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Artrial fibrillation, chances of getting stroke. Wants to do ablation. Should I do the surgery in stroke center?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
I am a 50 year old male, 6'2, 195 lbs. I am in really good physical condition, however I suffer from atrial fibrillation. My cardiologist has recommended a cryoablation for atrial fib and I am scheduled for the ablation in a couple of weeks at a decent size hospital in Columbia, SC. I have a great deal of trust in the competency of the cardiologist who will do the work. My concern is with the 0.4% risk of stroke. It is small but if it happens wouldn't I be better off in a major hospital like Ohio State University Hospital which is supposed to be a 'stroke center'? Is it worth exploring having the procedure done there or am I just as well off in my home town hospital?
Posted Sun, 15 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 12 hours later
Thank you for the query.

I understand that you are a hypertensive patient, well controlled on medication, and that you have paroxysmal AF and being planned for elective cryoablation.

Cryoablation is an advanced interventional procedure which is done by trained cardiac electrophysiologists in a specialized EP lab with all the equipment/facilities for monitoring and treatment.

In view of the nature of atrial fibrillation and the nature of the procedure, there is a small but definite risk of a peri-procedural stroke. This happens when a small blood clot is dislodged from the heart and makes its way to the arteries that supply blood to the brain and thereby causes a blockage of blood flow to the brain. The resultant acute damage to the brain results in a "stroke".

As you have yourself said, the statistical chances of such an event happening is 0.4%. This means that 99.6 times out of 100, you would go through the procedure without a stroke. Precautions are also taken in the form of anti-platelet drugs, use of anti-coagulant drugs like heparin during procedure, pre-procedure imaging to rule out pre-existing blood clots in the heart, etc.

If a stroke does occur during the procedure, it can be tackled by taking a catheter to the culprit artery and either breaking down the clot mechanically or administering medicines locally as infusion to restore the blood flow to the brain and reduce the disability.

However, strokes can be unpredictable and can cause considerable disability despite the best possible treatment.

You should also consider the fact that uncontrolled AF can have a higher risk of stroke than the chances of a peri-procedure stroke.

As regards the choice of the centre, I think it should be guided by the fact that the procedure is ultimately to be done by the cardiac electrophysiologist. The success of the procedure is more important than the treatment of a stroke which may or may not happen. There is always the option of transfer to a stroke centre if there is a complication. I would advise you to choose the place which offers you the best chances of a successful ablation procedure.

I hope these details will help you to reach a decision. I wish you all the best for a healthy and happy life. Merry Christmas and a Happy New Year to you.

With regards,
DR RS Varma
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