Health Care

Getting Back into Rhythm: Treatment for Atrial Fibrillation

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Lub dub, lub dub. The heart has a normal sinus rhythm. However, when a person’s mitral valve – the valve between the top chamber (atrium) and the bottom chamber (ventricle) on the left side of the heart – no longer closes properly and becomes leaky or narrowed, it places stress on the atrium, stretching it out.

“The left atrium is the chamber of the heart that generates the heart beat,” says Marc Bloom, MD, cardiovascular and thoracic surgeon and Chief of Cardiac Surgery at the AdventHealth Pepin Heart Institute. “It’s like the light switch and the ventricle is the light bulb.”

A stretched out “light switch” doesn’t work as it should, and so the left atrium’s electrical impulses can go haywire. When this happens, it results in a heart arrhythmia – a rhythm problem – called atrial fibrillation or sometimes “AFib” for short.

Dr. Bloom explains that when the left atrium goes into fibrillation, it resembles a “bag of worms.” The heart loses about 20 percent of its pumping efficiency, which can lead to fatigue during strenuous activity. However, even more concerning is that atrial fibrillation causes some blood to remain in the atrium, where it pools up without going anywhere.

“Stagnant blood forms blood clots,” Dr. Bloom warns. “Eventually this clot moves out of the heart. If a patient is lucky, it will go to a toe.” The danger is that the clot could move to the brain and potentially cause a stroke – which could be fatal.

When Your Heart Skips a Beat

Everyone has bouts of fibrillation, says Dr. Bloom, where they notice an irregular heartbeat now and then again. That’s not what he and his colleagues are concerned about. It’s when these bouts are prolonged, lasting anywhere from 10 minutes to days.

“Most patients feel terrible when they go into atrial fibrillation, so they will seek medical treatment,” Dr. Bloom says. Common signs are feeling sick, dizzy and the need to sit down and rest. He says that patients with symptoms are the safest because their doctors can diagnose their atrial fibrillation and treat it. Initial treatment usually involves medications. Beta blockers slow down the heart rate, and blood thinners prevent clots in the atrial appendage. About 9 in 10 AFib-related blood clots form in this atrial appendage.

It’s the patients without symptoms who Dr. Bloom worries the most about, as many don’t know they have AFib until they have a life-threatening event such as a stroke.

Preventing AFib Blood Clots with a Life-Saving Clip

While blood thinners can prevent deadly clots from forming, they only work for the patients who are taking them. Dr. Bloom also notes that there is a “significant downside” to being on blood thinners. For some patients, they cause bleeding issues, particularly in the gastrointestinal (GI) tract. Motor vehicle accidents, falls and even an active lifestyle can easily become life-threatening when a person’s blood doesn’t clot as readily because they are taking blood thinners.

To decrease the need for blood thinners, the cardiac surgeons at the Pepin Heart Institute complete a simple procedure with just about every heart surgery they perform: inserting a clip to block off the atrial appendage. It takes less than a minute to position this clip. The result is that clots can no longer break free from the appendage.

“It is literally a life-saving measure,” says Dr. Bloom. He and his colleagues insert them for every patient, not only the ones diagnosed with atrial fibrillation. Adding a clip treats some people who have atrial fibrillation and do not know it. It also prevents future issues for patients who go on to develop AFib.

Restoring the Heart’s Wiring – Electrophysiology and Maze Procedure in Tampa

Some patients with AFib for whom medication doesn’t work require a heart procedure. This procedure can either be minimally invasive or part of open heart surgery. Either way, doctors attempt to “rewire” the heart back to its normal electric rhythm so it beats efficiently again.

A heart specialist called an electrophysiologist can use a procedure in which a catheter, or thin tube, is inserted into a blood vessel in the groin and threaded up to the left atrium. There, small portions of heart tissue can be strategically scarred though either high heat (radiofrequency ablation) or cold (cryoablation). This scarring will prevent electrical impulses from traveling where they are not supposed to. This minimally invasive procedure avoids open heart surgery and has about a 70 percent success rate in curing AFib.

Dr. Bloom uses a similar approach called a maze procedure for treating persistent atrial fibrillation. In most cases, patients have the procedure when they are having open heart surgery for another reason such as a valve repair or coronary bypass. After the surgeon creates a “maze” pattern of scarring on a portion of the left atrium, about 80 percent of patients find relief from AFib. Dr. Bloom stresses that not every patient is a candidate for this approach. Some AFib cases require a different surgical approach to correct the structure of the heart or the coronary blood vessels.

Atrial fibrillation is the most common heart rhythm disorder and also one that is underdiagnosed. See your doctor if you experience an irregular heartbeat and symptoms of dizziness, light-headedness or fainting. Today, there are treatment options for AFib that can restore your quality of life – and might just save it.

If you have been diagnosed with atrial fibrillation, the AdventHealth Tampa Pepin Heart Institute can help treat it permanently. Call Call855-303-3627 to schedule an appointment with one of our experts.

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