What is Arrhythmia?

Atrial Fibrillation (AF) is the most common observed heart rhythm disorder. (1) Although it is generally seen in the elderly, it can also occur in young individuals without any heart disease. In AF, there is an irregularity in the stimuli that ensure the heart’s orderly functioning. This irregularity is often manifested as the heart emitting anarchic stimuli. The electrical stimuli of the heart, instead of proceeding smoothly in the atrium (the heart’s small chamber), attempt to pass through the atrioventricular node to reach the ventricle (the heart’s large chamber) by competing with an increased number of stimuli originating from many foci (300-600 beats/min) and originating from tissues outside the heart’s electrical system. Many of these stimuli are anarchic beats originating from tissues outside the heart’s electrical system. With these irregular beats, the heart accelerates, and in AF, the heart rate generally rises to 100-150 beats/min. The aimless fast-paced functioning of the heart can disrupt the pump function. If necessary treatment is not applied for a long time, it can lead to heart enlargement, heart failure, and the most feared consequence of arrhythmia, which is the formation of strokes due to blood clotting in the brain.

In general, patients experience severe palpitations, shortness of breath, chest pain, dizziness, and occasionally fainting. The most common symptom is palpitations. When the heart starts beating too fast or too slow, the patient may faint. Sometimes, there are pauses, and when the heart rate is not sufficient, the patient may complain of fatigue.

Atrial fibrillation (AF) is one of the leading causes of stroke in the elderly, and it is the leading cause of stroke among stroke causes originating from the heart. The likelihood of having a stroke in patients with AF is increased by 5 times. At the same time, the rate of disability and death in patients who have had a stroke due to AF is much higher than in patients who have had a stroke not related to AF. (2) It constitutes ¼ of the causes of strokes in the elderly.

AF can reduce the pumping ability of the heart. The irregularity can cause the heart to work less effectively. Also, prolonged AF can severely weaken the heart and lead to heart failure.

AF accounts for 1/3 of patients admitted to the hospital with rhythm disorders. While its prevalence in the general population is around 0.4%, it is seen in 3-4% of adults. 70% of AF patients are between 65-85 years old.

The treatment goals for AF are to restore a normal heart rhythm (sinus rhythm), control the heart rate, prevent blood clots, and reduce the risk of stroke. Various options, including medications, catheter-based procedures, and surgery, can be used in treatment. Here, only Surgical Ablation Treatment will be discussed.

If a patient has atrial fibrillation and surgery is required for the treatment of other heart problems (such as valve disease or coronary artery disease), surgical treatment of AF can be easily applied without creating an additional surgical risk. This treatment has been possible for the last 20 years. In scientific guidelines, it is strongly recommended that if there is an AF rhythm accompanying valve surgeries, isolated coronary artery bypass surgeries, or surgeries performed simultaneously, this arrhythmia should also be treated. (3) Today, new technologies designed to create conduction block lines using radiofrequency, microwave, laser, ultrasound, or cryotherapy (freezing) are widely used in the surgical treatment of AF. With these techniques, abnormal electrical stimuli are blocked from being transmitted through the heart by creating lesions and subsequent scar tissue, and normal stimulus transmission through the correct path is encouraged. Among these, radiofrequency and cryoablation that can be performed during surgery are the most popular.

Cryoablation, or Cryoablation, is a term given to the process of freezing the problematic area in the heart at temperatures between minus 150 and 170 degrees, a method that has been applied worldwide in recent years and has fewer complications compared to old methods, thus preventing complaints of palpitations. The most important advantage of this method is that the risk of perforation (tearing) and thromboembolism (clotting) is low, and a full-thickness lesion is obtained.

The introduction of ablation techniques into arrhythmia surgery after was the beginning of a new era in the treatment of AF. The principle in this technique is to create full-thickness lesions in certain regions of the atrium using the heat generated by radiofrequency energy. In this way, isolation of the foci triggering AF and prevention of the progression of large re-entry circuits by being hindered by the newly created lesions and natural anatomical obstacles are achieved.

Both methods can be applied at our center.