Ablation is a procedure to alter the electrical activation within the heart, undertaken to reduce the symptoms of atrial fibrillation.
The procedure can be done either under local anaesthetic with sedation, or under general anaesthetic, and this will be discussed with you. Small thin tubes called sheaths are inserted into the vein at the top of the leg, these allow the ablation catheters to enter the vein and be guided up to the heart using the x-ray machine. Once in the heart a small hole is created to allow the catheters to travel from the right hand side of the heart to the left where the pulmonary veins are.
When in the left side of the heart the pulmonary veins are identified and the balloon in inflated at the mouth of each vein and the temperature inside the balloon is reduced to freeze the heart tissue around the vein. Sometimes veins require multiple freezes, sometime a single freeze is required for a vein. There are usually 4 veins to freeze, some people have one big vein in place of two smaller veins and some people have 5 or even 6 veins.
When freezing the veins on the right hand side of the heart the operator will stimulate the nerve controlling the breathing muscle and you will experience hiccups, this is done to minimise the risk of injuring this nerve during the procedure.
When all the veins are frozen, the catheter is withdrawn and the small holes at the top of the leg are compressed by a temporary stitch to allow the hole to seal. The stitch is usually removed between 2 – 4 hours after the procedure and you can start to get up. IF you are feeling well and have no problems and your procedure was done in the morning, then you can usually get home the same day if you have someone with you. You re not allowed to drive for 72 hours.
Ablation is offered as a treatment option for patients with symptoms due to atrial fibrillation. Common symptoms include forceful or fast heart beats (palpitation), tiredness, lack of energy, reduced exercise ability, shortness of breath and lightheadedness. There are many symptoms that are associate with atrial fibrillation.
Ablation is not an appropriate treatment for patients who have atrial fibrillation but have no symptoms.
Approximately 70-80 % of patients, who have a normal heart and atrial fibrillation that comes and goes itself (paroxsymal), who have a pulmonary vein isolation procedure see a reduction in the symptoms of atrial fibrillation. Individual patients may have a higher or lower success rate depending on many factors such as heart size, age and type of atrial fibrillation. This will be assessed and discussed in detail at an appointment.
Pulmonary vein isolation, like any medical procedure, carries with it significant risks, thankfully these are uncommon. The risks for any individual person depend on many factors and will be discussed in detail. The main risks include: Failure to control symptoms, bleeding, perforation of the heart, the need for emergency cardiac surgery, stroke, damage to the nerve that control the diaphragm (the main muscle that controls breathing), damage to the vein or artery at the top of the leg, damage to your heart valve, heart attack and very rarely death.
It is very important that you understand all the risks and the benefits of having the procedure, and this will be discussed with you in detail and any appointment.
The electrophysiological studies and / or ablation procedures are offered in Spire Shaw Fair Park hospital in Edinburgh, and BMI Ross Hall Hospital in Glasgow. The consultations to discuss management and outpatient care before and after the procedure can be offered in any of the clinics in Dundee, Edinburgh or Glasgow.
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