Concomitant Surgical Ablation for Atrial Fibrillation (AFib)

• Patients scheduled for mitral valve surgery who have pre-existing AFib.
• Patients undergoing aortic valve replacement or repair with AFib.
• Patients scheduled for coronary artery bypass graft (CABG) with AFib, particularly if AFib is symptomatic or persistent.
• Patients with longstanding persistent AFib (duration >1 year) requiring other heart surgery, who have not responded well to medication alone.
• Patients in need of left atrial appendage (LAA) closure due to contraindications for long-term anticoagulation therapy.
• Elderly or complex patients with heart failure, especially if the pumping ability of the heart’s left ventricle is significantly reduced.

• Asymptomatic Patients: Patient who do not experience frequent or continuous AFib that significantly affects their quality of life.
• Advanced Age With Comorbidities: The risk of performing concomitant surgical ablation may not outweigh the benefits in elderly patients who also have severe pulmonary dysfunction, renal dysfunction or some other serious comorbidity.
• Full Medication Trial Hasn’t Been Tried Yet: Your doctor will likely not recommend surgical ablation until you’ve tried antiarrhythmic medications and those medications have either failed to control symptoms or caused intolerable side effects.
• Severely Dilated Left Atrium: Ablation is often unsuccessful in patients with an extensively enlarged left atrium.
• Structural and Tissue Factors: Severe atrial fibrosis, significant mitral valve incompetence and certain other underlying structural heart diseases may prohibit the use of concomitant surgical ablation.
• High Risk Surgeries: Certain complex cardiac surgeries may cause concomitant ablation to be technically impossible or too dangerous.
• Re-operative cardiac surgery: If you are undergoing a second or third operation on your heart, the MAZE procedure may not be done due to extensive scar tissue left after your first operations.

Only a specialist can determine if you’re a candidate for concomitant surgical ablation, so it’s important to talk to your doctor. Call 440-508-8966 to schedule an in-person or virtual appointment with a UH atrial fibrillation specialist today.

• Higher likelihood of needing a permanent pacemaker.
• A temporary increase in arrhythmias, including AFib episodes, palpitations and/or atrial tachycardia as the heart heals.
• Postoperative bradycardia (an abnormally slow resting heart rate).
• AFib recurrence or incomplete relief of AFib symptoms.
• Bleeding and vascular damage, including bleeding at insertion sites, blood accumulation in the pericardial sac (the sac that encloses the heart) and damage to blood vessels.
• Serious but rare complications include stroke and thermal injury to surrounding structures such as the pulmonary veins, esophagus and phrenic nerve.

Overall risks increase for patients in their 80s and 90s.

Your surgical team will connect you to a heart-lung bypass machine, which takes over the work of the heart and lungs during your surgery. Before completing the primary surgical procedure (valve repair/replacement, CABG, etc.), your surgeon will use special tools to apply radiofrequency (hot) or cryoablation (cold) energy to the upper chambers of the heart (atria). These energy sources create scar tissue in the heart, which blocks the triggers that cause AFib.

During the procedure, your surgeon usually will also close the left atrial appendage (LAA), a small pouch in the heart where blood clots often form in people with AFib. Closing the LAA has been proven to reduce the risk of AFib-related stroke after surgery by more than 90%.

• Spend one or two days in the ICU, where your vital signs will be closely monitored.
• Spend several more days recovering in a hospital room. The exact length of your hospital stay will depend on which primary surgery you had, your present condition and other factors. Studies show that adding ablation to open heart surgery does not extend hospital stay or recovery period.
• You may receive medication for arrhythmia (irregular heartbeat), depending on your procedure and condition. For example, arrhythmias are common after valve replacement surgery. Some patients temporarily require a pacemaker to correct an arrhythmia.
• If you had valve replacement surgery, you will start anticoagulation therapy to reduce the risk of getting a blood clot. If you received a biological valve, you’ll likely have to stay on anticoagulation medication for up to three months. If you received a mechanical valve, you’ll need to take anticoagulation medication for life.
• Learn about cardiac rehab, which can help recovery from valve repair/replacement surgery and CABG.
• Learn how to care for your incision at home.

After you return home, the length of your recovery largely depends on the primary cardiac procedure you had. For example:

• Recovery from CABG typically takes 6-12 weeks for initial healing, with full recovery generally taking several months. Most CABG patients can resume light activity and walking within 1-2 weeks after their surgery.
• Recovery from heart valve replacement surgery typically takes 4-8 weeks for initial healing, with a full recovery often taking 2-3 months. Most heart valve replacement/repair patients can resume light activity and walking within 1-2 weeks after their surgery.

Your doctor will give you more detailed information on what to expect during your recovery. They will also tell you when you can drive, return to work and resume different levels of physical activity.