Atrial Fibrillation

Atrial Fibrillation Overview

Atrial fibrillation is an arrhythmia that occurs when the heart’s sinus node loses its intrinsic pacing capability. Instead, erratic electrical impulses originate from the upper chambers (atria), causing them to contract irregularly. The signals then pass through the atrioventricular node (AV node) to the lower chambers (ventricles), disrupting the normal rhythm of the heart.

The heart in atrial fibrillation often responds by beating too fast, with potentially dangerous results. A normal heart rate is between 60 and 100 beats per minute. A heart in atrial fibrillation beats 100 to 175 times per minute. Though the heart is working hard, it is inefficiently pumping blood through the body, and may restrict oxygen delivery. The poor pumping function may also leave blood to collect in the atria, where clots can form. If a clot is pumped through the heart and into the body, it could reach the brain and cause a stroke.

Atrial fibrillation is the most common type of arrhythmia, affecting more than 2.2 million Americans each year. It affects both men and women, and it is more common in an older population.

The most common symptom of atrial fibrillation is heart palpitations, though some patients report dizziness, fatigue and weakness, chest pains, shortness of breath, confusion and lowered blood pressure. Symptoms may come and go, or they may be chronic. For many patients, however, atrial fibrillation remains asymptomatic.

Atrial fibrillation may be caused by another underlying health condition. On occasion, a patient may develop lone atrial fibrillation, which occurs without any more common, predisposing risk factors.

If you are experiencing symptoms of atrial fibrillation, it is imperative that you see your Wellstar Cardiologist as soon as possible for treatment. Those treated successfully for atrial fibrillation will live healthy, productive lives.

Symptoms

Some people with atrial fibrillation have no symptoms. For those who do, symptoms may be ongoing, or may start and stop suddenly. If you experience the following symptoms, seek immediate medical attention from your Wellstar Cardiologist:

Rapid or irregular heartbeat or pulse
Skipped heartbeats
Chest palpitations (common)
Lightheadedness or fainting
Confusion
Extreme fatigue
Shortness of breath
Chest pain, or angina (seek immediate medical attention at an emergency room)

Risk Factors

Atrial fibrillation typically results from some underlying health condition. Rarely, an otherwise healthy person develops the condition, called lone atrial fibrillation. Certain diseases, conditions or factors can raise your risk for atrial fibrillation. Such factors include:

Age (Your risk of atrial fibrillation increases as you get older.)
Heart disease, including coronary artery disease, heart valve disease, congestive heart failure, pericarditis and rheumatic heart disease
Hypertension (high blood pressure)
Hyperthyroidism or other metabolic disorder
Diabetes
Chronic lung disease
Congenital heart defects
History of heart attack
Viral infections
Concomitant pneumonia, surgery or other illness
Sleep apnea
Heart surgery, such as coronary artery bypass surgery
Some medications and stimulants, such as caffeine or tobacco
Alcohol use (binge drinking)
Family history of atrial fibrillation

Atrial Fibrillation Prevention

Atrial fibrillation is a syndrome that is rarely preventable.

Reduce Your Risk

You can lower your chances of atrial fibrillation through several methods:

Control blood pressure
Control blood sugar levels
Eat a low-fat, low-sodium diet
Control your cholesterol.
Don’t smoke
Limit alcohol consumption (no more than two drinks daily for men, and one drink daily for women)
Limit caffeine consumption
Exercise as recommended by your Wellstar Cardiologist

Tests and Screenings

Your Wellstar physician will conduct a physical examination, using a stethoscope to check your heart rhythm. Your physician may also check your blood pressure, your blood sugar and may check your blood levels of thyroid hormone.

Based on the physical exam, your physician might order some of these tests:

Electrocardiogram: An ECG (or EKG) records the electrical activity of your heart to reveal if there are rhythmic issues or heart injury.
Echocardiogram: Images of the heart may reveal structural heart disease, such as an enlarged atrium or valvular heart disease, which may predispose a patient to atrial fibrillation.
Holter monitor: This portable electrocardiogram monitor is worn for 24 hours and tracks your heart rhythm during a day of your regular activities. This is often necessary in cases where atrial fibrillation starts and stops.
Event recorder: This monitor is worn for a longer period, sometimes as long as one month, to detect heart rhythm disturbances that occur at unpredictable times.
Transesophageal echocardiogram: This test can reveal whether you have any blood clots in your heart.

Atrial Fibrillation Diagnosis

If screening tests or check-ups reveal abnormal results, your Wellstar Cardiologist may perform further evaluations to focus on atrial fibrillation.

Procedures

Electrocardiogram: An ECG (or EKG) records the electrical activity of your heart to reveal if there are rhythmic issues or heart injury.
Echocardiogram: This test uses sound waves to produce images of the heart that can show structural heart disease.
Holter monitor: This portable electrocardiogram monitor is worn for 24 hours and tracks your heart rhythm during a day of your regular activities. This is often necessary in cases where atrial fibrillation starts and stops.
Event recorder: This monitor is worn for a longer period, sometimes as long as one month, to detect heart rhythm disturbances that occur at unpredictable times.
Transesophageal echocardiogram: This test may reveal if blood clots are present in the top chambers of the heart.

Atrial Fibrillation Treatment

The goals of treatment for atrial fibrillation are to reset your heart rhythm, prevent blood clots and prevent recurrence of atrial fibrillation. Treatment methods include medications, pacemakers, surgery, other medical procedures and lifestyle changes

Your Wellstar Cardiologist may treat underlying health conditions predisposing a patient to atrial fibrillation.

Taking Care of Atrial Fibrillation

If you are diagnosed with atrial fibrillation, your Wellstar Cardiologist will determine the best treatment or combination of treatments, taking into account any underlying health problems and the condition of your heart.

If your cardiologist is concerned about blood clots, he or she may order a transesophageal echocardiogram to more closely evaluate for clots in the upper heart chambers. Your cardiologist may prescribe an anticoagulant (blood thinner) to prevent clots from forming. Some people require blood thinners for life to protect against blood clots and stroke. The most common anticoagulant is warfarin (Coumadin^®), but newer anticoagulants will become available by the end of 2010 and are appropriate for certain patient subsets.

Your cardiologist will weight the risks and benefits of each drug on an individual basis.

In some cases, your cardiologist may be able to return your heart beat to a normal rhythm. If appropriate to your condition, your physician may choose electrical cardioversion or drug cardioversion:

Electrical cardioversion: This procedure, performed while you are under anesthesia, can sometimes shock the heart back to normal rhythm. Your Wellstar Cardiologist may prescribe warfarin (Coumadin^®) or other blood thinners before and after this procedure to prevent blood clots from forming.
Drug cardioversion: Medication may be used to restore and maintain normal rhythm. Among these anti-arrhythmics: amiodarone (Cordarone^®, Pacerone^®); propafenone (Rythmol^®); sotalol (Betapace^®); dofetilide (Tikosyn^®). The differences between these drugs and potential side effects will be discussed with your doctor.

Sometimes, your heart rhythm cannot be returned to normal. In such a case, your cardiologist may use other medications, pacemakers or even surgery to control your heart rate.

Medications: Your Wellstar Cardiologist may prescribe digoxin (Lanoxin^®) to control your heart rate at rest. This medication, also known as digitalis, increases the strength of your heart muscle contractions but tends to slow the heartbeat. Calcium channel blockers or beta blockers may also be used to slow your heart rate during activity.
Atrioventricular (AV) node ablation: In this procedure, small catheters are routed through the blood vessels to the AV node, which is between the atria and the ventricles. Radiofrequency energy is then used to destroy the AV node tissue, and a pacemaker is implanted to create a normal rhythm. Though the ablation will interrupt the atrial impulse to the ventricles, the atria will still fibrillate. Your cardiologist may prescribe blood thinners to prevent blood clots.
Radiofrequency catheter ablation and Cryo-Ballon catheter ablation: This procedure is focused on the heart’s electrical tissue’s “hot spots,” the origins of the atrial erratic activity, by burning or freezing the tissue. Radiofrequency energy may scar the tissue, normalizing the electrical signals. Successful procedures, often achieved by Wellstar Cardiologists, correct the atrial fibrillation, without the need for a pacemaker or medications.
Surgical maze procedure: If appropriate, a cardiologist may refer a patient for this procedure during open-heart surgery for another necessary repair, such as coronary artery bypass surgery. The procedure involves making several precise incisions in the upper chambers of the heart, creating a pattern of scar tissue that disrupts abnormal electrical impulses. A pacemaker is usually required after this procedure.
Convergent ablation: A combined ablation approach using standard radiofrequency and minimal invasive surgery intended for more complex patients with refractory AFib. Kennestone is one of only a few hospitals in Georgia to perform the procedure. The goal is to improve success of the procedure for those more complex patients.

Ongoing Care for Atrial Fibrillations

Wellstar’s world-class, community-based physicians utilize state-of-the-art medical centers and hospitals with the latest technologies and medical resources. Our clinicians are dedicated to:

Helping you create and maintain healthy lifestyles.
Offering advice to prevent illness and injuries.
Providing early and appropriate care of acute illness to prevent its progression.

Heart Care at Wellstar

Wellstar’s Heart Care provides top-flight cardiac care throughout its physicians’ offices, urgent care centers and emergency rooms. Emergency departments at Wellstar Cobb, Wellstar Douglas, Wellstar Kennestone, and Wellstar Paulding hospitals provide comprehensive cardiac services. Wellstar Cobb and Wellstar Kennestone hospital’s cardiac diagnostic and treatment services provide the next level of defense against heart disease. The technologically advanced Cardiac Center at Wellstar Kennestone Hospital and partnership with Emory Healthcare for adult open-heart surgery raises the bar on world-class cardiac care. Wellstar’s Cardiac Rehabilitation Services’ medically supervised programs focus on helping heart disease patients maintain a healthier heart through education and support groups.

Ongoing Care at Home

The same lifestyle choices that help prevent atrial fibrillation can also help prevent a recurrence:

Control blood pressure.
Control blood sugar levels.
Eat a low-fat, low-sodium diet.
Control your cholesterol.
Don’t smoke.
Limit alcohol consumption (no more than two drinks daily for men, and one drink daily for women).
Limit caffeine consumption.
Exercise as recommended by your Wellstar physician.

Other recommendations for your on-going care after atrial fibrillation:

Keep track of all medications you take.
Keep track of your weight and blood pressure.
Write down your questions and never be afraid to ask your WellStar physicians for clarification regarding your condition or your treatment.