Keyhole Atrial Fibrillation Treatment

How Is Atrial Fibrillation Treated?

We tailor treatment to the individual and may include:

• Antiarrhythmic drugs to control heart rate or rhythm
• Blood thinners to reduce stroke risk

In selected patients, especially when atrial fibrillation is detected early, it may be possible to eliminate AF using minimally invasive treatments, including:

• Catheter ablation via a vein in the groin
• Keyhole surgical ablation 
• A combined approach known as convergent atrial fibrillation treatment, which combines AFib corrective surgery and catheter ablation

These advanced treatments offer excellent results for suitable patients.

Learn more about atrial fibrillation and these treatments below. 

What Is Atrial Fibrillation?

Atrial fibrillation (often called AF or AFib) is a common irregular heart rhythm that affects the heart’s two upper chambers (the atria). Instead of beating in a steady, coordinated rhythm, the atria quiver, leading to an irregular heartbeat and disrupted blood flow through the heart.

AF often progresses in stages:

1. Paroxysmal AF comes and goes
2. Persistent AF lasts longer and needs treatment to stop
3. Permanent AF is continuous and long-standing

Over time, some people feel fewer symptoms, but not because AF has improved, but because the body has adapted. Even then, heart function can be reduced by up to 30% due to the loss of normal atrial contraction.

AF Symptoms

Symptoms vary from person to person. Some people experience severe symptoms, while others may feel very little at first.

Common symptoms include:

• Palpitations or a racing heartbeat
• Shortness of breath
• Dizziness or fatigue
• Chest pain or discomfort
• Reduced exercise tolerance

If you experience chest pain, fainting, or sudden worsening symptoms, you should seek urgent medical care from a healthcare professional.

Atrial Fibrillation Diagnosis

Diagnosis involves a careful assessment by a cardiology team and may include:

• A detailed medical history and physical exam
• Heart rhythm monitoring
• Blood tests to rule out contributing conditions such as thyroid disease or renal failure
• Additional tests depending on symptoms and overall health

Diagnosis is individualised and sensitive to each patient’s risk profile and symptoms.

Why Atrial Fibrillation is a Concern

AF can significantly affect quality of life and heart performance, especially in patients with existing heart conditions, high blood pressure, or other risk factors.

The condition increases the risk of blood clots forming in the heart, which can lead to stroke. This risk exists even in patients with intermittent AF and in some low-risk patients.

Blood-thinning medication is often prescribed to reduce this risk.

When AFib Treatment is Required

Atrial fibrillation treatment is recommended when it affects your well-being or heart function, or increases your risk of complications.

Treatment may be needed if you:

• Have ongoing or severe symptoms, such as palpitations, shortness of breath, fatigue, dizziness, or chest discomfort
• Experience persistent or permanent AF
• Show signs of reduced heart function
• Are at increased risk of stroke or heart failure
• Cannot tolerate medication, or it is ineffective
• Have advanced AF or unsuccessful catheter ablation
• Need a more comprehensive or long-term solution

In these cases, your cardiology team may recommend options such as catheter ablation, keyhole surgery for AFib, or a combined convergent approach tailored to your needs.

Atrial Fibrillation Treatments

It is common that treatments for atrial fibrillation change over time to find what works best for you. These are some of the most common options, including heart fibrillation surgery.

Medications for Atrial Fibrillation

Medication is usually the first step to treat atrial fibrillation. Different medicines do different things, and understanding this can help you feel more in control of your care and health.

Common medication types include:

• Heart rhythm-controlling medicines: Aim to reduce the frequency of AF or help keep the heart in a more regular rhythm.
• Blood thinners (anticoagulants): Medicines such as warfarin, apixaban, or rivaroxaban help prevent blood clots from forming in the heart and lower the risk of stroke.
• Heart rate-controlling medicines (such as beta blockers): Help slow the heart rate when it is beating too fast, which can reduce symptoms such as palpitations, breathlessness and fatigue.

Your doctor will consider factors such as your age, weight, kidney function, symptoms and bleeding risk when choosing the most suitable medication.

Important: This information is for general education only and does not replace medical advice. Always speak to your doctor or healthcare team about the treatment options that are right for you.

Catheter Ablation Atrial Fibrillation Treatment

This minimally invasive treatment for atrial fibrillation is made possible by passing thin catheters into the heart via the groin vessels.

How it works:

• Catheters are placed at the opening of the pulmonary veins
• Abnormal electrical signals that trigger AF are detected
• This abnormal activity can be destroyed with radiofrequency energy

This treatment is only really effective in patients with Paroxysmal Atrial Fibrillation. The immediate result can be very good.

Limitations of catheter ablation:

• Recurrence occurs in as many as 30% of patients within one year
• Repeat therapies may be required.
• Not an effective therapy for permanent atrial fibrillation

Keyhole Surgical Ablation to Treat Atrial Fibrillation

Keyhole atrial fibrillation ablation is a minimally invasive surgery that we perform through small holes between ribs. It is often recommended for patients when other treatments have failed or are not effective, such as a catheter (through the groin).

How it works:

• A special clamp isolates the left and right pulmonary veins
• This interrupts the electrical continuity between the pulmonary veins and the heart
• The strategy follows the same principle as the catheter ablation, but from outside the heart

Advantages of surgical ablation:

• Direct visual guidance allows for a more thorough ablation
• Areas where blood clots commonly form, such as the left atrial appendage, can be safely closed using a surgical clip
• Access is through small telescopic incisions on either side of the chest

Different approaches depending on AF type:

• Paroxysmal atrial fibrillation usually does not require a heart-lung machine
• Persistent atrial fibrillation or the early phase of permanent AF may require a more aggressive keyhole therapy, which may be considered using the heart-lung machine. This is called the Maze procedure, which creates further ablation lines in addition to pulmonary vein isolation and is extremely effective

In experienced hands, atrial fibrillation ablation is generally low risk. These risks are carefully balanced against the well-established long-term risks of leaving AF untreated, which can have ongoing effects on heart health and overall well-being.

Hybrid (Convergent) Atrial Fibrillation Procedure

Some cases of AF are persistent or resistant to standard treatments. Hybrid or convergent ablation combines surgery and catheter-based therapy for a more complete solution in some cases:

1. Surgical keyhole approach: Isolates pulmonary veins and treats the heart’s surface
2. Catheter ablation: Targets remaining irregular areas from inside the heart
3. Left atrial appendage closure: Lowers stroke risk

This dual approach offers long-lasting results, particularly in advanced AF or when both rhythm control and stroke prevention are priorities.

AV Node Ablation

AV node ablation is only considered when other treatments have failed or are not suitable. The procedure interrupts the electrical pathway (the AV node) that carries rapid signals from the upper chambers of the heart to the main pumping chambers.

Healthy Lifestyle Changes to Help Manage AFib

Making healthy lifestyle changes is a fundamental part of AFib treatment. These modifications can help manage your symptoms, reduce risks, and improve your overall well-being.

• Eat a heart-healthy diet
• Stay physically active
• Manage stress
• Limit alcohol and caffeine
• Quit smoking
• Maintain a healthy weight

Supporting Your Mental Health

Atrial fibrillation can cause anxiety, fear, and frustration. Support, education, and clear action plans help manage these feelings. Mindfulness, support groups, counselling, or short-term medication can improve mental well-being.

Benefits of Surgical Keyhole Atrial Fibrillation Treatment

Keyhole surgical cardiac ablation is a minimally invasive option that may be recommended when other treatments have not worked or when atrial fibrillation is more advanced. Key benefits include:

• Can help when atrial fibrillation has not improved with catheter ablation alone
• Treats the heart rhythm problem directly and thoroughly
• Especially effective for persistent atrial fibrillation
• May also help patients with intermittent (paroxysmal) atrial fibrillation
• Includes closure of the left atrial appendage, which helps lower the risk of stroke
• A good option for people who cannot take blood-thinning medication
• Uses small keyhole incisions between the ribs, not open-heart surgery
• Usually means a quicker recovery than traditional surgery
• Offers many patients the chance of long-lasting symptom relief and better heart rhythm control

Combining AF Treatment with Your Planned Heart Surgery

Many patients with atrial fibrillation also have valve problems, such as a leaking mitral valve. When heart surgery is already planned, it’s often the ideal time to treat atrial fibrillation surgically. This is called concomitant atrial fibrillation ablation and:

• Adds very little extra time to the surgery or recovery
• Can significantly improve long-term outcomes
• Guidelines now recommend treating atrial fibrillation during traditional heart surgery
• The left atrial appendage is also closed, which can reduce stroke risk and even increase lifespan

Combining these treatments means that one operation can safely and effectively address multiple heart issues.

Sign up for our free mini-series on AF with pioneering heart surgeon, Mr Inder Birdi. He discusses stroke prevention, heart surgery to correct AFib and other essential information about this health condition.

Keyhole Heart Clinic: Advanced Surgical AFib Repair

Under the leadership of Mr Inderpaul Birdi, we bring advanced heart care within your reach at The Keyhole Heart Clinic. Mr Birdi is one of the few heart surgeons in the world with the expertise and experience to perform keyhole surgery to fix AFib and a range of other conditions, including:

• Keyhole coronary bypass surgery (from single to quadruple bypass)
• Keyhole mitral valve repair or replacement surgery
• Keyhole tricuspid valve replacement
• Keyhole aortic valve replacement
• Keyhole atrial septal defect closure

We also offer comprehensive heart screening services and a Cardiac Longevity Program.

If you wish to discuss atrial fibrillation treatment options, you can contact us at The Keyhole London Heart Clinic today.