When symptoms of atrial fibrillation persist despite drug treatment, doctors may suggest ablation. Why Doctor asked a specialist about this technique with a relatively good success rate.
Atrial fibrillation (AF) or atrial fibrillation, is a heart rhythm disorder. The latter is defined by an anarchic and rapid electrical activity of the muscle of the atria (upper chambers of the heart) and results in the disordered and ineffective contraction of the latter. It occurs especially in the elderly and suffering from a cardiac pathology or hyperthyroidism. This disorder can cause heart failure ranging from simple fatigue or shortness of breath on exertion to severe damage to the heart muscle. Worse still, poor drainage of the atria in fibrillation and the stagnation of the blood which can then clot increase the risk of a cerebrovascular accident (CVA).
This is why, when the symptoms of AF persist, despite daily arrhythmic treatment, specialists sometimes offer atrial fibrillation ablation. On the occasion of the awareness day for this affliction this Thursday, December 12, Why Doctor interviewed Doctor Guillaume Duthoit, cardiologist at La Pitié-Salpêtrière hospital, in Paris.
“The technique consists of mounting a catheter through the femoral vein to the right atrium and performing what is called a transceptal puncture using a small needle which allows the material to be brought in. It is a kind of long tube, a sheath, in the left auricle to be able to deliver the treatment at the level of the pulmonary veins. Four pulmonary veins must be isolated from the rest of the left atrium, either by hot cauterization or cold cauterization, much like burning a wart. This is called cryoablation”, explains the specialist.
A relatively good success rate
“In ten years, procedure times have been considerably reduced and today, it can last between an hour and a half and two and a half hours on average”, continues the doctor. He specifies: “The post-operative follow-up consists of monitoring the patient for one to two post-operative nights (…). The follow-up is centered on monitoring the femoral puncture point to check that there is no hematoma in an anticoagulated patient. Then you have to check the echocardiography, make sure there is no effusion around the heart. The patient then leaves. He is able to walk the day after the operation but should not force too much or carry heavy loads for two weeks.”
In terms of results, the success rate is relatively good. For a patient who had brief attacks (less than two days, schematically) and suffered from no underlying heart disease, it is around 90% in a single intervention. “This success is all the higher when we are going to treat a patient at the onset of atrial fibrillation disease and when the patient is young with a non-dilated atrium and no underlying heart disease”, explains the Doctor Duthoit.
The older the patient, the more common complications are
On average, “the expected results of the operation are around 70 to 80% success. It is sometimes necessary to redo an intervention in less than a third of the cases to be able to achieve this 80% success and to be able to definitively stop the anti-arrhythmics.”
Unsurprisingly, the older the patient, the lower the success rates. “Maybe more around 60-70% (…). This also increases the risk of general anesthesia and intervention under anticoagulants, continues the cardiologist. This is why we must offer this ablation as soon as possible to patients who remain embarrassed despite the treatments,” he concludes.
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