Atrial Fibrillation: Advice From A Cardiologist To His Mother
By Bryon Rubery, MD
As a cardiologist specializing in irregular heart rhythms, the most common rhythm disorder I see is known as atrial fibrillation (A-fib). A-fib can make patients feel exhausted, short of breath, and put them at risk for stroke and heart damage. In a normal heart, blood circulates through the four chambers of the heart and out to the body in an organized and regular rhythm. The electrical system of the heart fires the electrical impulses that maintain this rhythm. In A-fib, the regular electrical impulses are overcome by disorganized impulses, causing the heart to go into an irregular rhythm that is usually rapid.
Atrial Fibrillation Treatment
Unfortunately, there’s no simple treatment for A-fib. In most cases, we use medications to lower the heart rate. Often, we try to restore the normal heart rhythm using special medications, or perform a cardioversion, which is an electric shock given while under sedation.
Cardiac Catheter Ablation
If these options fail, we try to correct the abnormal rhythm with a procedure known as catheter ablation. Because atrial fibrillation is caused by abnormal electrical impulses within the heart, catheter ablation works by interrupting those abnormal impulses.
In order to get inside the heart, we sedate the patient, make tiny incisions in the two main veins in the legs, and run catheters through those veins up into the heart. We use the catheter to burn small regions of the heart wall that are sending out the irregular impulses, usually in the left atrium.
The scar tissue from these burns interrupts the abnormal signals so that the heartbeat can return to normal. When done by an experienced cardiologist who specializes in this procedure, the risks are low. In most cases, patients spend a night in the hospital and recover quickly.
There are many questions surrounding the causes and treatments of A-fib. Maybe it’s because so many of my patients are old enough to be my mother, but I’m often asked “What would you advise your own mother to do?”
Now I know.
For years, my mother suffered with A-fib. Most of the time, medicines kept her heart rhythm fairly regular, but every few months, the irregular rhythm would start again, making her tired and short of breath. The rest of the time she felt fine.
Then the medicines stopped working. Her heart stayed in A-fib, and she was so exhausted she could hardly leave the house. I suggested that she consider catheter ablation. The procedure doesn’t work for every patient, but it does work for some. I was hopeful that it would work for her.
My mom was reluctant to submit to an invasive procedure, but finally she couldn’t stand living such a restricted life. One of my former partners at Wake Forest Baptist Health treated her. Her ablation went well, although she was one of the rare patients who had a complication, which thankfully proved to be minor. Even though her recovery took longer than expected, my mom is glad to have her life back.
Diagnosing Atrial Fibrillation
Atrial fibrillation affects more than 2.2 million people in the United States, and the incidence increases with age. Obesity, heart disease, and sleep apnea put people at risk for A-fib. A-fib can also be inherited. Most patients with A-fib notice their heart racing, but some don’t. Instead, they feel tired all the time and short of breath, but don’t know why. Because A-fib often comes and goes, a patient’s heart rate may be regular when she sees her doctor. In these cases, the doctor may ask the patient with symptoms of A-fib to wear a heart monitor at home for several days to record the pattern of irregular rhythm when it occurs.
Because A-fib puts a patient at increased risk for stroke, the first thing I do for most patients is prescribe a blood thinner to prevent a clot from forming within the heart. I also want to prevent damage to the heart, so I prescribe medicine to lower the heart rate. Finally, I try one of several medicines that can sometimes restore the normal heart rhythm. If these medicines fail, or cause unwanted side effects, then catheter ablation may be the next step. Catheter ablation is a good option for many patients, but it’s not always a cure. Even after a successful ablation, some patients still need to take medications to help regulate their heart rhythm. But even in these patients, the ablation often improves their heart so that they don’t need to take as much medicine as they did before.
These days when a patient asks me what I would recommend if she were my mother, I know the answer.
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