Atrial Fibrillation (AFib) is a heart condition where the heartbeat becomes irregular. It’s
a significant concern for millions of people in the U.S. AFib patients,
especially those without a faulty heart valve, have a higher risk of stroke
because it affects the heart’s normal blood-pumping function.
Facts about AFib
It is estimated that 12.1 million people in the United States will have
AFib in 2030.
In 2019, AFib was mentioned on 183,321 death certificates and was the underlying
cause of death in 26,535 of those deaths.
Because the number of AFib cases increases with age and women generally
live longer than men, more women than men experience AFib.
According to the CDC, more than 750,000 hospitalizations occur each year
because of AFib.
The death rate from AFib as the primary or a contributing cause of death
has been rising for more than two decades.
What are the symptoms of AFib?
Some people who have AFib don’t know they have it and don’t
have any symptoms. Others may experience one or more of the following symptoms:
Irregular heartbeat
Heart palpitations (rapid, fluttering, or pounding)
Lightheadedness
Extreme fatigue
Shortness of breath
Chest pain
What are the risk factors for AFib?
The risk for AFib increases with age. High blood pressure, the risk for
which also increases with advancing age, accounts for about 1 in 5 cases of AFib.
Risk factors for AFib include:
Advancing age
High blood pressure
Obesity
European ancestry
Diabetes
Heart failure
Ischemic heart disease
Hyperthyroidism
Chronic kidney disease
Moderate to heavy alcohol use
Smoking
Enlargement of the chambers on the left side of the heart
Source: National Center for Chronic Disease Prevention and Health Promotion,
Division for Heart Disease and Stroke Prevention
AFib Awareness Month
Our experts from Mary Washington Cardiology held a live event on Facebook
to discuss and answer questions about cardiovascular disease, AFib, heart
failure, diet and exercise for cardiac patients, and more. The experts
in part 3 of this 4-part series were Aaron Schatz, MD, FACC; Peem Lorvidhaya,
MD, FACC; and Ariel Freeman, FNP-BC, MSN.
Electrophysiology (EP) is the study of the electrical activity and pathways
of the heart. You can think of electrophysiologists as the electricians
of the heart. Their patients are suspected of having or have been diagnosed
with an abnormal heart rhythm (arrhythmia). Treatment plans for arrhythmias
are very patient specific.
EP services provided by electrophysiologists
Peem Lorvidhaya, MD, FACC,
Daniel Carlson, MD, FACC, and
Ejaz Khan, MD, FHRS, FACC are available across the hall from Mary Washington Cardiology, 1201 Sam
Perry Blvd, in Suite 220. Coming soon to Stafford Medical Pavilion, Dr.
Carlson will be providing EP services in Suite 215 of 125 Hospital Center Blvd.
Catheter Ablation
Catheter ablation uses radio waves or freezing to silence an abnormal area
in the heart’s electrical system, which is usually found during
an electrophysiology study. Ablation is one option for treating abnormal
heart rhythms.
Three types of ablation:
Electrical or radiofrequency catheter ablation
AV node ablation
Cryoablation
Defibrillator Implant
An implantable cardioverter defibrillator (ICD) is a small device that’s
placed in your chest or abdomen. This device uses electrical pulses or
shocks to help control life-threatening, irregular heartbeats, especially
those that could lead the heart to suddenly stop beating. If the heart
stops beating, blood stops flowing to the brain and other vital organs.
This usually causes death if it’s not treated in minutes.
Placing an ICD requires minor surgery. You will be given medicine right
before the surgery that will help you relax and may make you fall asleep.
Your doctor will give you a local anesthetic so you won’t feel anything
in the area where the doctor puts the ICD.
Once you have an ICD, you have to avoid close or prolonged contact with
electrical devices or devices that have strong magnetic fields.
Devices that can interfere with an ICD include:
Cell phones
Appliances such as microwave ovens
High-tension wires
Metal detectors
Industrial welders
Electrical generators
These devices disrupt the electrical signaling of your ICD and stop it
from working properly. You can still use household appliances and cell
phones, but avoid close and prolonged exposure. You can walk through security
system metal detectors. Someone can check you with a metal detector wand
as long as it isn’t held for too long over your ICD site.
Micra® Wireless Pacemaker
The Medtronic Micra® Transcatheter Pacing System (TPS) is a heart device,
approved for Medicare reimbursement, that provides patients with the most
advanced pacing technology at one-tenth the size of a traditional pacemaker.
Bradycardia is a condition characterized by a slow or irregular heart rhythm,
usually fewer than 60 beats per minute. At this rate, the heart is unable
to pump enough oxygen-rich blood to the body during normal activity or
exercise, causing dizziness, fatigue, shortness of breath or fainting
spells. Pacemakers are the most common way to treat bradycardia to help
restore the heart's normal rhythm and relieve symptoms by sending electrical
impulses to the heart to increase the heart rate.
What is the Micra® Pacemaker?
Comparable in size to a large vitamin, the Micra TPS is a miniaturized
heart device designed to provide the most advanced pacing technology –
all while being cosmetically invisible.
Made by Medtronic, the Micra TPS is unlike traditional pacemakers because
the device does not require cardiac wires (leads) or a surgical “pocket”
under the skin to deliver a pacing therapy.
Designed to provide a safe alternative to conventional pacemakers –
without the complications associated with leads – the Micra TPS
is small enough to be delivered through a catheter and implanted directly
into the heart with small tines and delivers electrical impulses that
pace the heart through an electrode at the end of the device.
Customized to each patient’s needs, the Micra TPS automatically adjusts
pacing therapy based on a person’s activity levels.
Traditional Pacemaker
Doctors often treat irregular heartbeats with a device called a pacemaker.
A permanent pacemaker is a small device that is implanted under the skin
(most often in the shoulder area just under the collarbone), and sends
electrical signals to start or regulate a slow heartbeat. A permanent
pacemaker may be used to make the heart beat if the heart is not functioning
properly and has developed an abnormal heart rate or if the electrical
pathways are blocked. Pacemakers are typically used for slow arrhythmias
such as sinus bradycardia, sick sinus syndrome, or heart block.
Convergent Hybrid Ablation
Electrophysiology and Cardiovascular Surgery Partnership
As with other cardiac procedures at Mary Washington Healthcare, the convergence
procedure employs a heart team approach with the cardiac electrophysiologist
and cardiac surgeon collaborating to effectively treat patients with chronic
atrial fibrillation.
Performed either simultaneously or as separate procedures, the convergence
procedure begins with the surgeon performing minimally invasive surgery
to access the heart.
Making a small incision below the breastbone to access the heart, the
surgeon uses radiofrequency energy to block irregular electrical signals by creating
lesions, or scar tissue, on the surface of the heart, primarily in areas
known for initiating atrial fibrillation.
Once completed, the
electrophysiologist employs 3-D mapping of the heart’s electrical pathways to identify
any remaining irregular electrical signals. Using catheter-based techniques,
the electrophysiologist performs a second ablation of the heart.
Post-op recovery from the surgical portion of the convergence procedures
requires 2–3 days of in-hospital recovery, while the epicardial
catheter-based portion can be performed as an outpatient procedure. Patients
are often able to be weaned off antiarrhythmic and anticoagulant medications.
Compared to catheter-based ablation alone, patients who undergo convergence
procedures experience 70% freedom from atrial fibrillation, compared to
40%, after one year.
