If you have atrial fibrillation—also called AFib—you’re not alone. AFib is a common heart rhythm disorder. In the United States, more than 5 million people have atrial fibrillation.
As a cardiologist who specializes in heart rhythm disorders, I am seeing younger, healthier patients with atrial fibrillation than I did five years ago. There are many factors that can contribute to atrial fibrillation including: obesity, alcohol intake, high blood pressure, sleep apnea and genetic factors.
What is Atrial Fibrillation (AFib)?
Atrial fibrillation is a disorganized heart rhythm of the two atria of the heart. The atria are the upper two chambers of the heart that receive blood returning from other areas of the body. These disorganized electrical signals are then filtered to the bottom two pumping chambers of the heart, known as the ventricles. It is the job of the atrioventricular node (AV node) to keep the heart chambers synchronized. But in atrial fibrillation, this area gets bombarded by electrical signals. This leads to an irregular heart rate.
What health conditions should I be concerned about if I have AFib?
As the atrial (upper chambers of the heart) quiver, or fibrillate, the blood tends to move more sluggishly in this area. This sluggish movement allows the blood to clot along the walls of the atrium, which is a part of your heart. The most common areas to find blood clots are in the atrial appendages. As a result, atrial fibrillation contributes to an increased risk of stroke. In fact, the risk of stroke for people with atrial fibrillation is five times that of people who do not have this condition.
When my patients see me for management of atrial fibrillation, our first step is to assess their risk of stroke.
- The most common way to manage stroke is with anticoagulation or ‘blood thinner’ medication. If the blood is thinned, it has less of a chance to clot and this helps prevent a possible stroke.
- Another potential safety measure to prevent strokes due to blood clots forming in the atrial appendage area is covering the left atrial appendage with a device called a Watchman, made by Boston Scientific.
Once the assessment of stroke risk is complete, we then assess the heart rates. Generally, we want to keep heart rates between 60-100 beats per minute. People with atrial fibrillation can experience a much faster heart rate. When the atria are quivering, it can fibrillate at rates above 300 beats per minute. This causes the ventricles to move faster and the heart rate to increase.
By controlling heart rate during the atrial fibrillation events, we can help limit the symptoms of the arrhythmia. These symptoms include chest pressure, shortness of breath, inability to exercise, lightheadedness or feeling faint.
How is AFib managed?
No two patients are the same. I have discussions about rhythm control with my patients to discuss their needs and concerns. There are some folks where it is clearly better to try to control atrial fibrillation. There are some folks where stroke prevention and heart rate control are all that they need. Typically, the more symptoms someone has, the more aggressive we are about rhythm control.
The two main ways to control or manage atrial fibrillation are with arrhythmia medications or with ablations.
An ablation is the removal of body tissue. For AFib, this means to neutralize or silence tissue in key areas that trigger and maintain the arrhythmia or irregular heartbeats. This is accomplished by heating or freezing the atrial tissue.
A large part of my practice is doing ablations for atrial fibrillation. I like this approach as it avoids the risk and side effects of rhythm maintaining medication. Ablation has a good success rate in managing irregular heart rhythms, or AFib.
Generally, we are able to minimize atrial fibrillation in 75% of the patients who receive this treatment. This strategy works better when it is combined with lifestyle behaviors to address all factors related to the arrhythmia (or improper beating of the heart). This includes maintaining a healthy weight, regular exercise, minimal alcohol use, and treatment of associated conditions such as high blood pressure or sleep apnea.
Atrial fibrillation can feel scary; however this is a treatable heart rhythm. And, with proper treatment you will feel better and more comfortable doing the activities you enjoy in life.
Matthew Kapalis, DO
Dr. Matthew Kapalis, DO, is a cardiologist at Bryan Heart.