Atrial Fibrillation / Afib
Atrial fibrillation or Afib is the most common irregular heart rhythm, also known as a cardiac arrhythmia. Afib is the irregular, uncoordinated and fast beating of the upper chambers of the heart known as the atria. In a normal heart, the electrical signal that initiates the heartbeat begins in the sinoatrial (SA) node. However, the electrical signals in an Afib patient’s heart may fire randomly in the atria or pulmonary veins. As a result, the lower chambers of the heart, or ventricles, do not beat in a coordinated manner.
Symptoms of Afib
The result of the poorly coordinated heart rhythm is the sensation of one’s heart skipping a beat or beating extremely quickly. Some patients describe it as their heart pounding out of their chest. This can cause shortness of breath, and patients often mistake AFib for a heart attack. As a result, AFib is often diagnosed in the hospital setting. AFib is also often diagnosed incidentally when patients are admitted for other cardiovascular issues.
The symptoms of AFib can be more subtle too. Many patients do not realize that over time, their ability to perform exercise and other strenuous activities may decrease. They may believe that it is simply due to aging or lessened will and desire, but it can also represent a common symptom of Afib. Some patients experience no symptoms at all.
AFib is estimated to affect approximately 5 million patients around the US. However only a fraction of those patients understand the condition and have it treated appropriately. Many patients do not understand the severity of the consequences of untreated AFib, which can increase the risk of stroke by up to five times. The risk of heart attack and other cardiovascular disease including longer-term heart failure is also significantly increased.
The Risk of Stroke
Ultimately, while AFib can be uncomfortable and can cause long-term adverse effects in the heart, our biggest concern is the increased risk of stroke. Within the heart there is an outpouching known as the left atrial appendage or LAA. AFib can cause blood to pool and clot within the LAA and can result in a stroke if the clot breaks off and travels to the brain. Learn more about the risk of stroke as a relates to AFib
Progression of AFib
Typically, AFib begins as paroxysmal or occasional. Patients may experience an episode once in a while. The severity of the episode can range from mild with no symptoms at all to debilitating. The length of the “attack” can also vary, making paroxysmal AFib difficult to diagnose in a primary care setting. Indeed, when patients complain to their primary care physician or even general cardiologist of their heart skipping a beat or pounding out of their chest, they are often sent home without a definitive answer. This is because most non-specialized physicians use an EKG to monitor the heart. An EKG only offers us a snapshot of a single point in time, meaning that if a patient is not currently in AFib, the condition may not be diagnosed. Learn more about EKGs.
If left untreated, the condition can progress to become persistent, meaning that symptoms last for more than a week at a time. While often more complex, these cases can still be treated with interventions such as cardioversion, cardiac catheter RF ablation and cryo-ablation.
Eventually, Afib can progress to long-standing persistent…and the tools and treatments we use may no longer be effective.
Visiting a qualified electrophysiologist such as Dr. Banker opens the door to many sensitive and advanced diagnostic options beyond an EKG. These may include wearable or implantable monitors like a Holter monitor, event monitor or loop recorder. If these diagnostic tools do not detect AFib, but we suspect it is a culprit in the patient’s complaint, arrythmias can be monitored and even induced as part of an EP study where Dr. Banker can monitor the heart’s electrical activity in real time.
Treatment for AFib
The current standard of care, to which Dr. Banker subscribes, is a stepwise approach. Of course, there are also circumstances in which the patient is best served skipping straight to a procedural solution for Afib.
Oftentimes, we begin with lifestyle change. There is growing evidence of a connection between excess weight, high blood pressure, smoking and alcohol consumption and AFib. Of course, we look toward lifestyle change as the least invasive option. However, as we all know, diet and exercise programs tend to fail over the long term and many patients do not resolve their AFib through lifestyle change alone.
The next course of action is medication including anti-arrhythmic and anticoagulant medication. This can help pace the heart and lower the risk of stroke. However, medication is either ineffective or produces unacceptable side effects in about 50% of patients.
Minimally Invasive Therapies
For the 50% of patients unable to continue with medical therapy, minimally invasive catheter-based ablation procedures known as cardiac catheter RF ablation and cardiac cryoablation may be appropriate. These procedures use targeted heat therapy (generated by radio frequency waves) or cold therapy to destroy the heart tissue responsible for abnormal electrical activity.