Atrial Fibrillation

AFib Treatment

Photo by CDC

Atrial fibrillation is the most common arrhythmia.  It occurs in about one in four Americans in their lifetime.  In atrial fibrillation, the top part of the heart (atria) beats rapidly and irregularly.  The resulting symptoms are variable between patients.

When evaluating a patient with atrial fibrillation, it is important to look for any contributing conditions.  This is done as part of a multidisciplinary approach generally with a primary care physician and cardiologist.  Optimal outcomes in the treatment of atrial fibrillation require treatment of obesity, hypertension, diabetes, sleep apnea, heart failure, valvular disease, thyroid disease, substance abuse, and any other contributing illness.  These underlying diseases create enlargement and scar in the atrium, leading to a disorganized chaotic rhythm.  Treatments for atrial fibrillation generally cannot undo this existing scar, but instead focus on three areas:  stroke risk reduction, heart rate control, and heart rhythm control.

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Stroke risk reduction:

Atrial fibrillation increases the risk of stroke due to abnormal blood flow through the heart which leads to clotting.  Blood thinners may be recommended for patients at elevated risk of stroke.  Blood thinners are effective at reducing the risk of stroke, but unfortunately, also increase the risk of bleeding.  For some patients with bleeding concerns, they may be recommended for the Watchman procedure to close the area where most clots form as an alternative.

Heart rate control:

For many patients with atrial fibrillation, their heart beats very rapidly.  Without medication to slow down the rate, the heart muscle can be weakened.  Controlling the rate helps to protect against this and improves symptoms.  Some patients may ironically also have issues with slow heart rates alternating with fast heart rates.  For these patients, pacemaker surgery may be helpful for management to prevent slow rates.

Heart rhythm control:

Many patients still have bothersome symptoms of atrial fibrillation after controlling their heart rate and wish to suppress the abnormal rhythm itself.  While no treatment is considered a “cure” of the underlying process, there are several strategies to improve rhythm control including medication, ablation, and surgery.

Rhythm controlling medications, called anti-arrhythmic drugs can help improve symptoms for patients.  These medications require careful selection and monitoring to be utilized safely and effectively.

Catheter ablation of atrial fibrillation is more effective than medication at suppressing atrial fibrillation.  The ablation is performed in the electrophysiology laboratory with general anesthesia.  First, a transesophageal echocardiogram is performed to ensure there are no clots before proceeding.  Then, large IVs are placed in the groin to allow access with catheters to the heart.  A small hole is created allowing access to the left atrium.  Ablation energy is applied via a catheter to create a more organized scar in the atrium.  There are several reasons why this treatment can be beneficial for improving control of atrial fibrillation, though ultimately response rates vary from patient to patient.  After the procedure, the patient completes bedrest and monitoring before going home.

Surgical ablation is an even more aggressive option than catheter ablation that may be recommended for some patients, especially those that have other indications for undergoing open heart surgery.

Atrial Flutter

Atrial flutter is another type of arrhythmia that is very similar to atrial fibrillation in terms of causes and treatments discussed above.  The symptoms are generally the same.  However, atrial flutter is more regular and is due to a distinct short circuit in the atrium of the heart.  This means that ablation of atrial flutter is significantly more successful than ablation of atrial fibrillation.  Unfortunately, as the causes of atrial flutter and atrial fibrillation are similar, there is a lot of overlap, and up to 40% of patients with atrial flutter also develop atrial fibrillation.

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To determine whether you are dealing with atrial flutter or atrial fibrillation, contact a Colorado Springs Cardiology clinic today.

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