What is Atrial Fibrillation (AFib) and what causes it?
Afib has become a big problem in heart patients. It’s a problem with the conduction system with the heart, which refers to the heart’s pacemaker or the heart’s electrical system. In a healthy heart, this would keep your heart beat on a consistent rhythm. When a patient is in AFib, the rhythm gets off beat.
Symptoms
The most common system is the irregular heart beat, which many patients can feel in the form of palpitations, the feeling of a skipped heart beat, feel like you have a racing heart, feel short of breath or lightheaded or dizzy.
However, about 15-20% of patients do not have symptoms at all. This makes AFib a very dangerous condition because it can be hard to know it’s there without further testing.
AFib is very common. About one out of every 10 people over the age of 65 has AFib. However, patients with AFib often have other heart-related issues as well. These other issues, such as heart failure, leaky valves and other health problems such as smoking, COPD, sleep apnea, diabetes and obesity greatly increase the chance of a patient developing AFib.
Can I live with AFib?
Like any medical condition, AFib should be properly assessed based on symptoms and the likelihood of negative outcomes that include heart failure, recurrent hospital admissions, strokes and death for any given patient. Assessing symptoms, as well as morbidity and mortality, and determining the best treatment path is a complicated process performed by trained cardiac electrophysiology (EP) specialists.
AFib can cause clots to form in your heart that can lead to stroke. AFib is responsible for about 20% of strokes each year. Other complications include heart failure, leaky valves and increased risk of heart attacks.This is why proper assessment and treatment is crucial.
Treatment
Treatment of AFib has rapidly evolved over the last decade, thanks to a better understanding of which treatment strategy to choose at a given point in time based on the individual patient’s disease progression. Choosing the right treatment strategy initially is important in order to achieve best response and outcome.
The UT Health East Texas Heart & Vascular Institute’s AFib Clinic offers a comprehensive array of treatments ranging from choosing the right medication to offering advanced procedures when indicated. Every patient is different and our team will work with you to determine the best treatment option based on your symptoms and medical history.
The main treatment option is non-surgical. Depending on the patient, we’ll treat AFib with medicine that will slow down your heart rate to help with those racing heart symptoms. Then we’ll give you medication to help your heart rate return to a normal beat. We’ll also use a blood thinner to prevent any blood clots. Another option is to shock your heart back into rhythm.
There are a few surgical options that we can do as well. We reserve these for people who haven’t been able to get their symptoms under control with the medication.
The first option is a catheter ablation with an electrophysiologist. The procedure works by taking a catheter, or IV up through your groin to your heart and freeze the areas that are causing the AFib. This is great for people who haven’t had this condition for years and years, or it comes and goes and it’s constant.
For the people who are refractory (the catheter ablation didn’t work for them, they’ve had AFib for a long time or it’s constant and doesn’t come and go), we have some different surgery options.
One of the newest procedure is called Convergent. This is a set of procedures, starting with the cardiothoracic surgeon. The surgeon will make a small incision just under the breast bone to the back of the heart where all of those signals care coming from and burn them, turning that area into scar, neutralizing those signals. When you recover from that, the electrophysiologist will go in and do a catheter ablation. Another procedure with this is going and blocking off the back of the heart where clots typically form. For the convergent procedure, recovery is about two days in the hospital after the first surgery. It’s a pretty quick recovery, but patients will need to take it easy for a few weeks. Usually about six weeks later, you’ll go back in for the catheter ablation and most people go home the same day.
Some patients, who cannot tolerate standard blood thinners due to unforeseen bleeding, may qualify for implantation of the Watchman™ left atrial appendage closure device. The Watchman™ implant is a one-time procedure designed to reduce the risk of strokes that originate in the left atrial appendage (LAA). Once implanted, the parachute-shaped, self-expanding device permanently closes off the LAA and does not require replacement. The procedure takes about an hour to complete and is performed by staff who are specifically trained in the implantation technique
AFib can be very tricky. That’s why we have so many different treatment options. AFib messes with your quality of life. If you have a bad case of it, you can just feel rotten and even feel side-effects from the medication. The goal of treatment, right now, is to decrease your symptoms and risk associated with AFib.