Treating Atrial Fibrillation
A recent study (Circulation, March) suggests that Americans with a common heart rhythm disorder called atrial fibrillation (AFib) are surviving longer and maintaining a better quality of life. Mount Sinai cardiologist Bruce Darrow, MD, PhD, points to therapeutic advances as the likely reason. “Medications and other treatments have lowered mortality rates for AFib,” he says.
What Happens in AFib? AFib happens when erratic electrical signals in the heart cause the upper chambers (atria) to quiver chaotically and irregularly, instead of contracting in coordination with the lower chambers (ventricles). “While normal atria contract about 60 to 80 times each minute, AFib causes them to contract about 300 to 400 times per minute,” Dr. Darrow explains. “When this occurs, most people who have AFib feel palpitations, a racing heartbeat, and/or an uncomfortable fluttering sensation in their chest—however, some people with the condition are not aware that anything is going on with their heart.”
While AFib isn’t immediately life-threatening, it can impede blood flow from the heart to the body, causing fatigue, breathlessness and chest pain. “If uncontrolled, it can potentially weaken the heart, possibly leading to heart failure,” says Dr. Darrow. “It also can result in blood pooling in the atria and forming clots that could cause a stroke if they dislodge and travel through blood vessels to the brain.” AFib increases the risk of stroke five-fold, and according to the American Stroke Association, about 15 percent of all strokes in the U.S. occur in people with AFib.
Advanced age is a risk factor for AFib, but you also may be susceptible to the condition if you’ve had a heart attack, or have heart failure or another structural problem with your heart (such as valve disease or cardiomyopathy). Other risk factors include chronic obstructive pulmonary disease, hyperthyroidism (overactive thyroid), sleep apnea, stress, excessive alcohol consumption, and smoking.
Resetting the Heart’s Rhythm If your AFib is underpinned by another condition, treating the underlying cause may resolve your symptoms or at least reduce AFib episodes. “If your symptoms persist, you may be prescribed anti-arrhythmic drugs, including beta-blockers and calcium channel blockers,” Dr. Darrow adds. “You also will likely need to take blood thinners to reduce your risk for stroke.” Two recent studies (Journal of the American College of Cardiology, May 23; Heart, June 1) suggest that many AFib patients who should be taking blood thinners to help prevent stroke are not prescribed the drugs—if your doctor doesn’t discuss them with you, ask why.
Another method of resetting the heart’s rhythm is called electrical cardioversion, and involves delivering a mild electrical shock to the heart via electrodes placed on your chest (you’ll be sedated for the procedure, and won’t feel any pain). “The shock causes a pause in the heart’s abnormal rhythm,” Dr. Darrow explains, “and after the pause, it has a high likelihood of returning to a normal rhythm.”
Catheter Ablation an Option Even with drug treatment and electrical cardioversion, it is common for AFib to persist. If this is the case, or you are unable to take anti-arrhythmia drugs for some reason, your doctor may recommend catheter ablation. This minimally invasive procedure restores a normal heart rhythm by destroying small areas of heart tissue from which the erratic electrical signals originate. “It involves inserting a special catheter into a blood vessel via a small incision in the neck or groin,” says Dr. Darrow. “The catheter is then threaded through the blood vessel to the heart, and used to either burn or freeze small areas of the atrium. This creates a scar that effectively ‘fences off’ abnormal electrical signals so that they no longer cause AFib.”
There is evidence that catheter ablation is more successful in people who have paroxysmal AFib (in which each episode lasts less than seven days and stops spontaneously) than it is in people who have persistent AFib (in which each episode lasts more than seven days, and only stops with cardioversion). In another recent study (European Heart Journal, May), 3,630 AFib patients who were treated with catheter ablation found that their symptoms significantly reduced after the procedure, with more than half of them becoming completely asymptomatic. “However, keep in mind that while catheter ablation is generally safe, it is not risk-free,” Dr. Darrow cautions. “Moreover, some people need one or more repeat procedures to resolve their AFib.”
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