The Roper St. Francis Heart & Vascular Center provides clinical expertise for diagnosis and treatment of the most common heart arrhythmia, atrial fibrillation. Atrial fibrillation, or AFib, is an irregular and often rapid heart rate resulting from uncoordinated or chaotic electrical activity, and is associated with aging. Currently some three million Americans have AFib, a number that is anticipated to rise as our population ages.
Patients with AFib may report symptoms that feel like the heart is racing, fluttering or pounding, or a fish is flopping in the chest. Some people with AFib have no symptoms; however, this does not diminish concern or need for treatment.
Types of AFib
- Paroxysmal AFib occurs when faulty electrical signals and rapid heart rate begin suddenly and then stop on their own. Symptoms can be mild or severe, and duration is typically no more than a week but usually less than 24 hours.
- Persistent AFib means the arrhythmia continues for more than a week. It may stop on its own, or it may require treatment to be stopped.
- Longstanding Persistent AFib is a consistent state of irregular sinus rhythm that lasts for a year or longer.
- Permanent AFib is a condition when the rapid irregular heart rhythm cannot be stopped with intervention and treatment. Both paroxysmal and persistent AFib can become more frequent and eventually permanent.
Symptoms of atrial fibrillation can include:
- Shortness of breath
- Palpitations or irregularly fast heart rate
- Lightheadedness and/or muscular weakness
- Chest pain
Risk Factor for Stroke-Related AFIB
- Over age 65
- Those age 75 and older, additional concern and higher increase in the risk of stroke
- High blood pressure
If you have already had a stroke or a mini-stroke (transient ischemic attack), this substantially increases your risk of having an AFib-related stroke. Additional factors associated with increased stroke risk include having peripheral vascular disease and gender, specifically being female. These factors are cumulative, thus the more risk factors you have, the higher your risk of having a stroke associated with AFib.
If you are at increased risk of stroke with AFib, discuss with your doctor stroke prevention strategies such as anticoagulant medications or procedures directed at the left atrial appendage, an area in the left upper chamber. Procedures directed at the left atrial appendage are typically reserved for patients who are not considered good long-term candidates for medications to reduce their risk of stroke.
There are several tests that our Roper St. Francis doctors can do to determine if you have a fast or irregular heartbeat. Your doctor may order these tests if you are having signs or symptoms of a heart problem.
- Electrocardiogram (ECG)
- Holter monitor
- Mobile cardiac monitoring
- Event monitor
- Transthoracic echocardiogram (TTE)
- Transesophageal echocardiogram (TEE)
- Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI)
Treatments to Manage AFIB Symptoms
In addition to medication to reduce the risk of stroke, there is also medication therapy to control how fast the heart rate goes when in AFib. Some patients get adequate control of symptoms with these medications while others continue to experience AFib-related symptoms. If a strategy of long-term rate control is pursued, these medication therapies are typically taken for years.
Anticoagulation involves using medications to reduce the body’s ability to form blood clots. This is the first type of therapy the doctor may prescribe to prevent strokes associated with atrial fibrillation. The risks and benefits of these medications should be discussed with your doctor and need to be considered carefully. These medications that reduce the body’s ability to form blood clots can be associated with bleeding complications.
Medications that change the electrical flow within the heart sometimes have a stabilizing effect and can help keep patients in normal rhythm. These are more effective in some than others, and it’s important to keep in mind that there can be serious and even life-threatening side effects on rare occasions. While taking these medications, it is important to have routine follow-ups with your cardiologist, and to be very careful about mixing them with other medications, as this may increase the risk of dangerous side effects. If these medications are discontinued, AFib typically returns.
This procedure involves the use of an electrical shock which is administered through special pads applied to the chest to restore normal heart rhythm. This is performed while under a brief period of anesthesia. Electrical cardioversion is quite effective at restoring normal rhythm, but does not prevent atrial fibrillation from returning.
Catheter ablation therapy
Catheter ablation involves the modification of hard tissue in an effort to stabilize the heart rhythm and in some cases eliminate atrial fibrillation. Successful catheter ablation helps to maintain normal rhythm and prevent the recurrence of atrial fibrillation. Atrial fibrillation ablation can be performed with radiofrequency energy (which heats tissue to modify it) or cryo-energy (which cools tissue to modify it). Both procedures involve the insertion of flexible plastic tubes through the veins in the upper part of the leg. The procedures are performed under anesthesia, and you would typically spend a day in the hospital.
AV node ablation with pacemaker placement
In situations where other approaches have failed to adequately control AFib, a pacemaker can be placed with ablation on a part of the heart called the AV node. Ablation of the AV node limits the ability of atrial fibrillation to drive the heart at high and irregular rates. Once this has been performed, the body is typically dependent upon the pacemaker for their heart rhythm.
AFIB TREATMENT OPTIONS
For some, cardiothoracic surgery for the treatment of atrial fibrillation is the recommended treatment. At Roper St. Francis, we offer several treatments with varying degrees of invasiveness that we individualize for each of our patients.
This procedure is traditionally performed through a mid-chest incision, but variations of this procedure can be performed in less invasive fashions with smaller incisions and quicker recovery.
This technique involves a combination of a less invasive form of cardiac surgery with a catheter ablation to improve the odds of maintaining normal rhythm.
Anticoagulant medications that reduce the body’s ability to perform blood clots and help prevent strokes related to atrial fibrillation may not be an option for some due to a previous history of bleeding or falls. Most blood clots that causes a stroke are believed to come from an area in the left upper chamber called the left atrial appendage. This area can be surgically closed or removed, thereby reducing the risk of a clot escaping and resulting in stroke.
A device called the Watchman can be placed in the left atrial appendage through a small tube inserted through the vein in the upper leg, without the need for surgery. The Watchman device can reduce the risk of stroke associated with atrial fibrillation by preventing blood clots from leaving the left atrial appendage and lodging in arteries of the brain.
Meet Our Team
Brett Baker, MD
Brian Frain, MD
Matthew O’Steen, MD
Scott Ross, MD
Matthew Toole, MD
John Spratt, MD