Arrhythmia is a medical term used to describe any abnormality in the regular, predictable rhythm of the heartbeat. Arrhythmias can range in seriousness from almost immediately deadly to simply a minor inconvenience. The most common arrhythmia is called atrial fibrillation, or Afib. It is estimated that over 2.2 million people in the United States have this arrhythmia. The incidence of Afib increases with age and with the aging U.S. population; it is estimated that over 12 million people will suffer from this condition by the year 2050.
Atrial fibrillation is a condition in which the upper chambers of the heart, called atria, lose their regular, organized contraction and instead beat very rapidly and chaotically. This results in a loss of normal blood flow within the upper chambers and rapid and irregular beating of the lower chambers, called ventricles. When this happens, individuals can experience palpitation, or a sensation of irregular heart beats, sometimes described as “flip-flopping” within the chest. Additionally, cardiac performance is compromised, and sometimes people find that they are incapable of doing common tasks without becoming short of breath or very easily fatigued. In extreme cases, usually if the person also has other medical problems, heart failure can ensue, precipitating a medical emergency. Although most people are not this seriously compromised by Afib, the majority of people have experienced a significant decline in their quality of life.
Although the above symptoms can be quite extreme, the most serious consequence of Afib is the associated increased risk of stroke. The presence of Afib increases a person’s chance of having a stroke roughly five-fold. This risk is highest in people who also have risk factors such as advanced age, high blood pressure, heart failure, diabetes or a history of TIA or “mini-stroke.” Strokes occur in people with Afib due to the development of blood clots within the upper chambers of the heart where blood flow has been disrupted, causing pooling of blood within tiny pouches or crevices. Whenever blood is not flowing normally, the probability of blood clot formation increases. If that blood clot then becomes free and is released into the circulation, it can travel to the brain, causing a stroke. Protecting patients who have Afib from stroke is the most important job a doctor has in helping patients with this condition. This usually involves the use of medications that will decrease the body’s ability to form blood clots. Although effective, these medications increase the likelihood of bleeding and are sometimes not well tolerated. They cannot be safely used in people who have had a history of severe bleeding. In the past few years, there have been some exciting new developments in the creation of specialized, minimally invasive procedures and devices that promise to protect patients from stroke without the use of these types of medications.
People with symptomatic Afib have many more choices for treatment than they had in the past. Medications exist that can suppress recurrences of Afib episodes and help to make them more tolerable. These medicines can be very helpful and for many patients, all that is required. However, none of these medicines reliably, permanently prevent Afib or remain effective for prolonged periods of time. Of course, the permanent elimination, or cure, of Afib is the goal of intense research and much has been learned about how to reach that goal over the past 10 years. Procedures designed to eliminate Afib, called ablations, hold the prospect of providing a cure and for many people, ablation has resulted in its elimination. Ablation of Afib is a very complex procedure that is performed by specially trained cardiologists called electrophysiologists. Catheters, or long wires, are threaded into the heart from veins that are accessed in the legs. Specialized computer systems are used to create virtual maps of the inside of the heart and then used to position those catheters into very precise locations. Energy is then delivered from these catheters into the regions of cardiac tissue that have allowed Afib to occur and sustain. Once accomplished, the catheters are removed and the patient is left with no significant scarring. Recent remarkable advances in this procedure have allowed doctors to safely perform ablation with very limited use of x-rays, sometimes requiring less than two minutes of fluoroscopy. Since every patient is different and so many options exist for treatment, it is advised that individual cases be discussed with a cardiologist or electrophysiologist before treatment is considered. FBN
Dr. Thomas Mattioni MD, FACC, FHRS, has been a practicing cardiologist and electrophysiologist since 1991. He is board certified in Internal Medicine, Cardiology and Clinical Electrophysiology.
To reserve a space in Dr. Mattioni’s A-Fib clinic, call Mountain Heart at 226-6400.
StrokeF says
People need to be more aware of this, especially when there is a risk of a stroke.