Atrial fibrillation (AFib) is the most common cardiac arrhythmia. It may be asymptomatic or cause symptoms such as palpitations, lightheadedness, chest pain and heart failure. It also increases the risk of having a stroke. AFib is linked to several cardiac causes, such as coronary artery disease and valvular heart disease (particularly mitral stenosis or regurgitation), lung diseases, hyperthyroidism, and excessive alcohol intake, but it may also occur in otherwise normal hearts. It is classified as either paroxysmal (lasting less than seven days), persistent (lasting more than seven days) or permanent. It is often diagnosed through an electrocardiogram (ECG or EKG). When detected, a full workup is performed to try to identify the cause.
The main goals of treatment are to prevent hemodynamic compromise and stroke. Medications are used to control the heart rate and rhythm, and anticoagulation (a blood thinner) is used to prevent a stroke.
To restore normal sinus rhythm, electrical (electric shock) or chemical (medications) cardioversion is often attempted first. If unsuccessful, an ablation may be attempted by the cardiologist in a specialized cath lab called an electrophysiology (EP) lab.
Another form of ablation, the surgical MAZE procedure, may be performed as either a stand-alone procedure or in conjunction with open heart surgery. If stand-alone, this may be performed in a minimally invasive fashion with a minithoracotomy or with video-assisted thoracoscopic surgery (VATS) using either radiofrequency ablation or cryoablation.
A benefit to the surgical approach is that the left atrial appendage is ligated or clipped at the same time to decrease stroke risk. A hybrid approach is also often used where the cardiologist and surgeon work together performing a combination of ablations to improve the chance of success in restoring a normal sinus rhythm.