Radio frequency ablation

Specialties CCU

Published

What's been your experience with patients undergoing radio frequency ablation for chronic afib? Does it work? Do your patients tend to experience blocks and dysrhythmias post procedure, if so, does this tend to resolve over time or do they typically end up with needing a pacemaker? Thanks.

Specializes in Travel Nursing, ICU, tele, etc.

I keep watching to see if anyone will respond to your question. So, I will answer with my limited experience. (This may or may not be representative of what is happening out there in the real world.)

The 3 or 4 patients that I have run into who had it done years before were back in the hospital because it was no longer effective. The a fib had returned because other foci in the atria had begun to fire... There is also something called a maze procedure which actually involves creating a path for the electrical impulse to travel down the atria to the AV node and blocks those etopic stimulations. So, this is my hunch, is that it does work for people but often only for a few years or so and then they need further intervention...

Given the lack of responses, maybe it isn't all that frequently performed because of the lack of long-lasting success.

Hopefully more people will respond so we can get a sense of what is happening across the country!

Specializes in Cardiac Telemetry/PCU, SNF.

It's been a mixed bag. We get these kind of frequently, but I cannot remember the average success rate. Seen some work early, then drop back into afib later on. Our cards docs usually go for cardioversion and meds, resorting to EPS/ablation later. I had a couple of folks who had the MAZE procedure along with their OHS and that seemed to work better, but it takes time (time for the scar tissue that blocks the ectopic impulses to form.) At least 2 of them had been ablated prior to OHS (years past) for chronic fib and it just didn't stay in NSR. As for blocks and dysrhythmias it seemed to go pretty well, I don't recall much in the way of issues like that or an overabundance of pacers post-ablation.

Hope this helps,

Tom

Specializes in CVICU, MICU, CCRN-CSC.
It's been a mixed bag. We get these kind of frequently, but I cannot remember the average success rate. Seen some work early, then drop back into afib later on. Our cards docs usually go for cardioversion and meds, resorting to EPS/ablation later. I had a couple of folks who had the MAZE procedure along with their OHS and that seemed to work better, but it takes time (time for the scar tissue that blocks the ectopic impulses to form.) At least 2 of them had been ablated prior to OHS (years past) for chronic fib and it just didn't stay in NSR. As for blocks and dysrhythmias it seemed to go pretty well, I don't recall much in the way of issues like that or an overabundance of pacers post-ablation.

Hope this helps,

Tom

Our mini mazes ALWAYS seem to convert back to afib a couple of days post op....then will return to SR sometimes. It is such a painful surgery and so frustrating to have your patients not do well when it is suppossed to improve quality of life. I don't know anything about radio ablation...but I am going to find out.

Specializes in Travel Nursing, ICU, tele, etc.
Our mini mazes ALWAYS seem to convert back to afib a couple of days post op....then will return to SR sometimes. It is such a painful surgery and so frustrating to have your patients not do well when it is suppossed to improve quality of life. I don't know anything about radio ablation...but I am going to find out.

Let us know what you find out?? Thanks!;)

Specializes in CCU/CVU/ICU.
I keep watching to see if anyone will respond to your question. So, I will answer with my limited experience. (This may or may not be representative of what is happening out there in the real world.)

The 3 or 4 patients that I have run into who had it done years before were back in the hospital because it was no longer effective. The a fib had returned because other foci in the atria had begun to fire... There is also something called a maze procedure which actually involves creating a path for the electrical impulse to travel down the atria to the AV node and blocks those etopic stimulations. So, this is my hunch, is that it does work for people but often only for a few years or so and then they need further intervention...

Given the lack of responses, maybe it isn't all that frequently performed because of the lack of long-lasting success.

Hopefully more people will respond so we can get a sense of what is happening across the country!

Actually, what the MAZE procedure does (in a nut-shell) is 'burn' concentric 'rings' around the pulmonary veins in the left atrium. It's been found that a large percentage of A-fibs are initiated by impulses that originate at the junction of the pulmonary-veins and left atria (where they 'plug into the heart'). It's a common mis-conception that some sort of 'maze' is burned into the myocardium that somehow channels an impulse to somewhere that wont cause a-fib... But what it REALLY does is block the 'static' from spreading past these ablated 'rings'. These a-fib inducing impulses cant 'jump' the scar-tissue rings.. (does that make sense?).

Radiofrequency ablation done in an ep-lab for a-fib works by the same principal, just different approach (MAZE is done during CABG or Valve repair by a surgeon...not typically(or ever?) done on its own...it's too invasive)

MAZE and/or ep-lab ablation works best on new or paroxysmal a-fib. Chronic a-fib (from cardiomyopathy, cor-pulmonale, etc.) is not amenable to these treatments because the a-fib isnt being driven by localized/focal (ie pulmonary veins) impulses...

Also, many MAZE procedures come back in a-fib or convert back to a-fib shortly after surgery. The reason behind this is myocardial irritation and/or edema from surgery. It takes upwards of a month to 6 weeks before you can know if the MAZE was successful.

Does that help?

Specializes in CVICU, MICU, CCRN-CSC.
Actually, what the MAZE procedure does (in a nut-shell) is 'burn' concentric 'rings' around the pulmonary veins in the left atrium. It's been found that a large percentage of A-fibs are initiated by impulses that originate at the junction of the pulmonary-veins and left atria (where they 'plug into the heart'). It's a common mis-conception that some sort of 'maze' is burned into the myocardium that somehow channels an impulse to somewhere that wont cause a-fib... But what it REALLY does is block the 'static' from spreading past these ablated 'rings'. These a-fib inducing impulses cant 'jump' the scar-tissue rings.. (does that make sense?).

Radiofrequency ablation done in an ep-lab for a-fib works by the same principal, just different approach (MAZE is done during CABG or Valve repair by a surgeon...not typically(or ever?) done on its own...it's too invasive)

MAZE and/or ep-lab ablation works best on new or paroxysmal a-fib. Chronic a-fib (from cardiomyopathy, cor-pulmonale, etc.) is not amenable to these treatments because the a-fib isnt being driven by localized/focal (ie pulmonary veins) impulses...

Also, many MAZE procedures come back in a-fib or convert back to a-fib shortly after surgery. The reason behind this is myocardial irritation and/or edema from surgery. It takes upwards of a month to 6 weeks before you can know if the MAZE was successful.

Does that help?

One of our CT docs does the MAZE procedure without CABG or valve repair.

Specializes in CCU/CVU/ICU.
One of our CT docs does the MAZE procedure without CABG or valve repair.

Thats unusual. MOst wont. The patients take on all the risks associated with open-heart surgery, by-pass machine, etc.. MOst doctors/surgeons (just ask them) would reccomend rate-control/drugs...or an ep-lab ablation before cracking a chest for a MAZE without any other indications.

Apparently that doctor is one in a million....(or mis-informing his patients...)

Specializes in CVICU, MICU, CCRN-CSC.
Thats unusual. MOst wont. The patients take on all the risks associated with open-heart surgery, by-pass machine, etc.. MOst doctors/surgeons (just ask them) would reccomend rate-control/drugs...or an ep-lab ablation before cracking a chest for a MAZE without any other indications.

Apparently that doctor is one in a million....(or mis-informing his patients...)

Actually, we don't crack open the chest. It is a thoracotomy incision. Yes, we do it in one of our heart rooms in case the patient has to go on bypass emergently and we put in an introducer with a pulmonary vent in case we need to deflate the left lung. And they get a femoral and radial art line. Our MD has never had to put a patient on bypass while doing the maze, we just prepare in case he does. We also do less invasive valve repair and replacement through a thoractomy incision. It appears as though our surgeons are a little more advanced than others. We have the best numbers in Georgia except for St. Joes.

Specializes in CCU/CVU/ICU.
Actually, we don't crack open the chest. It is a thoracotomy incision. Yes, we do it in one of our heart rooms in case the patient has to go on bypass emergently and we put in an introducer with a pulmonary vent in case we need to deflate the left lung. And they get a femoral and radial art line. Our MD has never had to put a patient on bypass while doing the maze, we just prepare in case he does. We also do less invasive valve repair and replacement through a thoractomy incision. It appears as though our surgeons are a little more advanced than others. We have the best numbers in Georgia except for St. Joes.

I just have a quick question ...if your surgeon doesnt put these patients on bypass, is he doing a maze on a beating heart??? Thoracotomy approach with bypass standby is still much more invasive than an ep-lab ablation. I'll ask the surgeons i work with to get their input.

Specializes in CCU/CVU/ICU.
I just have a quick question ...if your surgeon doesnt put these patients on bypass, is he doing a maze on a beating heart??? Thoracotomy approach with bypass standby is still much more invasive than an ep-lab ablation. I'll ask the surgeons i work with to get their input.

Hey, is siri an allnurse-nazi or what!!??! (just teasing siri...before you cut this one up too!) ;)

Anyway, apparently with a simple google-search you can find lots of info on maze-procedures. Here's a good one: http://mmcts.ctsnetjournals.org/cgi/content/full/2007/0723/mmcts.2007.002758

The article does cover ablation with MAZE-procedure for a-fib without doing CABG or valve. Apparently the surgeon you know is one of a handful of people doing this (probably for study purposes??). Anyway, if you read over the 'discussion' it seems catheter (ep-lab) ablation is preferable because it's less invasive. And...in order to do a 'true' maze a patient has to go on bypass because (according to this article) the left atrium cant be ablated without it. The 'modified' maze with only rt atrium apparently can be done on beating heart.

But... it is clear that surgical MAZE for a-fib (without cabg or valve-repair) is NOT standard practice...again because of it's invasiveness...and i'll still get some cv-surgeons input on this...

Specializes in LPN school.

I've NEVER seen an oblation hold; they always seem to revert

limited experience though ---I've only seen 8-12 patients with an oblation or hx of oblation for a-fib

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