Atrial Fibrillation
Sutter Heart & Vascular Institute

• What is atrial fibrillation (Afib)?
• What are the warning signs and symptoms of Afib?
• What are the treatment options for Afib?

What is atrial fibrillation?
Atrial fibrillation (Afib) is the most common cardiac arrhythmia, or abnormal heart rhythm, affecting the heart with approximately 5 million Americans suffering from this disorder. On average, there are 160, 000 new cases of Afib per year. Afib is a disorder that involves the upper two chambers of the heart where they no longer beat in a normal, synchronized fashion. Rather, electrical impulses move about both atria in a chaotic, or circus-movement pattern, resulting in activation of the atria at somewhere between 400 and 600 times per minute. The impulses coursing through the atria traverse through a structure called the A-V node to reach the ventricles. The hallmark of Afib is an irregularly irregular rhythm where the ventricles, or bottom pumping chambers of the heart, beat in a very chaotic fashion.

What are the warning signs and symptoms of atrial fibrillation?
Individuals with Afib may have heart rates that are too slow, too fast, or within the normal range. Individuals with Afib may experience no symptoms, limited symptoms in the form of palpitations, or catastrophic symptoms such as loss of consciousness due to rhythms which are excessively slow or excessively fast. The main risk of Afib is stroke, with the incidence of stroke approximately five times that of similar-aged individuals who do not have Afib. The risk factors which appear to increase the risk of stroke in individuals with Afib include age greater than 65 years, presence of Diabetes Mellitus, presence of Hypertensive Heart Disease, Congestive Heart Failure, Mitral Stenosis (tight mitral valve), or history of prior stroke or near-stroke (Transient Ischemic Attack). The risk of stroke in individuals with Afib may be drastically reduced by use of anticoagulant therapy in the form of Warfarin.

What are the treatment options for atrial fibrillation?

The treatment of Afib is a highly individualistic process. Your doctor will take a thorough history and perform a thorough physical examination to determine if your Afib is due to another problem, such as hypertension, coronary artery disease, valvular heart disease, or thyroid dysfunction. Oftentimes, these primary problems may be treated, with resolution of the Afib.

4 treatment options:

• Cardioversoin
• Rx ( Antiarrhythmic / Anticoagulant)
• Non-Surgical (Catheter Ablation)
• Surgery (Open Heart Maze procedure / Minimally Invasive Procedure – Totally Thoracoscopic ( TT Maze )

Cardioversion
Cardioversion is the administration of electric shock therapy through patches placed on the chest. It often occurs in the early stages of Afib and is only a temporary solution. Cardioversion occurs in a hospital setting, with the patient under brief general anesthesia for two to three minutes. Following cardioversion, patients are frequently kept on anticoagulant therapy for a minimum of three to four weeks to prevent a stroke that may occur up to that period of time following cardioversion. There are many negative effects of cardioversion: low cardiac output, hypotension, build up of fluid in the lungs, heart block (non-coordinated heart contractions), death of heart tissue, skin burns, and pericardial effusion or embolic events.

Rx
Antiarrhythmics (or rate control) are drugs prescribed as a rhythm control to try and bring your heart back into a normal consistent rhythm. Antiarrhythmics don’t cure Afib, but try to control or treat symptoms of the irregular heartbeat. Less than ½ of the patients using antiarrhythmics for at least a year are able to maintain a normal heartbeat. Side effects may include dizziness, new types of irregular heartbeat, chest pains, shortness of breath, and vision problems. Amiodarone (Cordarone) is the most effective, but has additional, more serious side effects including heart block and toxicity in the lungs and/or liver.

Anticoagulants ( or blood thinners) are prescribed to Afib patients to prevent blood clots that could lead to a stroke. Anticoagulants do not treat AFib symptoms or causes, but can help reduce incidence of stroke. An anticoagulant like warfarin (Coumadin) is a highly prescribed option and has been shown to reduce the risk of stroke by 68% compared to no treatment at all. Warfarin requires careful monitoring, every 4-6 weeks; to ensure correct blood levels as too low doesn’t prevent clots from forming & too high can cause internal bleeding. Consistent use is absolutely critical, activity limitations accepted, dietary restrictions must be followed, and the patient’s doctor must be made aware of all other drugs and dietary supplements being taken as there are many that can either increase or decrease warfarin’s effectiveness

Nonsurgical (catheter ablation)
An ablation is a procedure that attempts to eliminate the main cause of your Afib. It is used to treat an abnormal heart rhythm by ablating or destroying an area of your heart that is responsible for initiating an abnormal impulse, or conducting the impulse in your heart. Read More about ablations…

Surgical
Maze Procedure (open heart) is usually done at same time as another heart surgery – like valve replacement/repair or bypass surgery. This is an open chest surgery, with the heart stopped and a heart-lung bypass machine being used. It adds only a few extra minutes to your other surgery to create the scars (ablation lines) that will block the abnormal electrical impulses causing AFib. It can eliminate AFib in more than to 90% of patients who receive this procedure. Read More about the Maze Procedure…

Totally Thoracoscopic Maze Procedure is a minimally-invasive surgical ablation procedure which was devised and perfected at Sutter Medical Center. Four small incisions are made on each side of the chest. All are about the size of a dime. With special instruments, the surgeon will create the scars (ablation lines) on the heart that will abolish and/or redirect the abnormal electrical impulses causing AFib. Typical hospital stay is 2-3 days, with resumption of normal activities in 2 weeks. Although, still in its infancy, success rate is greater than 90% in the initial results at 6 months. This exciting data is to be published soon. Read More about Totally Thorascopic Maze Procedure…