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Atrial fibrillation is a common occurance for those with heart disease


Feb. 27, 2013

SPRINGFIELD – Our bodies are complex, finely-tuned machines, which like any mechanical contraption can easily get out of tune when its "gears" aren't working properly. And, that goes for the human heart.

When the heart's internal electrical system is out of sync, the results can be quite serious and life threatening, as is the case with atrial fibrillation (AF), one of the most common types of arrhythmias.

February is American Heart Month, a special time set aside each year to focus on ways to prevent heart disease by adopting a healthy lifestyle and the consequences that can result otherwise, including atrial fibrillation, which is more common in people who have heart disease such as an enlarged heart or pulmonary hypertension.

"What makes atrial fibrillation concerning, especially for those with no underlying symptoms, is that over time it can weaken their heart and lead to heart failure. The inefficient blood flow can also cause the blood to clot and travel to the brain, resulting in a debilitating stroke," arrhythmia specialist Dr. Mathias L. Stoenescu, a cardiac electrophysiologist in the Heart & Vascular Program at Baystate Medical Center, said.

"Atrial fibrillation strikes more elderly with 10 to 15 percent of those over 80 likely to develop the irregular heart rhythm during their lifetime," Dr. John Rousou, chief of Cardiac Surgery at Baystate Medical Center, added.

In addition to the elderly, atrial fibrillation affects more men than women, and more whites than African Americans or Hispanic Americans. About half of the more than two million sufferers are under the age of 75.

Other risk factors include those who have had previous heart surgery, heart failure, congenital heart defects, pericarditis in which the membrane that surrounds the heart becomes inflamed, cardiomyopathy, pulmonary embolism, and some structural heart defects such as mitral valve prolapse. Other conditions that can raise your risk for AF include hyperthyroidism, obesity, diabetes, and lung disease.

"While some may suffer from atrial fibrillation without any symptoms, shortness of breath, heart palpitations, chest pain, lightheadedness, and extreme exhaustion are often signs that your heart may be misfiring and is pumping inefficiently," said Dr. Rousou.

When atrial fibrillation occurs, the heart's electrical signals don't travel through the heart in a normal way, but as rapid, disorganized electrical signals that cause the heart's two upper chambers known as the atria, to fibrillate or contract very fast and irregularly. In AF, blood pools in the atria and isn't pumped completely into the heart's two lower chambers, called the ventricles. As a result, the heart's upper and lower chambers don't work in harmony together.

Common treatments for those with AF include medications such as blood thinners to prevent blood clots, or heart rate or rhythm control drugs; lifestyle changes that could include quitting smoking, limiting or avoiding alcohol, and maintaining a healthy weight and following a heart healthy diet; and various medical procedures and surgery.

"The most successful treatment is usually in the first stage, called paroxysmal atrial fibrillation, when episodes can last for just a few seconds or for a few days, but stop spontaneously with no intervention. In the second stage, where atrial fibrillation becomes more persistent, it will often require medications to stop or undergoing procedures called cardioversion or ablation," said Dr. Stoenescu, who as a cardiac electrophysiologist treats the majority of patient with atrial fibrillation.

In cardioversion, low-energy shocks are administered to the heart while the patient is under anesthesia in order to trigger return to a normal rhythm. When medications or cardioversion are not successful, patients may undergo catheter ablation, where a wire is inserted through a vein in the leg or arm and threaded to the heart. Radio wave energy is sent though the wire to destroy abnormal tissue that may be disrupting the normal flow of electrical signals.

"Over the past 14 years, ablation, alongside medication, has become the most prevalent treatment for atrial fibrillation and has become a much safer and more successful procedure. Its overall success rate is 75 to 85 percent for those with paroxysmal atrial fibrillation. Some patients, however, will require a second procedure," said Dr. Stoenescu.

For those requiring further treatment when cardioversion or ablation do not restore the heart's natural rhythm, or for those who cannot tolerate the medications, they may be referred to a cardiac surgeon to consider maze surgery.

An open-heart surgical procedure, maze is most often performed on patients undergoing heart surgery for other reasons such as bypass or mitral valve repair, but can also be performed as a stand-alone operation. During the open-heart procedure, a cardiac surgeon makes small cuts or burns in the atria to help prevent the spread of disorganized electrical signals.

To learn more, visit baystatehealth.org/bhvp.



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