GOODMEDICINE | ATRIAL FIBRILLATION
atrial Fibrillation
—Causes and Cures-- with ablation
WHEN IT COMES TO MATTERS OF THE HEART, IGNORANCE IS NOT BLISS.
SYMPTOMS SUCH AS HEART PALPITATIONS, SHORTNESS OF BREATH,
LIGHT-HEADEDNESS AND DIZZINESS SHOULD NOT BE DISMISSED, AND
REQUIRE A CHECK-UP WITH YOUR DOCTOR.
BY
ALICIA DOYLE
Such symptoms could indicate a heart arrhythmia (irregular heartbeat) such as atrial fibrillation (A-Fib), involving the two upper chambers
of the heart, or tachycardia, a heart rate of more
than 100 beats per minute. Considered the
world’s most common cardiac arrhythmia, A-Fib
is not in itself life-threatening, however, “it can
lead to complications such as stroke or congestive heart failure (CHF) without proper diagnosis
and treatment,” says cardiac arrhythmia specialist Dr. Leo Polosajian, Director of Cardiac Rhythm
Specialists, Inc.
“The chaotic beating of the atrium does not
allow the blood to be properly pumped. Instead,
it quivers, causing blood to stagnate in the atrium,” explains Dr. Polosajian. “The stagnation of
the blood can lead to blood clot formation if the
patient is not on a blood-thinning medication
such as Warfarin or Coumadin and is in A-Fib for
48 hours or longer. If the blood clot reaches the
brain, it can lead to a stroke, which can be
extremely debilitating or even fatal.”
>>
Atrial fibrillation
occurs when the heart muscles
of the two upper chambers
(atria) beat in a chaotic and
unorganized manner, uncoordinated with the bottom chambers (ventricles) of the heart.
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Other forms of tachycardia, especially ventricular tachycardia (rapid
heart beat in the ventricles), can be life-threatening. The most serious
cardiac rhythm disturbance is ventricular fibrillation, where the lower
chambers quiver and the heart cannot pump sufficient volume of
blood. Collapse and sudden death follow unless medical help is provided immediately.
“Persistent and permanent A-Fib patients are at the
highest risk for likely developing CHF or having exacerbations of CHF,” says Dr. Polosajian. “Likewise, in patients
with chronic CHF, A-Fib is likely to occur secondary
to the dilation of the left atrium in the event that the
patient has developed mitral valve regurgitation
(valve leakage).”
What is Atrial Fibrillation and Congestive Heart Failure?
A-Fib may cause palpitations, fatigue and stroke. In some
patients, it may lead to fainting, chest pain and/or CHF. It
causes up to 20 percent loss of cardiac output, known as
the “atrial kick,” which is the pumping of the blood out of
the atrium and into the ventricles. Sinus rhythm is the
rhythm of the heart produced by impulses from the
sinoatrial node. “Once sinus rhythm is restored in symptomatic A-Fib or atrial flutter patients, they may immediately feel an improvement in their energy and are able to
perform activities they were no longer able to do while in
the arrhythmia,” explains Dr. Polosajian.
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“A-Fib or flutter with rapid ventricular response can also
cause weakening of the heart muscle, known as tachycardia-induced cardiomyopathy,” says Dr. Polosajian. “With
A-Fib, the atrium is beating at an extremely rapid rate as
high as 300 to 400 beats per minute, which causes the
heart muscle to become tired and weak. Cardiomyopathy
itself can increase morbidity due to the decrease in ejection fraction (EF) and the greater risk for sudden cardiac
death from the weakened heart muscle.” Ejection fraction is the ratio of the volume of blood the heart empties
to the volume of blood in the heart — usually between 55
and 70 percent.
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Atrial fibrillation occurs when the heart muscles of the two upper
chambers (atria) beat in a chaotic and unorganized manner, uncoordinated with the bottom chambers (ventricles) of the heart. They
quiver, or “fibrillate,” rather than beat rhythmically and effectively,
resulting in decreased blood circulation to the body.
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A-Fib can occur for minutes, hours or all the time. A-Fib and CHF are
commonly linked to one another and either condition can predispose
the patient to the other. CHF and A-Fib share common risk factors
such as hypertension, valve disease, coronary heart disease (such as a
history of a heart attack resulting in weakening of heart muscle)
and/or genetic predispositions.
“Your heart will actually go through remodeling if you
have A-Fib. The fast, erratic rhythm causes electrical
changes and stretching in the atria,” explains
Dr. Polosajian, further noting that the heart can also
develop fibrosis, the formation of fibrous tissue in the
heart. “The A-Fib episodes then start to occur more
frequently with longer durations and can lead to chronic
A-Fib. However, this remodeling of the heart can be
partially or completely reversed with a curative procedure
known as an A-Fib Ablation. Once the patient restores
sinus rhythm, the heart begins to remodel itself back to
its original state with more efficient cardiac output.
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What causes A-Fib?
A-Fib is most commonly caused by an underlying heart
condition such as mitral valve disease, hypertension,
coronary artery disease, cardiomyopathy leading to congestive heart failure or sick sinus syndrome (improper
conduction of the sino-atrial node, the natural pacemaker of the heart).
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Natalie Sampson, DPT
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“However, A-Fib may also occur without evidence of heart disease.
This is mostly common in young patients and is called lone atrial fibrillation,” says Dr. Polosajian. Some causes may be genetic; however,
other reversible causes may be hyperthyroidism, excessive alcohol use
or pulmonary embolism.
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Cardiac CT Scan Prior to A-Fib Ablation
Patients require a cardiac CT scan prior to the ablation in
order to delineate the left atrium and pulmonary veins.
“This allows the physician to have a thorough understanding of your heart anatomy, specifically, the left atrial
volume and pulmonary vein anatomy and size,”
Dr. Polosajian says. “The imaging data can then be used as
adjunct to the 3-dimensional electroanatomical map
created during the ablation to find the abnormal nerve
fibers triggering the arrhythmia.”
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To learn more about A-Fib, visit the Heart Rhythm Society
website at www.HRSonline.org.
Which therapy is best for A-Fib?
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“A-Fib ablation is usually an outpatient procedure; this can be performed at your local community hospital,” says Dr. Polosajian. “The
length of stay for hospitalization may include an overnight stay. The
risk of complication — or major adverse effects — is approximately 1
percent to 2 percent or less.”
Catheter Ablation
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Medical therapy may include heart rate-controlling or anti-arrhythmic
drugs, or a combination of both. Ablation therapy is a curative therapy with an extremely high success rate, especially in patients who
have paroxysmal atrial fibrillation (episodes that come and go sporadically). In these patients, the success rate ranges from 80 percent
to 85 percent.
A minimally invasive procedure, catheter ablation is a procedure
where flexible, thin tubes (catheters) are guided into the cardiac
chambers through the blood vessels using fluoroscopy. Electrical signals are then recorded and mapped with a 3-dimensional electroanatomical system. Intra-cardiac ultrasound is also used during the
procedure to visualize the cardiac chambers and pulmonary veins. The
three-hour procedure is performed while the patient is under conscious sedation or general anesthesia.
Designated among the “Patient’s
Rank of Top Cardiologists” in
California, Leo Polosajian, MD, MS,
FACC,
of
Cardiac
Rhythm
Specialists, Inc., is board certified in
Internal Medicine, Cardiology, Adult
Comprehensive Echocardiography,
and sub-specialized in Clinical
Cardiac
Electrophysiology.
Committed to providing the highest quality care for his
patients, Dr. Polosajian’s clinical areas of expertise include
complex arrhythmia management and ablation, atrial fibrillation ablation, supraventricular tachycardia ablation,
heart failure management and cardiac resynchronization
therapy. He also specializes in pacemaker and cardiac
defibrillator implantation, including implantation of
Cardiac Resynchronization (Bi-Ventricular) Devices for
patients with congestive heart failure. For more details,
you may contact:
Leo Polosajian, MD, MS, FACC
805.230.2626 in Thousand Oaks or
818.718.1600 in Northridge
www.crsmdinc.com
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