Non-surgical procedures for Atrial Fibrillation (AFib)

About 0.5% of the world’s population have atrial fibrillation (AF or AFib). According to estimates (CDC) , approximately 2 percent of people younger than 65 years old have AF, while about 9 percent of people ages 65 and older have it.

Vibrating hearts in lights
It may not always be a sign of love when your heart flutters!

The American Heart Association notes that an episode of AFib rarely causes death. However, these episodes can be alarming, lower the quality of life and contribute to other complications, such as stroke and heart failure, that can lead to death.

The diagnosis of Atrial Fibrillation.

After a review of signs and symptoms, the medical history, and a physical examination, several tests may be considered, including:

Electrocardiogram (ECG) for for Atrial Fibrillation diagnosis. 

An ECG uses small sensors (electrodes) attached to your chest and arms to sense and record electrical signals as they travel through your heart. This test is a primary tool for diagnosing atrial fibrillation.

Holter monitor used for for Atrial Fibrillation diagnosis

 This portable ECG device is carried in your pocket or worn on a belt or shoulder strap. It records your heart’s activity for 24 hours or longer, which provides your doctor with a prolonged look at your heart rhythms.

Event recorder for the diagnosis of Atrial Fibrillation.

 This portable ECG device is intended to monitor your heart activity over a few weeks to a few months. When you experience symptoms of a fast heart rate, you push a button, and an ECG strip of the preceding few minutes and following few minutes is recorded. This permits your doctor to determine cardiac rhythm at the time of your symptoms.

Echocardiogramfor for Atrial Fibrillation.

This test uses sound waves to create moving pictures of your heart. Usually, a wand-like device (transducer) is held on your chest. Sometimes, a flexible tube with the transducer is guided down your throat through to your esophagus. Your doctor may use an echocardiogram to diagnose structural heart disease or blood clots in the heart.

Blood tests for for Atrial Fibrillation. 

These help your doctor eliminate thyroid problems or other substances in your blood that may lead to atrial fibrillation.

Stress test for for Atrial Fibrillation.

 The “stress test, also called exercise testing, stress testing involves running tests on your heart while you’re exercising.

Chest X-rayfor for Atrial Fibrillation

X-ray images help your doctor see the size and condition of your lungs and heart. Your doctor can also use an X-ray to diagnose conditions other than atrial fibrillation that may interpret your signs and symptoms.

The Age of Self-awareness

In our digital age it’s hardly surprising that we’re moving toward our own advocacy in the screening and diagnosis of common diseases. Fit Bit the watch manufacturer, sold to Google now produces a watch to individually screen for this.

Non-surgical Procedures for Atrial Fibrillation

Electrical cardioversion– the rhythm reset for for Atrial Fibrillation.

Electrical cardioversion is a procedure in which a patient receives an electrical shock on the outside of the chest (while under mild anesthesia) using either paddles or patches. 

The shock can be used to “reset” the heart to a normal rhythm. The procedure is similar to defibrillation, but uses much lower levels of electricity.

When to use electrical cardioversion for for Atrial Fibrillation.

Your provider may recommend a transesophageal echocardiography (TEE) as a first step. The TEE procedure involves swallowing a small ultrasound device that allows the healthcare team to view the inside your heart atria for blood clots.

If you already have blood clots in the atria of the heart, you will need protection from increasing your stroke risk. For this reason, your healthcare provider may recommend that you take a *blood thinner before having an electrical cardioversion procedure.

This is also why it is crucial that hypertension and obstructive sleep apnea have been investigated and treated.

Hospital room with heart monitor

Electrical cardio-version often successfully restores regular heart rhythm, but for some patients their atrial fibrillation may return. In many instances, anti-arrhythmia medications are needed indefinitely to keep the heart’s rhythm and rate in the best range.

Radiofrequency ablation or catheter ablation for for Atrial Fibrillation.

Ablation is used for cardiac arrhythmias when long-term medications or electrical cardioversion are either not preferred or were not effective.

Before ablation surgery, electrical mapping of the heart is performed. An electrically sensitive catheter is used to map the heart muscle and the origins of the “extra” electrical activity throughout the heart.

The “map” tells the physician which areas of the heart are creating problematic electric signals that interfere with the proper rhythm.

How is an ablation performed for for Atrial Fibrillation?

A catheter (thin, flexible tube) is inserted into the patient’s blood vessels and is gently guided to the heart. The physician carefully destroys malfunctioning tissue using the catheter to deliver energy (such as radiofrequency, laser or cryotherapy) to scar the problematic areas.

The scarred areas will no longer send abnormal signals.

If successful, the heart will return to a normal rhythm. But in some cases, atrial fibrillation may return. Sometimes the ablation procedure may need to be tried multiple times.

This minimally invasive procedure usually has a short recovery period. Patients are generally placed on a short course of anti-arrhythmic drugs while the procedure takes full effect.

Common types of ablation for AF include:Pulmonary vein isolation ablation (PVI ablation or PVA). In some AF patients, fibrillation is triggered by extra electrical currents in the pulmonary veins.

During this procedure, the catheter tip is used to destroy the tissue that is sending the extra currents and, in most cases, normal heart rhythm returns.

AV node ablation with pacemakers for Atrial Fibrillation.

In other AF patients, the trigger for their AF occurs in the AV node (the place where the electrical signals pass from the atria to the ventricles). The catheter is placed near the AV node and a small area of tissue is destroyed.

A pacemaker is then implanted to restore and maintain the heart’s normal rhythm.

Prevention of Atrial Fibrillation

Screening for causative factors which may themselves not be apparent or obvious is the first step to correcting causative factors. Clearly there can be many areas in a medical history but hypertension, past heart disease ,heavy snoring and/or obstructive sleep apnea are all known and documented factors which cannot be ignored.

Stephen Bray

4th May – “May the fourth be with you”

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