism, acute alcohol poisoning, and drugs, it may disappear on its own after the cause is eliminated.

2. Medication

Currently, drug therapy is still an important method for treating atrial fibrillation. Drugs can restore and maintain sinus rhythm, control ventricular rate and prevent thromboembolic complications.

Drugs for converting sinus rhythm (normal rhythm): For new-onset atrial fibrillation, since the rate of spontaneous sinus rhythm conversion within 48 hours is very high (about 60% within 24 hours), observation can be performed first, or propafenone or flecainide can be taken orally at one time. For patients whose atrial fibrillation has lasted for more than 48 hours but less than 7 days, intravenous drugs such as flecainide, dofetilide, propafenone, ibutilide and amiodarone can be used to convert the rhythm, with a success rate of up to 50%. If an atrial fibrillation attack lasts for more than one week (persistent atrial fibrillation), the effectiveness of drug conversion is greatly reduced. Commonly used and proven effective drugs include amiodarone, ibutilide, dofetilide, etc.

Drugs for controlling ventricular rate (frequency control): Controlling ventricular rate can ensure basic heart function and minimize heart dysfunction caused by atrial fibrillation. Commonly used drugs include:

(1) β-blockers are the most effective, most commonly used and most often used alone drugs;

(2) Calcium channel blockers such as verapamil and diltiazem can also be effectively used to control ventricular rate during atrial fibrillation. They are better than digoxin in controlling ventricular rate during exercise, and the effect of using them in combination with digoxin is also better than using them alone. It is especially used for patients without organic heart disease or with normal left ventricular systolic function and chronic obstructive pulmonary disease;

(3) Digitalis is the first-line drug for controlling the ventricular rate of atrial fibrillation in emergency situations. It is currently used clinically to control the ventricular rate in patients with left heart failure.

(4) Amiodarone can reduce the ventricular rate during atrial fibrillation. It is not recommended for long-term ventricular rate control in chronic atrial fibrillation. It is only the first choice for use in combination with digitalis when other drugs are ineffective or contraindicated, or when atrial fibrillation is combined with heart failure and the ventricular rate needs to be urgently controlled.

(5) Anticoagulant therapy is a necessary means to prevent thrombosis and embolism in patients with atrial fibrillation. Patients with atrial fibrillation should receive anticoagulant therapy if they have the following conditions: age ≥ 65 years; previous history of stroke or transient ischemic attack; congestive heart failure; hypertension; diabetes; coronary heart disease; left atrial enlargement; left atrial thrombus found by echocardiography. Anticoagulant treatment must be guided by a specialist. Excessive anticoagulation may cause bleeding, while insufficient anticoagulation will have no preventive effect.

3. Non-drug treatment

Non-drug treatments for atrial fibrillation include electrical cardioversion (conversion to sinus rhythm), radiofrequency ablation, and surgical maze procedure (complete cure for atrial fibrillation).

(1) Electrical cardioversion is a method of restoring sinus rhythm by placing two electrodes on appropriate parts of the patient's chest and delivering an electric current through a defibrillator. Electrical cardioversion is suitable for: emergency cases of atrial fibrillation (such as myocardial infarction, extremely fast heart rate, hypotension, angina pectoris, heart failure, etc.), severe symptoms of atrial fibrillation that the patient cannot tolerate, the last successful electrical cardioversion, and recurrence of atrial fibrillation without drug maintenance. Electrical cardioversion is not a cure for atrial fibrillation. Atrial fibrillation often recurs in patients, and some patients need to continue taking antiarrhythmic drugs to maintain sinus rhythm.

(2) Catheter ablation is suitable for the vast majority of patients with atrial fibrillation. It is less invasive and is easily accepted by patients.

(3) Surgical maze surgery is currently mainly used for patients with atrial fibrillation who need cardiac surgery due to other heart diseases. The operation is effective but traumatic.