National Atrial Fibrillation Month

By Debbie Keasler, RN, Director, Stead Heart and Vascular Center

Atrial fibrillation is an irregular heartbeat that increases the risk of stroke and heart disease. Treatment involves medication and procedures such as cardioversion, ablation, pacemakers, or surgery.

Atrial Fibrillation also called AFib or AF is a quivering or irregular heartbeat (arrhythmia) that can lead to stroke and other heart-related complications. In atrial fibrillation, the upper chambers of the heart (the atria) beat irregularly (quiver) instead of beating effectively to move blood into the ventricles.

A Fib is the most common clinically significant cardiac arrhythmia. A Fib accounts for 34.5% of patients hospitalized with cardiac rhythm. It is estimated that 2.2 million Americans have paroxysmal or persistent AF. The rate of ischemic stroke among patients with AF (non-rheumatic) averages 5% per year, which is 2 to 7 times the rate for people without A Fib. One of every 6 strokes occurs in patients with A Fib. Including transient ischemic attacks and clinically silent strokes detected radiographically exceeds 7% per year.

AF can be symptomatic or asymptomatic, even in the same patient. Symptoms vary and include dizziness, weakness, and fatigue. Most patients with AF complain of palpitations, chest pain, dyspnea, fatigue, or lightheadedness. The major issues in management of patients with AF are related to the arrhythmia itself and to prevention of the formation of blood clots (thromboembolism). In patients with persistent AF, there are multiple ways to manage the dysrhythmia.

Cardioversion is often performed electively to restore sinus rhythm in patients with persistent AF. The need for cardioversion can be immediate, however, when the arrhythmia is the main factor responsible for acute HF, hypotension, or worsening of angina pectoris in a patient with CAD. Cardioversion can be achieved by means of drugs or electrical shocks. Drugs were commonly used before electrical cardioversion became a standard procedure. The development of new drugs has increased the popularity of pharmacological cardioversion, although some disadvantages persist, including the risk of drug-induced torsade de pointes ventricular tachycardia or other serious arrhythmias. Pharmacological cardioversion is still less effective than electrical cardioversion, but the latter requires conscious sedation or anesthesia, whereas the former does not.

The risk of thromboembolism or stroke does not differ between pharmacological and electrical cardioversion. Thus, recommendations for anticoagulation are the same for both methods.

Pharmacological cardioversion appears to be most effective when initiated within 7 days after the onset of AF. Most such patients have paroxysmal AF, a first-documented episode of AF, or an unknown pattern of AF at the time of treatment. A large proportion of patients with recent-onset AF experience spontaneous cardioversion within 24 to 48 h. This is less likely to occur when AF has persisted for more than 7 days.

Non-pharmacological correction of A Fib includes; surgical ablation, catheter ablation internal atrial defibrillators.

The Maze procedure is performed by isolating the atrial appendages and cutting the atrial walls in a specific pattern. This procedure depolarizes the electrical wave front and forces it to follow one specific path from the sinus node to the atrioventricular node, and thus the atrial contraction will be organized.

Catheter based atrial ablation delivers a high-frequency (radiofrequency) alternating current to create small lesions inside the heart exactly at the anatomical substrate of various arrhythmias. Thus, rerouting the electrical current in the heart. Today, more than 90% success rate may be achieved, with few complications.

Patients may also need a pacemaker. Atrial pacing, has been shown to decrease, thromboembolic complications as well as a reduced burden of atrial fibrillation.

Cardioversion for atrial fibrillation provides an external synchronized direct current shock to the heart, essentially “shocking” the heart out of the irregular a fib rhythm. This procedure has a high success rate. An Internal defibrillation with catheters inside the heart has an even higher success rate.

Overall it is important to take time this month to recognize atrial fibrillation as a significant heart condition, advocate for yourself and your family members by seeking treatment and prevent the risk of catastrophic stroke and other heart disease.

Circulation. 2001; 104: 2118-2150

Indian Pacing Electrophysiol J. 2002 Jan-Mar; 2(1): 4–14.