Dr. Michael Rowe Interventional Cardiologist
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Dr. Michael Rowe
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Atrial Fibrillation

Atrial Fibrillation is a very common heart condition caused by a malfunction of the heart's electrical conduction system. This malfunction causes the upper chambers of the heart, the atria, to contract in an uncoordinated manner resulting in an irregular, and often fast, heartbeat. Atrial Fibrillation is a serious condition and is a major cause of stroke as well as a precursor for Congestive Heart Failure and Cardiomyopathy.

Most patients with Atrial fib can be successfully treated with medications, however some patients either cannot tolerate the side effects of the medications or do not respond to the medications and require further intervention.

One surgical option for treating Atrial fibrillation is a minimally invasive procedure called Mini-Maze. The Mini-Maze surgery can potentially cure Atrial fibrillation by blocking the abnormal electrical impulses through the creation of scar tissue. The scar tissue creates a maze-like pathway for the electrical impulses to travel. Because the impulses cannot travel over scar tissue this surgery pro

motes normal conduction of impulses through the proper pathway.

What is Atrial Fibrillation?

Atrial Fibrillation is an arrhythmia or irregular heartbeat caused from abnormal electrical impulses in the heart. This causes the atria, the upper 2 chambers of the heart, to fibrillate or quiver instead of beat in a regular pattern. This fibrillation often causes the heart to beat rapidly while pumping less efficiently. Atrial Fibrillation increases the risk of stroke 5-7x, weakens the heart muscle, a condition called Cardiomyopathy, and can lead to Congestive Heart Failure and even death.

There are 3 types of Atrial Fibrillation and treatment varies depending on the type:

  • Paroxysmal: This type of Atrial fibrillation is intermittent, meaning it comes and goes. The heart rate converts spontaneously back to normal sinus rhythm without medical intervention. It may occur for seconds or over a period of days

  • Persistent: This type of Atrial fibrillation does not convert itself back to normal sinus rhythm but continues until medical treatment is administered

  • Chronic (Permanent): This type of Atrial fibrillation is ongoing meaning the heart is always in Atrial fib. Converting the heart back to normal sinus rhythm is not possible

  • Lone AF: This type of Atrial fib is traditionally used to describe patients under 60 without heart or lung disease and a low risk of stroke

Risk factors for Atrial Fibrillation include the following:

  • Aging: Over age 60 although it may occur at any age
  • Affects more whites than blacks
  • Affects more men than women
  • Uncontrolled Hypertension (High Blood Pressure)
  • Chronic lung disease
  • Pulmonary embolism: blood clot in the lungs
  • Diabetes
  • Nerve conditions
  • Excessive alcohol, caffeine, or tobacco intake
  • Heart disease caused by high cholesterol
  • Leaky heart valves
  • Cardiomyopathy: Disease of the heart muscle
  • Congestive Heart Failure
  • Electrolyte imbalances
  • Inflammation
  • Viral infections
  • Congenital heart disease
  • Hyperthyroidism
  • Family history

In many cases of Atrial fib, no cause can be identified.

Signs and Symptoms of Atrial Fibrillation include the following:

  • Palpitations: This is a sensation of abnormal heartbeats sometimes described as a "fluttering" feeling in the chest.
  • Irregular pulse
  • Shortness of breath with exertion
  • Tiredness
  • Syncope or fainting
  • Light-headed or faint
  • Chest Pain
  • No symptoms at all

Diagnosis

A Cardiologist should evaluate all heart conditions for proper diagnosis and treatment.

Your Cardiologist will perform the following:

  • Medical History
  • Physical Examination

Diagnostic Studies may include:

  • Blood tests
    Routine blood tests may be done for complete blood counts, drug levels if you are taking digoxin or coumadin, electrolytes to assess sodium and potassium levels, cholesterol levels, thyroid levels and cardiac enzymes. The cardiac enzymes in blood are markers of heart damage

  • (EKG or ECG) Electrocardiogram
    EKG is a test to measure the electrical activity of the heart and provides your doctor with information about your heart rate, rhythm, size of the heart chambers and previous damage to the heart. It is non-invasive and painless and is performed by attaching electrodes to various parts of the body

  • Chest X-Ray: A form of electromagnetic radiation that is used to take pictures of bones. Non-invasive and painless, a chest x-ray can show signs of CHF, pneumonia, and Pulmonary embolism

  • Echocardiogram: Echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than x-ray images and involves no radiation exposure. These ultrasound images help identify abnormalities in the heart muscle and valves, and find any fluid that may surround the heart

  • Holter Monitor: This is an ambulatory device that is worn by the patient and records electrical activity of the heart over a 24-hour period. The patient keeps a diary of activities and symptoms for the doctor to compare against the test results

Management of Atrial Fibrillation depends on the following:

  • Type of Atrial Fib
  • Severity of symptoms
  • Underlying cause
  • Your overall health

The goals of treatment of Atrial fibrillation are:

  • Restore normal heart rhythm
  • Control the heart rate
  • Prevent blood clots and strokes

Management Includes:

  • Lifestyle Modifications
  • Medications

Lifestyle Modifications

Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:

  • Healthy Diet Choices – Eating a low fat, low salt, low cholesterol diet while avoiding excessive intake of alcohol and caffeine

  • Don't Smoke – If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit

  • Reduce stress through exercise – Increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of wellbeing. Always discuss with your doctor before beginning any new exercise program

  • Weight Loss – Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice

Medications

Along with life style modification for heart health, medications are needed to control symptoms of Atrial fibrillation. More than one medication may be prescribed. Some common medications are listed on the left. Move your cursor over the medications to find out more.

  • Anti-arrhythmia medications – These medications may be prescribed for Atrial fib patients to prevent irregular heartbeat

  • Anticoagulants or Thrombolytic agents – These blood-thinning medicines may be prescribed to prevent the formation of blood clots and reduce the risk of stroke in patients with Atrial fib

  • Digitalis – Digitalis makes the heart contract harder and is used when the heart's pumping function has been weakened; it also slows some fast heart rhythms

  • Beta-blockers – Beta-blockers work by slowing down the heart rate and decreasing the force of the heart muscle. This reduces the heart's need for oxygen and improves the supply of blood to the heart muscle

  • Calcium Channel Blockers – Calcium Channel Blockers reduce the frequency and severity of chest pain. They reduce the muscle tension in the coronary arteries, expanding them and creating more room. They also slightly relax the heart muscle, reducing the heart's need for oxygen and reducing blood pressure
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