Nationally Recognized Center for Atrial Fibrillation Care
As one of the first specialized electrophysiology centers in the country, our Atrial Fibrillation Center at University Hospitals Harrington Heart & Vascular Institute provides state-of-the-art diagnostics, management and treatment of atrial fibrillation, a condition that increases the risk of stroke and congestive heart failure.
What is Atrial Fibrillation?
Atrial fibrillation, or AFib, is an abnormal heart rhythm. During AFib, the signal to start the heartbeat is disorganized, causing the upper chambers or atria of the heart to quiver or fibrillate. The contraction of the atria and the ventricles is no longer coordinated and the amount of blood pumped out to the body varies with each heartbeat. This can lead to blood pooling, increasing the risk of forming blood clots. These clots can then break off and lodge in an artery leading to the brain, which is why AFib significantly increases your risk for stroke.
Understanding Atrial Fibrillation Risk Factors
AFib can occur from a range of conditions that change the heart’s electrical system. The risk of AFib increases as you age mostly because the risk for heart disease and other conditions that can cause AFib also increase as you get older.
AFib is more common in those who have:
- Coronary heart disease
- Heart defects at birth or congenital heart defects
- Heart failure
- Heart valve defects (like mitral valve prolapse)
- High blood pressure
- Inflammation (pericarditis)
- Lung diseases, such as COPD or emphysema
- Metabolic syndrome
- Obstructive sleep apnea
- Rheumatic heart disease, caused by rheumatic fever in which permanent damage to the heart valves occur
- Sick sinus syndrome, when the normal pacemaker of the heart, called the sinus node, isn’t working properly
AFib is also more likely to happen due to stress from an infection such as pneumonia or other illnesses, or right after surgery. Even stress from daily living, caffeine and alcohol may also induce an occurrence of an AFib attack or heart rhythm disturbances.
Diagnosing Atrial Fibrillation
With atrial fibrillation care available at convenient locations across northeast Ohio, our board-certified physicians perform a thorough medical examination, along with the latest in diagnostic tests to record the heart’s rhythm or identify any irregularities. Tests for AFib include:
- Electrocardiogram (ECG): A noninvasive recording of the electrical activity of your heart.
- Holter monitor: A portable device that records a continuous record of the electrical activity of your heart for 24-48 hours; this would record heart rhythm abnormalities that occur intermittently and may be undetected on the ECG.
- Event monitor: A portable device usually issued for 12-30 days to record arrhythmias that occur infrequently.
Atrial Fibrillation Treatment Options
Beyond providing leading medical, ablative and surgical treatments, University Hospitals’ experts also participate in investigational clinical trials evaluating new strategies, medicines and technologies for treating AFib. Our team will work with you to create a specific treatment plan for your AFib targeting stroke prevention, heart rate control and ultimately means to restore normal sinus rhythm.
Typically, medications are the initial treatment method for AFib. With all medications, you will need regular follow-up care for your AFib. Medications may include the following:
- Stroke prevention with blood thinners or anticoagulants with warfarin or another drug such as apixaban, rivaroxiban or dabigatran: These are indicated based on your risk factors that increase the likelihood you will develop blood clots associated with AFib such as being over age 65 or 75, heart failure, coronary artery disease, prior heart attack, hypertension, diabetes, stroke or mini-stroke, or vascular disease. If you have two or more of these risks, you will need to be on a blood thinner.
- Heart rate control medications: These medications (beta blockers, calcium channel blockers, digoxin) are used to slow the transmission of electrical signals from the atria to the ventricles, thus slowing the heart rate.
- Heart rhythm control may be achieved with medications (antiarrhythmic drugs), but often it requires AFib ablation. A number of different medicines with different characteristics may be used to convert or prevent AFib. These drugs need to be tailored to the individual patient.
- Electrical Cardioversion
For most individuals with persistent AFib or those whose symptoms do not improve with medications, the heart’s normal rhythm may be restored by delivering a controlled electric shock to the heart through special cardioversion pads that are applied to the chest and back under general anesthesia. This procedure is called electrical cardioversion, and it can help get the heart back into a normal rhythm. The cardioversion pads are attached to a defibrillator that delivers the energy or shock that will cause a split-second interruption of the abnormal rhythm, allowing the heart’s electrical system to regain control and restore its rhythm without injury. However, this may only have temporary results and AFib recurs.
- Atrial Fibrillation Ablation or Pulmonary Vein Isolation
Atrial fibrillation (AFib) ablation, also called pulmonary vein isolation (PVI), is a potential cure for AFib. The procedure does not necessarily require general anesthesia, and most patients are allowed to go home within 24 hours.
AFib ablation is a minimally invasive option for symptomatic patients who failed or developed side effects to at least one antiarrhythmic medication. For some patients, ablation can be considered as the first line of treatment.
Benefits of minimally invasive ablation via a heart catheterization include:
- No splitting of the breastbone (sternum)
- Faster recovery than with a large chest incision
- Less time spent in the hospital
- Less pain because the incisions are small
- Minimal blood loss
- Little scarring
During AFib ablation, several catheters (thin, flexible tubes with platinum rings and tips) are inserted into blood vessels in the groin and at times at the neck and are advanced to different locations in the heart under X-ray guidance. The catheters are used to record and map the arrhythmia. One of the catheters has a larger tip and is used to deliver radiofrequency energy to electrically isolate the pulmonary veins.
Radiofrequency ablation is the most common type of ablation. Radiofrequency energy creates lesions by destroying (ablating) small areas of heart tissue containing the triggers for atrial fibrillation. After several weeks of healing, the lesions form a permanent circular scar that blocks the abnormal electrical impulses from the pulmonary veins, thus preventing AFib.
AFib ablation can also be performed by a cryo-balloon to isolate the pulmonary veins, the source for AFib triggers, by freezing the opening of the pulmonary veins. This procedure has been shown to be safe and successful for patients with intermittent AFib or paroxysmal AFib.
- Surgical Atrial Fibrillation Ablation – Maze Surgery
Patients who have conditions requiring heart surgery may benefit from surgical treatment of AFib in the same procedure. Maze surgery uses cuts or ablation to isolate the pulmonary veins to prevent AFib. Patients who have failed catheter ablation for AFib may also benefit from surgical ablation.
- Atrioventricular Node Ablation and Pacemaker Implantation
Atrioventricular (AV) node ablation targets the AV node (the filter between the upper and lower heart chambers), which creates a heart block requiring a permanent pacemaker. This procedure does not cure AFib but may provide some relief of AFib symptoms and/or facilitate management of other medical problems.
- Left Atrial Appendage Occlusion for Stroke Prevention without Long-Term Blood Thinners
The implantation of a left atrial appendage occlusion device may lower the risk of stroke in AFib patients. The left atrial appendage (LAA) originates in the left atrium of the heart and is where over 90 percent of stroke-causing clots that come from the heart are formed. The doctor implants a device to seal off the LAA, and it is left permanently fixed in the heart. Learn more about left atrial appendage closure at UH.