Fall 2011 - The ABCs of Afib
It is the cause of 15 percent of preventable strokes among Americans,
and approximately 2 million Americans have it.
The condition is atrial fibrillation (Afib).
Afib is the most common heart rhythm disorder. It is a condition that gets progressively worse in most people, but it is treatable, particularly if patients seek help early, when they first begin having symptoms or when their doctor first suspects it.
Understanding the “ABCs” – the basics of atrial fibrillation – is the first step in preventing its harmful complications, including stroke and heart failure.
About Atrial Fibrillation
When the heart beats regularly, its two upper chambers (atria) are beating in sync or in rhythm with the heart’s two lower chambers (ventricles). Atrial fibrillation is a condition in which the heart’s atria quiver and do not participate in blood transport.
This creates areas of slow blood flow that predispose to blood clot formation. If a blood clot breaks free and lodges in an artery leading to the brain, a stroke occurs. Blood thinners, when appropriate, dramatically reduce the risk of stroke.
Common symptoms of Afib include heart palpitations from erratic and irregular ventricular contractions (steady or come and go), shortness of breath, fatigue and the sensation of feeling weak from reduced cardiac output. Some patients experience no symptoms and find out they have the condition during a regular visit to their primary care physician. Asymptomatic patients still remain at risk for stroke. It is one more reason why people of all ages, particularly those over 65, should see their doctor at least once a year.
Aging is a risk factor for Afib. People age 65 and older are more likely to develop the condition than younger individuals. Other risk factors include:
- Congestive heart failure
- High blood pressure
- Sleep apnea
- Family history of Afi b
- Alcohol and stimulants
- Coronary artery disease
- Thyroid disorder
Treating Atrial Fibrillation
Physicians goal for all of patients is to return to an active, happy lifestyle. This is very achievable for most Afib patients. Emphasizes that treatment is most effective if atrial fi brillation is diagnosed as soon as possible. If atrial fi brillation is left undiagnosed and untreated, it can lead to stroke and other serious complications such as heart failure.
Electrocardiography (EKG) is a painless test that is used to diagnose Afi b. Once Afi b is confi rmed, treatment depends on several factors:
- How long the patient has had atrial fibrillation
- The cause of the atrial fi brillation
- How burdensome the symptoms are
The top priorities for treating Afib includes controlling rhythm so the heart beats normally, and prevent blood clots that can cause a stroke.
There are several treatments for Afi b. If one does not work, another can be administered.
- Antiarrhythmic Medication – These medications affect ion channels of heart cells reducing the number and duration of Afi b spells. In some cases the patient begins treatment with these medications in the doctor’s offi ce. In other cases, the patient is admitted to the hospital and receives anti-arrhythmic medication either orally or intravenously. The patient’s heart rate is continuously monitored and his or her dosage is adjusted accordingly.
- Electrical Cardioversion – Some patients need electrical cardioversion to restore sinus rhythm. This quick procedure delivers an electrical impulse to the patient’s heart through paddles or patches placed on the patient’s chest. The shock terminates the disorganized electrical activity of Afi b, resetting the heart into a normal rhythm. Cardiologists use sedation so the patient doesn’t even feel the shock and is comfortable throughout the procedure. It is mandatory for patients to take blood-thinning medications before and after the procedure to prevent blood clots. Transesophageal Echocardiography is also used with some patients to determine if any clots exist in the heart before an electrical cardioversion procedure.
- Radiofrequency Catheter Ablation – This procedure is performed by cardiologists who are also electrophysiologists who specialize in treating disorders of the heart’s electrical system. During a radiofrequency catheter ablation procedure, the patient is sedated. The electrophysiologist threads a catheter up to the heart from intravenous access in the patient’s groin and then isolates the sources of abnormal electrical signals, which are usually located in pulmonary veins. Many patients who undergo radiofrequency catheter ablation will be able to discontinue or reduce the use of antiarrhythmic medications.
- Maze Surgical Procedure – Performed as either a traditional, open-chest procedure (usually if another cardiac surgical procedure like a valve replacement is being performed) or a minimally invasive procedure, the surgeon makes precise incisions on the right and left atria that interrupt the abnormal heart rhythm and correct the direction of the heart’s electrical impulses. The procedure is more invasive than the catheter approach, and some patients require a pacemaker for extra support.