Atrial Fibrillation Video Series: Day Thirteen
Two Problems, One Solution: Treating AF During Valve Surgery
Atrial fibrillation often coexists with other heart conditions. One common scenario is a patient with AF who also has a heart valve issue – for example, a leaky or tight mitral valve – that requires surgical repair or replacement. You might be reading this and thinking of your own situation or someone you know. Let’s talk about the benefit of treating AF at the same time as valve surgery, a classic “two birds with one stone” opportunity in cardiac care.
If you’re undergoing heart surgery for a valve (or other issues like a bypass), the chest is already open and the heart can be directly accessed. This presents an ideal chance to perform a surgical ablation for AF (often a full Cox-Maze procedure or a variation of it) without much additional risk or invasiveness. The Cox-Maze procedure is considered the gold standard surgical treatment for AF. In open-heart surgery, the surgeon creates a series of precise scars on the atria (originally done with cuts and stitches, now often done with freezing or heat energy) that direct the electrical impulses to follow a “maze” to the AV node, preventing the chaos of AF. This can restore normal rhythm in a high percentage of patients long-term.
When combined with valve surgery, the surgeon can perform this ablation maze pattern on the heart after fixing the valve. They will also usually remove or close the left atrial appendage during the surgery (since we know that’s crucial for stroke prevention). So, in one operation, the patient gets their valve problem fixed and their AF addressed.
Why do it together? For one, it’s efficient – the patient only undergoes anesthesia and the surgical opening once. Secondly, treating AF can improve outcomes: an irregular heartbeat after surgery can make recovery harder (AF after cardiac surgery is common if you don’t address it, even in people who didn’t have it before). If a patient already has AF going into surgery, not treating it means they’ll come out of surgery still in AF, with all the attendant stroke risks and symptoms. Studies have shown that patients who get a concomitant (simultaneous) AF surgery with their valve surgery have better long-term rhythm control and stroke prevention than those who just have the valve fixed. In fact, current guidelines often recommend doing AF ablation during valve surgery if the patient has significant AF history.
From a patient perspective, adding an AF ablation to valve surgery doesn’t usually change the recovery time significantly. You might have a few extra temporary pacing wires or need to take an antiarrhythmic medication for a short while after, but the overall hospital stay and recovery tasks (like walking, rehab) are the same. The surgeon might discuss a slightly increased time on the heart-lung machine or cross-clamp (the time the heart is stopped) to do the ablation, but in experienced hands this is minimal.
So, if you or someone you know is heading into heart surgery and AF is part of the picture, it’s absolutely worth a conversation about addressing the AF during the operation. It could spare you from a second procedure down the road and increase the likelihood of enjoying a normal heart rhythm after you’ve healed from surgery. I always tell my patients: our goal is not only to fix the plumbing (valves, arteries) but also the wiring (rhythm) of the heart when needed, so the heart can function optimally.
Next email: We’ll shift gears from the medical and procedural side to the human side of AF. Living with atrial fibrillation can take an emotional toll. Let’s talk about the emotional impact of AF and ways to cope with it in our next discussion.
