by Polsdorfer R

Surgical Procedures for Arrhythmias (Heart Rhythm Disturbances)

Ablation

If other treatment methods have been unsuccessful, it is possible to cure some recurrent, life-threatening arrhythmias with a surgical procedure called ablation. When abnormal electrical circuits in the heart generate harmful rhythms, they can be located and destroyed. Ablation can usually be performed without making an incision in the chest. Your doctor reaches the heart by inserting wires and catheters (tiny tubes) into a blood vessel in the arm or leg.
During the procedure, the physician will try to induce the arrhythmia using small radiofrequency currents in various places inside your heart. This helps locate the exact area of malfunction and assures that the right area is treated. Here’s how it works:
In a special room filled with cardiology and x-ray equipment, you will lie on the table attached to intravenous lines and heart monitors. A blood vessel in your arm or groin will be sterilized, through which a wire used to locate and destroy the abnormal circuits is threaded. Using x-ray guidance, the cardiologist or radiologist will thread the wire through the vein and into your heart. While attached to an electrical sensing and current generating machine, the wired device will probe the heart's electrical circuitry until it finds the origin of the abnormal signals. A small cauterizing current or a burst of radiofrequency energy will then destroy the tiny area that is malfunctioning.

Maze and Mini-Maze Procedures

The Maze procedure is a technique used to surgically treat atrial fibrillation that involves making several small incisions within the wall of the atria. This results in formation of scar tissue that ensures propagation of the electrical impulses in the proper direction.
The Maze procedure may also be done as minimally invasive surgery (called mini-Maze ). It only requires one or two small incisions in the chest.

Corner Artery Bypass Surgery

This surgery can sometimes be recommended for patients with coronary artery disease and ventricular tachycardia (a type of a heart arrhythmia). Unfortunately, the results are unpredictable, and a recurrence rate is high.

Surgical Subendocardial Resection

In certain cases of a ventricular tachycardia, specific abnormalities within the heart muscle might be responsible for generating the arrhythmia. The removal of the scar tissue underneath the lining of the heart may prevent the arrhythmia from occurring.

Automatic Implantable Defibrillator

A tiny defibrillator can be surgically implanted in your chest to monitor your heart rhythm. If a dangerous arrhythmia is detected, the device automatically shocks the heart in an attempt to return the heart rhythm to normal.

Artificial Pacemaker

This device is surgically implanted in your chest. The pacemaker takes over the job of providing the electrical impulses needed for establishing an appropriate heart rhythm.

References

Barnett SD, Ad N. Surgical ablation as treatment for the elimination of atrial fibrillation: a meta-analysis. J Thorac Cardiovasc Surg. 2006;131:1029

Current Surgical Diagnosis and Treatment . 10th ed. Appleton & Lange;1994.

Haines DE, Lerman BB, Kron IL, DiMarco JP. Surgical ablation of ventricular tachycardia with sequential map-guided subendocardial resection: electrophysiologic assessment and long-term follow-up. Circulation. 1988;77:131.

Harrison's Principles of Internal Medicine . 16th ed. McGraw-Hill; 2004.

Horowitz LN, Harken AH, Kastor JA, Josephson ME. Ventricular resection guided by epicardial and endocardial mapping for treatment of recurrent ventricular tachycardia. N Engl J Med. 1980;302:589.

Lee R, Mitchell JD, Garan H, et al. Operation for recurrent ventricular tachycardia. Predictors of short- and long-term efficacy. J Thorac Cardiovasc Surg. 1994;107:732.

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

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