What is Atrial Fibrillation or Afib?
Afib is the most common heart arrhythmia in the United States and around the world. Normally the heart beats in a rhythmic motion, at between 60 and 100 beats per minute, with synchronization of the upper chambers (atria) and lower chambers (ventricles) of the heart. During Afib, the atria begin to beat rapidly (up to 175 bpm), in an uncontrolled manner, caused by misfiring electrical signal in the heart. The irregular and fast heartbeat of the upper chambers creates an uncoordinated heartbeat in the ventricles. The result can be significant. In fact, patience with Afib have a five times higher risk of stroke and have a significantly higher risk of heart failure as well.
Causes of Afib
Afib may be caused by excess weight, including obesity-related diseases, heart disease, lung disease, stimulants including caffeine, some medications and drugs, and even viral infections. Further data is required to fully understand these connections and which individual risk factors are most problematic. Some patients may also have a genetic or congenital component, where patients are at higher risk for Afib due to a heart defect from birth or from a family history of heart disease.
Concerns of Untreated Afib
The most concerning potential consequence of untreated Afib is blood pooling and clotting in the heart. If a blood clot breaks off, it can travel to the brain and cause a stroke. In fact, those with Afib are at a five-times-higher risk of stroke. If a patient has significant risk of stroke, we may also consider Left Atrial Appendage closure with a Watchman device or Lariat Procedure.
The difference between occasional and persistent A-fib
Occasional or paroxysmal Afib is where the irregular heartbeat comes and goes seemingly randomly. Paroxysmal AFib can be significant or mild, however it is usually progressive, and “episodes” tend to get worse over time. Significant cases may be mistaken for a heart attack, and consequently, Afib is often first diagnosed in the emergency room. However, Afib is often underdiagnosed, especially in the paroxysmal phase, because traditional EKGs only offer a snapshot of the heartbeat at a single point in time. If the patient is not in active Afib during that time, the arrhythmia may be missed.
Proper diagnosis typically requires a visit to an electrophysiologist where patients will be outfitted with a Holter monitor or an implantable loop recorder that can track heartbeat and rhythm over days, weeks or even months. Data is then transmitted to our office where it can be analyzed for the presence of any arrhythmias.
Persistent Afib is easier to diagnose. As the name suggests, the patient is in a constant state of Afib. As a result, even a regular EKG at your primary care physician’s or cardiologist’s office may detect the arrhythmia. Persistent Afib is typically a longer-term manifestation of untreated, occasional Afib.
How We Treat Afib
Our treatment for Afib takes a step-wise approach, starting with lifestyle change, including improved diet and exercise. If this fails, medical therapy in the form anticoagulants and antiarrhythmic medication may be started. However, approximately 50% of patients do not achieve the desired result with medication management, and a curative procedure may be considered including cardiac catheter ablation or cardiac cryo-ablation.