Many weapons in play against common heart problem: AFib

July 26, 2018 | by Cash Casey, M.D.
Categories: Healthy Driven Hearts

Walk into a senior center filled with 100 people over 65 and odds are the group will include about nine who have atrial fibrillation (AFib), the most common type of heart rhythm problem. While younger people can have AFib, the percentage of those under 65 who do is only 2 percent.

AFib is marked by an irregular heartbeat in which the two upper chambers of the heart (the atria) quiver or flutter. In addition to palpitations, symptoms may include weakness, extreme fatigue, shortness of breath and lightheadedness. 

Timely diagnosis and treatment is key: AFib causes a four- to five-fold increase in risk of stroke and, if uncontrolled, AFib may weaken the heart and lead to heart failure. It’s estimated that AFib contributes to 130,000 deaths in the U.S. yearly.

Fortunately, there are many options for diagnosis and treatment. To determine the best course for a particular patient, we consider the severity of symptoms and whether the episodes are fleeting, persistent or permanent.

Diagnosis

An EKG, or electrocardiogram, uses electrodes attached to your chest and arms to sense and record the speed and rhythm of your heartbeats and the timing of electrical impulses passing through your heart. There also are portable devices for longer-term EKG monitoring: the Holter monitor, for 24-48 hour observation, and an event recorder if we want to see how the heart performs over 30 days.

Recent advances in technology have brought us new and improved implantable monitors that can be used for as long as 2-3 years.

One of these monitors is the Confirm Rx, which is inserted just below the patient’s skin in an outpatient procedure. This device enables the patient to use their smart phone to transmit heart rhythm information to their doctor’s office. It’s exciting that technology like this can give patients and doctors better access to information.

Additional cardiac tests that might help assess a patient’s condition include an echocardiogram, which produces a video of the heart in motion, and a stress test, which shows your heart’s reaction to exercise.

Treatment

In the course of treatment, AFib patients might be given medications to control heart rhythm and blood pressure. Because AFib brings an especially high risk of blood clots that can lead to a stroke, patients typically need blood thinners.

In some cases, the arrhythmia is resolved with medications. For many other patients we need to reset the patient’s heart rhythm using a procedure called cardioversion. This involves delivering an electrical shock to the heart or using medications called anti-arrhythmics.

When the rhythm still hasn’t normalized after the cardioversion, we may try catheter ablation to destroy the area of the heart causing the abnormal rhythm. This procedure involves threading electrode-fitted catheters through blood vessels from the groin to the heart. While the electrodes can use heat or radiofrequency in the ablation, at Edward-Elmhurst we most often use extreme cold (cryotherapy).

Another catheter-based treatment for some AFib patients is a left atrial appendage (LAA) closure. The LAA is a small pouch on the heart where 90 percent of blood clots in AFib form.

The goal is to reduce the patient’s heightened risk of blood clots and strokes. Traditionally after these procedures, the patient would need to remain on blood thinners, which can bring unwanted side effects.

At Edward-Elmhurst we have been using the WATCHMAN device for LAA closures. This first-of-its-kind implant option treats the AFib and reduces stroke risk without extended use of blood thinners. We insert the device via catheter into the heart where it opens up like an umbrella to permanently seal off the LAA.

Open surgery is very rarely part of the AFib treatment plan, but if a heart valve repair is needed, the surgeon may cauterize the AFib problem area at the same time.

Common questions

How do you know when you need treatment? If you only have a two-second palpitation once a year, you may not need medical attention. However, if symptoms are affecting your quality of life, such as your ability to exercise or socialize the way you want to, see your doctor. If you have severe or dangerous symptoms, such as fainting or chest pain, go to the ER.

What causes atrial fibrillation? Certain chronic conditions can cause damage to the heart’s electrical system and may lead to AFib, such as high blood pressure, heart attack, obesity, obstructive sleep apnea, heart valve disease, chronic alcohol abuse and heart failure. Certain reversible conditions, such as pulmonary embolism, heart surgery and pneumonia, can also trigger an episode of AFib.

AFib can’t always be cured but you can manage the risk with a healthy diet, exercise and watching your alcohol consumption.  

To find out if you’re at risk for heart disease, take an online HeartAware assessment. 

Learn more about heart and vascular services at Edward-Elmhurst Health.

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