Doctors often prescribe anticoagulants (blood thinners) to AFib patients to prevent blood clots that can result in stroke. Studies show the most commonly prescribed anticoagulant, warfarin (Coumadin, Jantoven), has reduced the risk of stroke by 68 percent. To reach this stage of defense, it is imperative to maintain the proper amount of Coumadin in the blood stream since too little can lead to clots and too much can lead to severe bleeding. A-Fib patients should follow their doctor’s instructions closely and monitor their blood levels regularly because many drugs, dietary supplements and foods can negatively influence blood levels.
Fortunately, over the last few years, three new blood thinners have become available to replace warfarin: dabigatran (Pradaxa), rivaroxiban (Xarelto) and apixiban (Eliquis). Each of these has advantages and disadvantages over the others, and the OHI Heart Rhythm Service can help identify the best choice for you.
Oklahoma Heart Institute’s Advanced Center for Atrial Fibrillation offers multiple procedures that may eliminate AFib. As with any surgery, there are risks involved. Oklahoma Heart Institute physicians will explain the risks and advantages of each procedure and discuss what might be right for you.
Catheter ablation is an effort to remove the principal cause of a patient’s AFib. In this procedure, a small catheter is inserted through a vein in the groin and threaded up to the heart where it makes a small hole to access the left atrium. For most patients, the irregular heartbeat initiates with the pulmonary veins. The area around these sites is then scarred (or ablated) with hot or cold energy. The scars block the primary electrical impulses responsible for AFib. The success rate for curing AFib with catheter ablation varies depending on duration of AFib and scarring with the heart. If necessary, your physician may suggest the procedure be repeated. The procedure can take up to six hours to perform. Typically, an overnight hospital stay is required.
More than 35,000 patients have opted for this procedure. Frequently referred to as the Maze, this procedure has a high success rate for a broad range of AFib patients – including chronic AFib patients. However, while open-chest surgical ablation can cure AFib, this highly-invasive procedure calls for open-heart surgery and generally includes heart-lung bypass.
If surgery is already being considered for other reasons such as a valve repair or replacement, your doctor may recommend this option. It only takes an extra 15 to 25 minutes to create the necessary ablations to block the abnormal electrical impulses that cause AFib. In addition, many surgeons will close or remove the left atrial appendage (a small flap on the heart) that is thought to be the primary location where blood clots form during AFib, which could lead to a stroke.
Frequently referred to as the Mini-Maze, this recently developed procedure is minimally-invasive. This procedure is similar to the open-chest ablation but differs in that the surgeon gains access to the heart by way of three small incisions on each side of the chest. This approach generally takes two to four hours. As in the open-chest procedure, the cardiovascular surgeon uses hot or cold energy to make precise ablations within certain areas of the heart to stop the abnormal AFib-causing electrical impulses. Many surgeons may also remove or close the small flap on the heart where most stroke-causing blood clots occur.
LARIAT Procedure This new minimally invasive catheter-based procedure is used to close the left atrial appendage (LAA). The procedure, which uses the LARIAT® Suture Delivery Device, permanently closes the LAA which is a benefit for individuals with Atrial Fibrillation (AFib) who cannot tolerate blood thinners.
The LAA is a structure in the heart that normally contracts, allowing blood to flow in and out of the LAA. For patients with AFib, the most common heart rhythm disorder, the LAA no longer rhythmically contracts creating a sluggish blood flow that can cause blood to pool and clot. These blood clots can lead to stroke. AFib patients are often prescribed a blood thinner, such as warfarin or Coumadin, to prevent clotting; however these drugs cannot be tolerated by all patients. During the LARIAT procedure, a local anesthetic is used to numb the area under the breast bone. After the area is numbed, two catheters are guided into the patient’s heart to seal the LAA with a pre-tied suture loop – similar to a lasso – using the LARIAT Suture Delivery Device. Once tied off, the appendage will turn into scar tissue over time. This procedure has the potential to reduce risk of stroke. Unlike traditional surgical treatments, this procedure is completed through small punctures in the skin, so in addition to less pain, the patient benefits from a shorter recovery time and less risk of complications.