Atrial Fibrillation

Atrial fibrillation, or “A-Fib”, is the most common heart rhythm problem (“cardiac arrhythmia”) in the US. A patient with A-Fib may have no symptoms or they may experience palpitations, dizziness, chest pain, shortness of breath or even fainting spells. Because the top chambers, the atria, are not contracting in coordination, the blood tends to pool and clot. These clots can then dislodge and travel out of the heart. If these clots reach the brain arteries and block flow, a stroke can occur. Atrial flutter, or “A-Flutter” is very similar to A-Fib.

An electrocardiogram (ECG/EKG) measures the electrical activity in the heart and is used to diagnose A-Fib/A-Flutter. Your doctor may order a Holter monitor, which is a “wearable ECG” that can detect cardiac arrhythmias if the arrhythmias “come-and-go”.

Atrial fibrillation is treated with medications for two different purposes. First, medications are used to control the rhythm and heart rate. Second, medications to “thin” the blood to reduce the stroke risk might be necessary. For some patients, blood thinners are not an alternative.

For A-Flutter, the catheter ablation procedure is safer and more effective than medical therapy. During a catheter ablation, electrode-tipped, flexible plastic tubes (called catheters) are inserted into a vein, usually in the groin area. The catheter tips are positioned at different locations inside the heart. Measurements of the heart electrical system’s health can be obtained and abnormal heart rhythms can be studied and mapped. The tip of a catheter can be used to burn the short circuit causing the heart rhythm disorder. If the procedure is performed successfully it is curative without the need for surgery or further medications. There are no residual scars and patients can usually resume normal activities within 1 week of the procedure.

For atrial fibrillation, medications are usually tried first. If medications are ineffective or not tolerated, a catheter ablation for A-Fib, sometimes referred to as a pulmonary vein ablation, is a highly effective procedure for controlling symptomatic A-Fib. The procedure initially focuses on the pulmonary veins, which are the blood vessels that return oxygenated blood from the lungs to the left side of the heart. These veins and the adjacent areas are the most common sources and drivers of A-Fib. Ablation is administered around the orifice of the veins to isolate the veins from the rest of the heart. If there are sources of A-Fib arising remote from the pulmonary veins these may be targeted with ablation as well. Due to the complex nature of the arrhythmia, the procedure is technically difficult and should be performed only by skilled and experienced operators.