Atrial fibrillation, even when there are no symptoms, requires treatment

Special to the Herald-LeaderDecember 26, 2011 

Central Baptist


Atrial fibrillation, or A-fib, an abnormality in the heart's electrical system, causes the top chambers, or atria, of the heart to beat fast and irregularly. The atria then quivers instead of squeezes.

A-fib is a "nuisance" rhythm. It is not life- threatening; however, if left unchecked, it can lead to problems. In A-fib, blood isn't pumped as efficiently out of the atria. This can form a clot that can cause a stroke. By causing the heart to beat fast, A-fib can weaken the heart's overall pumping ability, which can lead to heart failure.

Some people with A-fib have disabling symptoms such as fatigue, shortness of breath or palpitations. Others go in and out of A-fib totally unaware. Either way, those with A-fib need treatment.

Some people need "blood-thinning" medications to minimize the risk of stroke. Many need medications to slow their heart rates to prevent heart failure. A cardiologist or electrophysiologist — a cardiologist who specializes in treating problems with the heart's electrical system — can offer other treatment options.

Generally, the first line of defense is anti-arrhythmic medications. Unfortunately, these keep the heart in rhythm only about 50 percent to 60 percent of the time and can have side effects.

For some, cardioversion might be an option. During this outpatient procedure, an electric shock is delivered to the heart to reset it to normal rhythm. The nature of A-fib is to recur. It might take only a few seconds or several years for A-fib to recur after a successful cardioversion.

If A-fib does recur, a minimally invasive procedure called catheter ablation can be performed by an electrophysiologist. Catheters are inserted in the groin and neck, and guided to the heart. One of the catheters helps "map" the heart via a tiny electromagnetic sensor in the tip that communicates with a sophisticated 3-D mapping system. The map provides detailed information about where the heart's electrical system is "broken." Using this map, the electrophysiol ogist maneuvers a catheter to deliver radio frequency energy to create a burn to the areas generating and conducting the abnormal electrical activity. The burn does not affect the heart's function, but many of the triggers of A-fib are eliminated.

Initially, ablation was thought of as a cure for A-fib. We are learning that we might not be extinguishing all A-fib with ablation, but we're taking away the symptoms that cause such a disruption in life.

Dr. Aaron Hesselson, an electrophysiologist/cardiologist with Lexington Cardiology at Central Baptist, practices at Central Baptist Hospital.

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