– Hey, I'm Dr. Morales and in this video I'm gonna
talk about AFib ablations. I'm gonna walk you through a consultation for AFib ablations. I'm gonna talk about why somebody should
consider an AFib ablation, when is the right time
to do an AFib ablation. Talk about the procedure details as well as talking about expected recovery and risks of the procedures as well. And I'm gonna talk to you just like as if you were a patient,
coming to see me in my office. I'm gonna talk to you exactly the way that
I would talk to my patients.
I even have a heart model because that's what I use in
the office to help describe to patients what I do
during ablation procedure. So let's talk about ablation procedures and in the end, make sure you stick around because I'm gonna talk about
how I can actually help you with your ablation procedure,
no matter where you live. So let's talk about AFib
ablation procedures. First, let's talk about why somebody should
consider an ablation procedure. An ablation procedure works better than any medication can
to suppress your AFib. You know, I always tell patients that medications are always an option. You know, I don't ever
want anybody to think that doing a surgery on their heart, doing
an ablation procedure is their only option. Medications are usually an option, but there comes a time when medications are just not doing enough and people get significant
episodes of AFib.
They end up having recurrent times when they go into the emergency room or hospitalization due to AFib, sometimes even
despite being on medications. In addition, sometimes people, even though they might be doing better, they're just taking a
handful of medications for their AFib to try to
suppress their episodes and they don't wanna be on those medications forever and so an ablation procedure
definitely works better than any medication does. I always tell patients though… We'll talk about ablation procedures, but it's never a 100% cure. So then, in the long-term,
you'll have less AFib with an ablation procedure, usually.
But sometimes, medications,
lifestyle modifications, they're all very important
and need long-term strategy to prevent recurrences of AFib or to have as little as AFib as possible. So when it comes to an ablation procedure,
what about timing? When is the right time to
actually do an ablation procedure? Well, there's different levels
of success rate depending on where somebody is with their AFib. In general, people who are in
the earlier stages of AFib, that's called paroxysmal AFib. People's AFib comes and it goes and they are not in AFib all the time. They have the highest
spectrum of success rate for an AFib ablation procedure where they can do very
well, have very minimal AFib afterwards and need less medications. So certainly, the less
time somebody has AFib, people who have been diagnosed
shorter periods of time, there have been some studies even recently that show people who get
an ablation procedure within one year after being diagnosed of AFib, also have better
success rate as well.
Like most things in medicine, the earlier you get it treated,
the better the success rate. And so having AFib for a long time, waiting too long, there's just inherently more damage done to your own heart's electrical system where an ablation procedure's
success rate will just not be as good, and so definitely
when your AFib comes and goes and you haven't had AFib that long, it would definitely
be a more ideal time to have an AFib ablation. And this is where you have
the better success rate.
So what actually happens
during an ablation procedure? So this is again, how I explain it to my patients and hopefully,
this can be helpful to you in your discussions
with your doctor as well. So in an ablation procedure, first of all, I always tell patients with my ablation procedure,
people are completely asleep. So I do all of mine with an anesthesiologist so the patient doesn't
feel a thing at all. I think that's probably
the most common way that this is done in the United States. I have heard some cases in Europe or in other countries where it's done with kind of more twilight
sleeping medications and not full anesthesia. But I do mine with full anesthesia so the patient doesn't feel anything.
In addition, usually the anesthesiologist will put a catheter
inside of their arteries in the wrist to monitor
their blood pressure from moment to moment
throughout the procedure. But as far as actually starting the
ablation procedure itself, I usually enter through the femoral vein. It's a large vein in the top
of your leg by your hip bone. It's a very large vein that
goes directly up to your heart. These days I only use
three needle punctures during the ablation procedure, they all go into the same side in
the right femoral vein because I use different catheters that have its own different
role during the procedure. There's the one catheter
that does the ablation, the actual ablating itself. In addition, there's a catheter that I put inside a vein that's inside of the heart
called the coronary sinus which helps monitor the heartbeat
throughout the procedure. And then, the third catheter will be, what's called an intracardiac echo. That's an ultrasound catheter that's placed actually,
inside of your heart and it can be very useful for a lot of the steps of the
ablation procedure itself.
So I take several catheters,
go up to your heart. Now for ablation for Afib, the majority of the ablation is done in the left upper chamber of your heart. And I'm gonna get into a moment here, discuss
what I'm actually ablating in the left upper chamber of your heart. But to get it from the right side to the left side, you
actually have to cross over and that's what's called
a transseptal puncture.
So basically, I and other electrophysiologists
will actually take a needle inside the heart and cross from the right side to the left side. And it sounds dramatic to say that, but it's actually one of
the more routine parts of the ablation procedure especially, in experienced operators. And that's where that ultrasound that's inside your heart
can be extremely beneficial. There's a very thin portion in the middle part of that
upper chambers of your heart between the right atrium and the left atrium
called the fossa ovale. It's a very thin, little, paper thin piece between the two chambers. And that's where we would cross from the right side to left side.
And that intracardiac
echo shows us exactly where the catheters are so when we advance the needle, we know that we're exactly in that thin part of the heart where we wanna be because people's hearts
are a little bit different. You know, some's are bigger than others, some's are more rotated than others but that echo is always right. It knows exactly where that catheter is so that we can exactly, put
the hole in the right spot. And once you've been doing it for a while, it's
actually a very quick part of the procedures. I mentioned that for a moment because people get kinda
hung up on that part, even though it's probably
one of the more routine parts of the procedure. So once we cross over from the
right side to the left side that's when we will advance
the ablation catheter. So the areas of ablating for AFib are routine for most people. It's an area in the left upper chamber of the heart called the pulmonary veins. This is where I usually
bring out my heart model.
So if you open up a heart,
you look at the atrium with the top portions of your heart in the back of that chamber right here, right where my fingers are right here, there are these four veins that go from your lungs back to your heart. They're called the pulmonary veins. They have extensions of
heart muscles and nerves. And this is where most
people's AFib come from.
This was first identified and described in the late '90s, came
outta researchers in Europe that this was kind of the hotbed. This is where most
people's AFib comes from. So the ablation procedure in terms of the technique, has been around for gosh, you know, 20 years or now to do ablation around these veins. You know, people always ask me, "Well, do you ablate all four? Do you do one versus just another one? How do you know which one to ablate?" Well, back when the procedure
was first being described, people didn't ablate all
four pulmonary veins. They would try to ablate whichever one they thought
was the problem child or the worst one of them. But then, people just
kept having recurrences. They kept having more AFib and they would have to come back and just ablate all of them. So it's been pretty routinely standard for a long time now that the main area to ablate would be around
these four pulmonary veins.
So you're actually inside of the heart and I always tell patients that you're making strategic burn marks inside of your heart, okay? Strategic burn marks to block the areas that cause Afib, the areas that cause these extra beats and nerve endings that
tend to contribute to AFib. So inside your heart,
I'm with the catheter that does burning or as a simple way to describe it, radiofrequency
is the technical term, but burning is a simple
way that I describe it to patients and it basically
makes strategic burn marks around these veins. Now there's actually a
couple of different options to make these strategic scar marks around these veins these days. Still, radiofrequency or burning is probably the
most common method that's used. That's what I use on a
great majority of time. But there's all different
energies that are being evaluated. There's lasers, there's freezing balloons, there's another new energy that's under clinical trials right now called electroporation, so
there's all different energies being looked at and evaluated but still, burning is the
most common method that's used and that's what I use
for majority of patients.
So I do strategic burn marks
around the veins over here on this side here, and then the
veins are on this side here. Whole procedure itself,
usually takes about less than two hours to do from start to finish. You lay in bed for a few hours afterwards, if everything looks good, these days I'm sending most
patients home the same day of the procedure. If for any reason there's
some shortness of breath or the patient's numbers don't look right, I might keep 'em overnight. But I would say these days, about 80% of our patients are
going home the same day of the procedure. Ironically, a few years ago I pretty much kept everybody overnight. But ironically, with the pandemic, you know, really changed the
way that we manage patients and trying to not keep
people overnight anymore. And it kind of forced to change, and it's actually worked very well that nowadays, I rarely
ever keep anybody overnight and most people do well.
I did mention briefly, about advancements in the technology for AFib. The catheters are constantly changing. You know, when it comes to medicines for AFib, there hasn't been
a whole lot of changing. But when it comes into equipment used for ablation procedures, it
changes every year like iPhones. I mean there's constantly a
new equipment, new technology or just better ways to use
the existing equipment. These changes have definitely
improved the procedure. It's improved the success
rate of the procedure. It actually reduced the procedure time. Back 20 years ago before I started doing
ablation, I've been doing 'em for about 10 years now,
it would not be uncommon to see ablation procedures that were six to eight hours long.
I've had countless people telling me how long their ablation procedures took. These days, pretty common to have one less than two hours long. And that's a lot of time
because the advancements in the equipment allow
you to do a good job and an efficient job. In addition, because the
procedures are getting shorter and the technology is getting better, the recovery time is better
for most patients as well. Like I mentioned for most patients, if
the numbers are good, they're going home the same
day of the procedure, itself. But what can you expect at home? Okay, so let's first talk
about the routine things and then we can talk about the risk and precautions for the
dangerous risk as well. Routine stuff, bruising and some soreness in the area of your groin
where I enter is pretty common and expected, it should never
be any severe pain, you know.
But some bruising and
soreness is expected, okay? There's inflammation in your heart from the areas that have been burned. So people sometimes get
chest pain for a few days and actually, with the advancements of technology, the chest
pain that people have from the ablation procedure
is actually less than it used to be several years ago. But they still get it sometimes, and usually it's a very
inflammation type of pain. It's very associated with positions. It's very similar to another medical condition
called pericarditis in a sense where that chest pain is basically,
very positional in nature.
You notice it more when
you're taking a deep breath or you're moving in certain positions. It's worse when you're laying
down versus sitting up. And that's very common for
an inflammation type of pain which can happen after
an ablation procedure. Also, sometimes people can
feel shortness of breath after an ablation procedure. That's usually due to fluid retention during an ablation procedure, especially the burning catheter,
you know, you don't want it to actually get too hot or
hotter than you'd want it to be, it has to be a very kind
of controlled type of burn. And because of that, the catheter
is actually spewing fluid while it's burning. I usually give the comparison
of a car's radiator. You know, the radiator
of a car is designed to make sure the engine doesn't overheat. The catheter's radiator system is meant to prevent the catheter from overheating and burning more than what you want it to. But it spews fluid
throughout the procedure and so as a result, after the procedure's
over, it's not uncommon that people have, you know,
a liter or so of fluid pumped into their bodies.
So they may have fluid retention cause some shortness of breath. Sometimes I have to give
patients some fluid medication or a diuretic for a few days
after an ablation procedure. Because of that inflammation after an ablation procedure in the first day or two, sometimes people get
low-grade fevers as well. That usually just goes back to that type of inflammation in your body. And that's sort of the common kind of more expected recovery
from the procedure.
I usually tell people
they have to take it easy for a couple days, two,
three days, you know. No prolonged standing and walking. After that, most normal
activities are fine is what I tell my patients. However, I tell people
give it about a week before you do really strenuous activity such as exercise, you know
or really heavy lifting. Give that a good week. But most normal things after
a few days, are usually fine. Let's talk about major risks
of an ablation procedure. Major risk of ablation procedure, I always tell people that
there's four main things that I worry about but I also
emphasize the precautions that I take to minimize those risks, okay? Number one is bleeding
in the are of your groin where I go in. I minimize that for a couple things. One, I use an ultrasound. Most people are using
ultrasounds these days, shows you exactly where the veins are and it minimizes any bleeding risk from the area of your veins.
In addition, there's also plugs now that go on top of the veins
to prevent any bleeding after the procedure itself. And that's really been very
useful to get people up and moving pretty quickly
after an ablation procedure. Let's talk about the area of the heart. Any one of those catheters
can get a blood clot and gives a small, less than 1% risk for stroke during the procedure.
So how do I minimize
that risk of blood clots during the procedure? So when somebody's getting
a ablation procedure it's actually crucial
to give blood thinners during the procedure. And so I'm actually
giving IV blood thinners or heparin during the procedure to minimize any risk of blood
clots during the procedure. And the good thing about
using IV blood thinners is that you can monitor throughout the procedure, make sure the blood is not too thick or too thin during the procedure. We're constantly checking
the blood thinning levels you know, every 10 to 15 minutes to make sure the blood is not too thick or too thin throughout the procedure.
And fortunately, once the procedure's over, you actually can
reverse that IV blood thinner and it wears off in just
a couple of minutes. Third thing I worry about is
bleeding around the heart. Any one of those
catheters can cause a poke or a tear and cause
bleeding around the heart. Fortunately, that risk has actually been getting significantly
lower these days and most of that is because of the safety of the equipment has gotten just so good over the last several years. One of the most important features of the equipment that I use for an ablation procedure is that the ablation catheter, the one that does the actual burning,
it actually has a direct kind of pressure sensor tells me how strong I'm touching somebody's heart.
You can imagine if you're
burning somebody's heart and you're touching it like this, you may not have that bit of risk of poking or bleeding around the heart. But if you're pushing it like that and you're really causing a lot of tension on the heart, you can
imagine how easy it would be to poke through, especially
when the ablation catheter is on and burning, okay? And so that direct feedback of knowing how strong I'm
touching a person's heart, has definitely helped
reduce the risk of bleeding around the heart. Last thing I worry about
is damage to the esophagus that goes from your mouth to your stomach. I worry about that
because it's right here. It's right next to the area that gets ablated during AFib and it can be very rarely damaged just as a collateral damage just
because it's in the same area.
So if I'm burning somebody's heart that heat might get transmitted over to the esophagus and then
damage the esophagus as well. Damaging the esophagus is called an atrial esophageal
fistula, is very rare. I believe the statistics
are about one in 1,000 but it is actually very serious and people can die from it and it's a very, very serious and probably the most serious complication from having an AFib ablation. And the bad thing is that, that damage doesn't happen right away. That irritation and damage to the esophagus takes
a few weeks to build up.
So people might actually
get severely ill a few weeks after the ablation procedure. It's so serious even though it's rare, it's so serious that there's all these
precautions that I take and there's many different options to try to minimize that heat transfer or burning on the esophagus. I'm constantly monitoring the
temperature in the esophagus. If it starts to heat up when I'm in that area, I
stop, I go someplace else and then I come back and finish the job after it's cooled down again.
Universal precaution, I give people some acid
suppressing medication for about a month after the procedure but there's a lot of
different techniques as well. There's different catheters that can help actually, move
the esophagus a little bit if it's in the way of where
you're trying to burn. And there's also cooling catheter that can help kind of
cool inside the esophagus while you're burning inside the heart. So there's a lot of
different products out there to help minimize the risk
of damage to the esophagus because yes, it's very rare but it's also very
serious if it does happen. But those are the main risks that I tell to everybody as well as
the precautions that I take to minimize AFib as well. So how can you minimize your risk for having an AFib ablation procedure? One of it would be, being tuned up. You know, I don't like to
do an ablation procedure on somebody who is having
decompensated AFib, very short of breath at that time. I usually tell people
you need to get better with medications first,
not be so short of breath because that's how you
make a smoother recovery.
In addition, if somebody's in AFib all the time, they're in persistent AFib,
they're feeling very short of breath, feeling very terrible before, I will usually do a cardioversion first, that's that electrical shot to get somebody out of AFib just to get them feeling better, make them a little bit more stable. And then long-term, I tell them that an ablation procedure
will help prevent the AFib from coming back. But once they're kind of tuned up whether that's medications, whether that's a cardioversion if needed, usually, the procedure
itself becomes much smoother for the patient as well
as smoother recovery time for the patient as well.
So people may look at ablation procedures and say, "Well how does it work? How do I improve my success rate? Will it work for me? Well, what are the most
important features?" Of course, knowing the timing of the ablation procedure,
the earlier somebody has AFib, when you're in that
paroxysmal AFib where it comes and goes, definitely
in the higher spectrum for success rate, you wanna be
tuned up as best as possible before the procedure to
minimize the procedure time as well as your recovery
from the procedure.
But there are plenty of lifestyle things that can improve the success
rate of an ablation procedure and there's been research that have shown that it can be beneficial. So weight loss improves the success rate of ablation procedure, reducing or eliminating alcohol
improves the success rate of ablation procedure. Also treating sleep apnea can
help improve the success rate of an ablation procedure. So there are many things that you can do that can help improve the success rate of an AFib ablation procedure, which is kind of why I've created the Take
Control Over AFib program. The Take Control Over AFib
program is my step-by-step plan to help you with all the natural things that could help improve
your ablation procedure and actually improve symptoms of AFib. All the things from reducing
inflammation, weight loss, reducing artificial ingredients,
removing added sugar, I put that all in one program so that you can help improve your symptoms of AFib as best as possible.
In addition, this type
of stuff only improves the success rate of an ablation procedure. So if you end up needing
an ablation procedure and you're also doing the
lifestyle modifications as well, your success rate of
your ablation procedure can be that much better and
last that much longer. So right underneath this
video, there'll be a link to the Take Control Over AFib program. Check out my website, see
what's included in the program, and make sure you look at those testimonies of people who have
actually taken the program and see what they have to say. And otherwise, I hope this
video was very helpful for you if you're considering
getting an AFib ablation. I hope you can understand the
procedure a little bit better and when it might be the right time for you to get an ablation procedure. And I wish you nothing but the
best for your AFib symptoms..