Before the Procedure
For most patients, surgery for atrial fibrillation is elective. This allows you to qualify for our TCI program. TCI stands for To Come In and allows patients to arrive at Cleveland Clinic on the same day as their scheduled surgery, instead of being admitted several days before. Before your scheduled surgery date, you will have a preoperative appointment to:
- Receive specific instructions to help you prepare for surgery. Information about eating, drinking and taking medications prior to surgery will be discussed.
- Meet with your anesthesiologist, nurse clinician, cardiologist and surgeon.
- Discuss your surgery and have an opportunity to ask questions.
Patients admitted to the hospital prior to surgery will receive details of pre-surgical procedures and preparation from their cardiologist and surgeon.
- See Heart Surgery at Cleveland Clinic for more information
What happens during the surgery?
During minimally invasive surgery, the surgeon views the epicardial (outer) surface of the heart using an endoscope. Specialized instruments are used to isolate the pulmonary veins and create the other lines of conduction block. Unlike traditional heart surgery, there is no large chest wall incision. Therefore, recovery is rapid.
Because the surgeon can view the outside of the heart, the risk of pulmonary vein stenosis is nearly eliminated. In addition, no catheters are introduced into the left side of the beating heart, reducing the risk of blood clots and strokes.
The left atrial appendage is a small, ear-shaped tissue flap located in the left atrium. This tissue is a common source of blood clots in patients who have atrial fibrillation. During surgical procedures to treat atrial fibrillation, the left atrial appendage is either excluded or removed, reducing the risk of late stroke.
After the Procedure
The patient is transferred to an intensive care unit (ICU) for close monitoring for one to two days after the surgery. The patient is then transferred to a private room on a regular nursing unit. Most patients can leave the hospital in 4 days after minimally invasive surgery, this will be longer for combined surgery; return to full activity is generally possible within 3 to 6 weeks.
Thirty to fifty percent of patients experience skipped heartbeats or short episodes of atrial fibrillation during the first three months after the procedure. This is common due to inflammation (swelling) of the atrial tissue and is treated with medications. After the heart has healed, these abnormal heartbeats should subside.
A small number of patients (about six percent) require a pacemaker after surgery due to an underlying rhythm, such as sick sinus syndrome or heart block, which previously was undetected.
Medications after surgery may include:
- Anticoagulant (blood thinner), such as Coumadin, to prevent blood clots
- Antiarrhythmic medication to control abnormal heartbeats
- Diuretic to reduce fluid retention
- Other medications as needed
Your doctor will monitor your recovery and determine when or if these medications can be discontinued.