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Atrial Fibrillation (AF)

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Atrial fibrillation (AF) is a rapid and irregular heart rhythm that originates from the top chambers of the heart called the atria. The rapid rate in the atria causes the bottom chambers of the heart, the ventricles, to also beat rapidly and irregularly. In a manner similar to other pumps, the heart pump does not work as efficiently as it should when it is beating rapidly and irregularly. This inefficiency often causes symptoms such as a skipped heart beat, fatigue, shortness of breath and lack of energy. Sometimes, patients have no symptoms.

Why Choose The Ohio State University Wexner Medical Center?

Ohio State's Ross Heart Hospital has a specialized team of heart rhythm specialists, called electrophysiologists, and more than 100 nursing personnel who specialize in caring for patients with heart rhythm problems. Ohio State's electrophysiology program is the largest program in Ohio, and one of the top three in the nation, with extensive experience in managing a wide spectrum of heart rhythm problems.

How Common is Atrial Fibrillation

Atrial fibrillation is the most common heart rhythm problem. Nearly three million people in the United States have AF and this number is increasing. While it usually occurs in patients who have other heart disease, it also is frequently found in patients who do not have heart disease. With increasing age, AF becomes more common, roughly doubling with each 10 years of life. In other words, three percent of people in their 60s, about six percent of people in their 70s, and about 10 percent of people in their 80s will develop AF.

In many patients, an episode of AF will stop on its own, and this is termed paroxysmal AF. For other patients, the AF will not stop unless the patient is given a medication, called an antiarrhythmic medication, or an electrical cardioversion (an electrical shock to the heart) to interrupt the AF. This type of AF is termed persistent AF. In general, patients with persistent AF have a "tougher" variety of AF and tend to be less responsive to medications than patients with paroxysmal AF.

What Causes Atrial Fibrillation?

There are many factors that can contribute to AF, including high blood pressure, diabetes, being overweight, sleep apnea, heart valve disease, a weakened heart muscle (called cardiomyopathy), severe lung disease, abnormalities of the thyroid gland or excessive alcohol intake. However, in some patients there is no identifiable cause. Unfortunately, even when contributing factors are corrected, such as controlling high blood pressure, patients often still experience AF. Atrial fibrillation may also be due to a genetic abnormality that is inherited.

In nearly all patients with AF, a key cause of AF is electrical short circuits or abnormal electrical firings from within the heart. These rapid electrical firings can lead to an episode of AF. Using special electrophysiology catheters (catheters that record electrical signals from within the heart) it has been found that many of these electrical firings arise from within or near the pulmonary veins. The pulmonary veins are blood vessels that carry blood from the lungs back to the heart and join the heart in the left atrium.

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Diagnosis of Atrial Fibrillation (AF)

The first step in the diagnosis of AF is a medical history and physical examination by your doctor. Sometimes, when patients experience their first episode of AF, they feel the irregular beats of their heart and seek help at an Emergency Department. Obtaining an electrocardiogram (EKG/ECG), an electrical recording of the heart, while the patient is experiencing their symptoms is one of the most reliable and most common ways of first diagnosing AF.

If you have not had an EKG/ECG showing AF, other methods to diagnosis AF involve recording the heart rhythm at the time of your symptoms. These recordings are obtained as an outpatient and include:

Holter monitor – A portable, battery-operated EKG/ECG that is worn for a day or two and provides your physician with continuous data about the electrical activity of your heart.

Cardiac event monitor – A small device that is worn for longer periods of time (weeks to months) to record the heart rhythms.

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Treatment of Atrial Fibrillation (AF)

Physicians at Ohio State design a specific, personalized plan for each of our patients. This plan will consider your medical problems, the health of your heart and your goals. In general, the AF plan will consider three major components: prevention of blood clots and stroke; controlling your heart rate; and controlling your heart rhythm.

Prevention of Blood Clots and Stroke

During AF, there is no organized vigorous contraction of the top chambers of the heart (the atria) and so blood clots may form within the heart chamber. This increases the chances that the blood clot may travel from the heart to the brain resulting in a stroke, which is permanent damage to part of the brain.

Even though a patient may have a diagnosis of AF, the risk of stroke varies greatly from one patient to another. Your physician will discuss with you whether your risk of stroke is high enough to warrant the use of an anticoagulant (blood thinner) such as warfarin (Coumadin) or if a different therapy, such as aspirin, is more appropriate.

Controlling Heart Rate During Atrial Fibrillation

For many patients, symptoms related to AF are due to a rapid heart rate. Controlling your heart rate may help to minimize your AF symptoms and can be done through the use of medications such as beta blockers, calcium channel blockers and digoxin. These medications slow your heart rate when you are in AF. Patients often use a monitoring device, such as a Holter monitor or cardiac event monitor, to ensure that their heart rate is being controlled.

It is important to note that medications used to control heart rate are unlikely to reduce or eliminate the episodes of AF. In other words, these medications are designed to reduce the heart rate but not to control the heart rhythm, so these medications are unlikely to reduce the occurrence of AF.

For some patients, treating the heart rate but not eliminating the AF heart rhythm will be the proper therapy. This approach is called rate control.

Controlling The Heart Rhythm: Restore Normal Rhythm and Prevent Recurrences of Atrial Fibrillation

There are many treatment options (medications, cardiac catheterization or surgery) that treat AF by preventing recurrences of the AF and restoring normal rhythm. These therapies are called rhythm control and treatment options include:

Antiarrhythmic medications – These are medications specifically designed to help restore and to maintain normal rhythm by preventing recurrences of AF.  The majority of patients will require daily medications, but rarely, some can be managed with "Pill-in-the-Pocket."  This treatment is based on the concept that because the episodes of AF are so infrequent and because there are no other significant heart problems, the patient can take an antiarrhythmic medication soon after the AF begins.  In this manner, the hope is that the medication will help stop the episode of AF quickly.  If this is a successful method, then the patient will not need to take medicine on a daily basis, but only at the time of their infrequent episodes of AF. This approach is not suitable for most patients.

Electrical cardioversion – An electrical shock is delivered to the heart to convert the heart rhythm to normal. The electrical shock is quite successful in restoring normal rhythm, but the shock does not have any lasting effect to prevent recurrences of the AF. Patients will often require an antiarrhythmic medication or catheter ablation procedure.

Catheter ablation – An ablation therapy to permanently eliminate AF by burning away the electrical short circuits that are the root cause of the AF. This procedure is performed through a small hole in the leg vein that involves inserting catheters – thin, flexible wires – into a blood vessel, and winding the catheter into the heart. By use of a technique called radiofrequency ablation, energy in the radio wave frequency is delivered through the tip of the catheter to eliminate (or ablate) the site of the AF. Another ablation technique is the use of cryoablation, an ultra-cold substance that freezes the site of the AF.

Thorocoscopic maze procedure – A minimally invasive surgical ablation therapy for AF performed through small incisions in the chest wall.

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Ohio State Medical Center Physicians Who Treat This Condition

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