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04.06.2015

Treating atrial fibrillation with catheter ablation, diarrhea fatigue - Within Minutes

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Drugs are often ineffective at preventing attacks of atrial flutter, and occasionally side effects may limit drug use, and, with the more powerful drugs, rarely the arrhythmia is exacerbated.
Invasive treatment: For many patients with atrial flutter, cure can be achieved with a cauterising procedure called ablation and is described below. As the procedure is largely based upon a detailed knowledge of heart anatomy, a successful procedure can usually be obtained even if the patient is in a normal rhythm at the time of the procedure – atrial flutter does not need to be stimulated for a successful ablation to be performed. In approximately one percent of cases ablation damages the normal electrical wiring of the heart, resulting in a very slow heart beat. There is a very small risk of stroke with this procedure, approximately 1 in 1000.
A related abnormality of rhythm, called atrial fibrillation, is very common in patients with atrial flutter. Your doctor will carefully discuss the procedure, including all the potential risks with you, and will obtain informed consent before starting.
Anti-arrhythmic drugs, which can help to restore the heart's 'normal' rhythm (sinus rhythm) and to prevent the return of atrial fibrillation.
If you have treatment which restores a normal heart rhythm (for example, ablation) you may still need to continue taking a blood-thinning medicine. In some rare cases, if your risk of stroke is very low (you have atrial fibrillation and NO other risk factors for stroke) and if the episodes of atrial fibrillation have disappeared completely, then it may be possible to stop taking medication. Vitamin K antagonists have been widely used in patients with atrial fibrillation to reduce the risk of stroke. Warfarin is very effective at reducing the risk of stroke in patients with atrial fibrillation.
In people who are not taking a blood-thinning medicine, blood clots with INR of around 1.0. Make sure that you check with a doctor or pharmacist every time you are prescribed a new medication, or when you buy medicines (including herbal remedies and vitamin tablets) over the counter, to make sure that they are all compatible to take with warfarin.
Yes, there are currently 3 alternative blood-thinning medicines available for people with atrial fibrillation which can help to reduce the risk of stroke by thinning your blood.
These new medications have all been successfully tested on thousands of patients with atrial fibrillation and are effective and safe medications which can be used to prevent strokes.
The limitations of warfarin (interactions with food, other drugs and alcohol, and the regular blood tests to monitor the INR) have led to development of these new medications, with the aim to make them more convenient for patients to take than warfarin and at least as effective and safe. Do not take aspirin with any of these blood-thinning medicines unless a doctor has specifically told you to. Studies have shown vitamin K antagonists (such as warfarin and acenocoumarol) and the new blood-thinning medicines, dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) are all effective treatments for the prevention of stroke in patients with atrial fibrillation.
The decision about which blood-thinning medicine is most appropriate for you will be made following a discussion between you and doctor and will be based on your individual risk of stroke and your risk of bleeding with the medication.
The most common side effect that occurs with all blood thinning medications (vitamin K antagonists, dabigatran, rivaroxaban, and apixaban) is bleeding.
Your doctor will not prescribe a blood-thinning medicine if the risk of bleeding with such treatment outweighs the benefit of reducing your stroke risk. If you and your doctor decide that you would like to try to restore your heart rhythm from atrial fibrillation to the heart's normal rhythm (known as "sinus rhythm") then your doctor may suggest a controlled electric shock to the heart (known as "electrical cardioversion") or a specialist procedure known as "catheter ablation". In patients who refuse any form of blood-thinning medicine with an oral anticoagulant (warfarin, dabigatran, rivaroxaban, apixaban), then the use of two drugs taken together that prevent cells in the blood called "platelets" from sticking together may be recommended.
Attached to the top left chamber of the heart (the left atrium) is a "pocket" which is called the left atrial appendage.
The operation required to fit a left atrial appendage closure device carries some important risks. You should discuss the treatment options for atrial fibrillation, including a left atrial appendage closure device, with your doctor.
The left atrial appendage in the left atrium is one of the areas in which blood is more likely to pool during atrial fibrillation, which can lead to the development of a blood clot.
There are several medicines, taken as tablets, that can help to slow the heart rate down in people with atrial fibrillation and your doctor will choose a drug that fits you best.
If you have an irregular heart rhythm such as atrial fibrillation, your doctor may suggest that you have a procedure called a cardioversion.
In about 1 in 10 patients electrical cardioversion is not able to restore the heart rhythm back to normal (sinus rhythm), so it is possible that you may continue to have atrial fibrillation after the procedure. If you have had atrial fibrillation or the symptoms of atrial fibrillation for a year or more, or if you have had high blood pressure for a long time or if you have certain problems with the valves in your heart, then cardioversion is less likely to be successful in returning your heart rhythm to normal (sinus rhythm) and you may need to have the procedure repeated. You should be aware that even after a successful cardioversion, where your heart rhythm is returned to normal (sinus rhythm); it is possible for your atrial fibrillation to return. The aim of this procedure, called a catheter ablation, is to electrically isolate the areas of the heart that are causing the abnormal electrical activity.
Catheter ablation is an invasive procedure which means that special thin flexible tubes (electrodes) are passed into your heart through a blood vessel, usually in your groin.
The scars that form in the ablated area stop the abnormal electrical signals, which  are responsible for atrial fibrillation, from spreading to the rest of the atrium.
Often, especially in the case of persistent or long-standing atrial fibrillation, other areas involved in the creation and persistence of atrial fibrillation are also ablated.
Another area of the heart were faulty electrical activity can occur is the atrioventricular node, which is the gateway through which electrical signals coming from the atria (top chambers of the heart) move into the ventricles (the bottom chambers of the heart). It will be possible to stop the drugs controlling your heart rhythm (anti-arrhythmic drugs ) if there are no relapses of atrial fibrillation after the procedure.


However even if your ablation is successful you may still be needed to continue taking an anticoagulant (blood-thinning drugs).
In some rare cases, if your risk of stroke is very low (you have atrial fibrillation and NO other risk factors for stroke) and if the episodes of atrial fibrillation have disappeared completely, then it may be possible to stop taking your blood-thinning medication. 2 or 3 patients out of 100 will experience a large bruise in the groin (the place where the catheter is inserted into the body) that gets better by itself in the vast majority of cases. During open heart surgery (for example, when having a valve in your heart replaced), a surgeon can perform a similar procedure to a catheter ablation using either heat (radiofrequency ablation) or cold (cryoablation).
Nowadays surgery alone for the treatment of atrial fibrillation is carried out very rarely.
In some specialised hospitals, a procedure called a Maze operation can be done to help patients with atrial fibrillation to return to normal heart rhythm (sinus rhythm). The Maze operation is usually only done in patients with atrial fibrillation who are having open heart surgery for another reason, for example, when having a valve in your heart replaced.
The Maze operation is not carried out that often anymore because surgeons tend to use surgical ablation instead. In some patients with atrial fibrillation, the heart continues to beat very fast despite taking several medications designed to slow the heart rate down and when electrical cardioversion (controlled electric shock to the heart to try to return a "normal" heart rhythm) is either unsuccessful or unsuitable. More recently, some patients who have both atrial fibrillation and a very poorly pumping heart may receive a more complex pacemaker treatment called "cardiac resynchronisation therapy".
In about 1 in 200 ablations a leak of blood occurs into the sac surrounding the heart. It should be remembered that the condition itself is associated with a very small risk of stroke. This arrhythmia may be seen following an entirely successful ablation for atrial flutter, particularly in elderly patients. Many patients with atrial flutter are taking blood thinning medications (such as warfarin).
The ablation catheter is advanced to the left atrium via a puncture across the atrial septum.
As a result, not every patient is an appropriate candidate for rhythm-control, and your physician may opt to treat with rate-control only.
External defibrillation pads are placed in certain locations on the outside of the patient’s chest, with the delivery a brief electric shock (less than a second). For most people with atrial fibrillation it is necessary to take medication for the rest of your life. This is important because atrial fibrillation can return and you may not be aware that it has returned and this can increase you risk of stroke. You should discuss this with your doctor as decisions regarding medication need to be made on an individual basis. To reduce the risk of a stroke in atrial fibrillation the blood needs to be 2-3 times thinner than normal. If you decide to have a cardioversion or an ablation procedure, you will need to take an anticoagulant drug for a period of time before and after the procedure to reduce the risk of a blood clot forming as a result of the procedure. The risk of serious bleeding with aspirin is similar to the risk of bleeding with warfarin, especially in older people (those aged 65 years and older).
Although blood clots in the heart can sometimes form in the top chambers of the heart (the atria), in 9 out of 10 cases they occur in this "pocket" (the left atrial appendage).
This device is not usually considered as the first treatment option to try to reduce the risk of stroke in patients with atrial fibrillation.
For many patients with atrial fibrillation one tablet is enough to slow the heart rate down sufficiently but some patients may need to take two or more types of tablets in order to control their heart rate. There are other treatments available and these may involve medication to control the rate of your heart or catheter ablation for some patients. The doctors first create an image of the heart chamber which helps them with moving the catheter during the procedure.
This will stop the abnormal electrical signals from spreading from the atria to the ventricles.
The success of the treatment depends on your age, type of atrial fibrillation, and other illnesses you may have. This will depend on your risk of stroke .This is important as the atrial fibrillation may return and you may not be aware that the atrial fibrillation has come back. Catheter ablation of atrial fibrillation can cause a stroke or temporary signs of a stroke in 1% of all people who undergo such a procedure. The Maze operation aims to cut routes in the top chambers of the heart (the atria) which help faulty electrical signals to travel in patients with atrial fibrillation. However some patients who have both atrial fibrillation and a low heart rate may need to have a pacemaker fitted. For this reason many patients are treated with blood thinning medications called anticoagulants, such as warfarin. Once in the left atrium, the ablation catheter is maneuvered to the area of origin of the pulmonary veins responsible for the triggering foci.
The treatment option chosen should be done after careful consultation with your physician given the severity of your symptoms, the compromise to your quality of life, and your coexistent medical conditions. Atrial fibrillation increases the risk of stroke and you will usually stay on your blood-thinning medication for the rest of your life.
Surgery for atrial fibrillation may also be an option for some patients, with a procedure called surgical ablation or a Maze procedure.


It is possible to close or block the entrance between the top left chamber of the heart and this pocket (the left atrial appendage), by using a special device called a left atrial appendage closure device. The main treatment option for reducing the risk of stroke in the majority of people with atrial fibrillation is a blood-thinning medicine (an anticoagulant). In addition, only 9 out of 10 blood clots are formed in the left atrial appendage (pocket) and therefore having this device fitted does not completely remove the risk of stroke.
A special device can be inserted using a catheter placed in the left atrium, then the catheter is removed and  the device is left in place in the left atrial appendage. Taking anti-arrhythmic drugs may help to reduce your chances of relapsing back into atrial fibrillation, but these drugs do not guarantee that you will not experience episodes of atrial fibrillation.
The chances of your atrial fibrillation returning depends on many factors but this is more likely if you have other heart problems (including high blood pressure) and if you have had atrial fibrillation for more than 1 year. It is possible that when the cardioversion returns your heart rhythm to normal and the top chambers of the heart (the atria) start to beat normally, this might cause blood clots that have formed in the heart to be squeezed out into your blood stream. Once  the exact site that triggers the abnormal electrical activity has been identified then these cells are modified or destroyed by extreme heat (burning), known as radio-frequency ablation or extreme cold (freezing), known as cyroablation.
This treatment is carried out by an electrophysiologist, who is a heart doctor with specialist training and experience in carrying out this  treatment. In this situation, one of the options for such patients is to burn (similar to ablation) a small part of the heart, called the atrio-ventricular node and to implant a pacemaker. In these cases another catheter is introduced and positioned in the right atrium (upper chamber). The resultant heartbeat on exam is typically fast, but with medications, it can be slow with an irregular pulse. Catheter ablation at the left atrial-pulmonary vein junction serves to electrically isolate the pulmonary veins, thereby trapping these foci that are now unable to excite the left atrium. There are many antiarrhythmic medications, with only a few requiring a brief hospital stay for initiation. With the use of specialized electronic and computer equipment, in conjunction with the intracardiac electrode catheters (placed into the heart via the femoral veins) and specialized 3-D electroanatomical mapping systems, your heart rhythm specialist will deliver radiofrequency energy to isolate each of the left atrial pulmonary veins. The red dots represent sites of delivery of radiofrequency energy by the intracardiac ablation catheter. More information is given below on warfarin and the available to treat patients with atrial fibrillation. If you buy any medicines over-the-counter, check with the pharmacist that they can be taken with warfarin. In addition, the way the body responds to these new medications is much more stable than with warfarin, so you do not need regular blood tests to measure the effectiveness of these new blood-thinning medicines, as you do with vitamin K antagonists such as warfarin and acenocoumarol. However, the new blood-thinning medicines are not suitable for every patient with atrial fibrillation, particularly those with severe kidney or liver problems. If you buy any medicines over-the-counter, check with the pharmacist that it is safe to take with your blood-thinning medicine.The effectiveness of these new blood-thinning medicines is not affected by the food that you eat. The left atrial appendage closure device may be an alternative treatment option if you are not able to take any of the blood-thinning medicines, usually because of a very high risk of bleeding. Other devices are applied to the outside of the left atrial appendage during surgical procedures. The reason for doing this is because faulty cells in the lung veins can trigger atrial fibrillation).
If catheter ablation is a treatment option for you, your doctor will discuss it with you and explain about the procedure in more detail.
The atrio-ventricular node serves as a bridge between the electrical signals in the top chambers of the heart (the atria), where the signal is generated and the bottom chambers of the heart (the ventricles), which pump the blood.
A series of applications of energy (usually radiofrequency) is delivered between a heart valve and a large blood vessel, and in most cases the atrial flutter will break and a normal rhythm supervene.
The decision to implement long-term anticoagulation (that is blood thinners) must be individualized after a discussion between you and your treating physician. Radiofrequency energy employed during the catheter ablation procedure heats the tissue enough to destroy the local heart cell function, but without physically cutting through the tissue.
These ablation lesions are delivered at the junction of the left atrium with pulmonary veins, with the goal of electrically isolating each vein to prevent premature atrial beats and focal atrial tachycardias from the pulmonary veins from entering the left atrium. Several different left atrial appendage closure devices are available and your doctor will discuss the available options if this type of device is a suitable treatment option for you. This controlled "burning" or "ablation" of the atrio-ventricular node stops the fast atrial fibrillation signals from the top chambers of the heart (atria) from reaching the bottom chambers (the ventricles) and the pacemaker now controls the rate at which the ventricles beat. In general, medical therapy is first-line with invasive procedures reserved for patients who have failed or cannot tolerate medical therapy. Other problems, which are common to many drugs, such as headache, nausea or stomach upset are less common with blood thinners and, if they occur, should prompt you to seek medical attention to look for another cause. Your doctor will help to choose the best anti-arrhythmic drug for you and discuss the benefits and possible side effects in more detail with you.



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