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HOUSE CALL: Outlook good for patients with atrial fibrillation

 


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For many patients, episodes come without warning. They could be walking down the street or talking with friends, and then, when least expected, they feel their chest pounding, a racing heart beat and shortness of breath. It can be terrifying.

Atrial fibrillation (A-fib) is the most common arrhythmia in the U.S. It is caused by abnormal impulses in the upper chambers of the heart and results in an irregular and rapid pulse. The most common symptom is palpitations, or a sense of the heart racing and beating erratically. A-fib can also cause shortness of breath, chest pain and weakness. Many patients have no symptoms, and A-fib is detected only on an EKG.

The likelihood of being diagnosed with A-fib increases as we age.

A-fib is not generally a life-threatening disorder, but serious complications may occur such as heart failure or stroke. During A-fib episodes, the heart's two small upper chambers (the atria) quiver, and this results in blood not being efficiently pumped out of the chambers.

Blood clots are more likely to form. If a blood clot in the atria leaves the heart and becomes lodged in an artery of the brain, a stroke results. Blood-thinning medications often are recommended for patients with A-fib and are very effective in reducing the risk for a stroke.

With an increasing population of patients suffering from abnormal heart rhythms, it is important to recognize the signs and symptoms of A-fib. They may include palpitations, fluttering, shortness of breath, weakness or difficulty exercising, chest pain, dizziness or fainting. An EKG or cardiac monitor is used to definitely diagnose A-fib.

There are a number of ways to treat A-fib. Attention is first directed at preventing strokes, often using a blood-thinning medication to prevent blood clots. The purpose of treatment for A-fib is to reduce the symptoms and decrease the frequency. A variety of medications are available to suppress the arrhythmia and make the occurrences less frequent.


Unfortunately, anti-arrhythmic drug therapy fails to suppress atrial fibrillation in a certain percentage of patients. Their symptoms may become more frequent, and the A-fib can seriously curtail their quality of life.

Today, when such drug therapy fails, patients may be referred to a comprehensive arrhythmia specialty center to discuss further options like catheter ablation.

The catheter ablation procedure involves threading thin wires or catheters to the heart and destroying areas in the atrium where the A-fib may be originating. The procedure may cure some patients and, in others, result in an improvement in symptoms.

The field of catheter ablation is rapidly evolving, and many options for therapy are now available at arrhythmia centers that were not present in the recent past.

Advancements in technology have provided new tools for the specialized treatment of A-fib, such as sophisticated computerized mapping techniques that allow specialists to accurately and safely locate the source of the problem, and robotic-controlled ablation techniques that improve the safety and precision of the procedure.

Dr. Karthik Ramaswamy is board-certified in cardiovascular medicine and clinical cardiac electrophysiology and is Director of the Electrophysiology Laboratory at Missouri Baptist Medical Center. He also is a member of BJC Medical Group.

He received his medical degree from the University of Miami School of Medicine and completed an internship/residency in internal medicine, fellowship in cardiology, and fellowship in clinical cardiac electrophysiology at the University of Texas Southwestern Medical Center.


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