Atrial Fibrillation, (AFib or AF) is the most commonly diagnosed arrhythmia (cardiac rhythm disturbance), impacting more than 2.7 million Americans. The condition itself isn’t life-threatening, but if left untreated, can severely erode your quality of life and lead to complications such as blood clots, heart failure, or stroke . In fact, AF can increase the risk of stroke by five times and may be responsible for up to 20 percent of all strokes.
The Kansas City Heart Rhythm Institute (KCHRI) at the HCA Midwest Health Heart and Vascular Institute offers a team of nationally and internationally renowned, board-certified, fellowship-trained electrophysiologists who are continuously advancing the research, care and treatments for atrial fibrillation. Collectively, our specialists have over 65 years of experience treating patients with all types of atrial fibrillation.
- Comprehensive care – We offer care throughout the entire disease process including prevention, diagnosis, treatment and management
- A multi-disciplinary approach – Our cardiac EP team collaborates with cardiac surgeons, structural heart specialists, dietitians, psychiatric and psychologists, behavioral specialists, sleep specialists and yoga instructors
- Convenience – Our electrophysiologists care for patients at five practice locations and four hospitals conveniently located throughout the metro area
- Cutting-edge medicine – We perform the latest minimally invasive treatments which can offer a faster recovery and significant improvement in symptoms in just a few months
- Internationally renowned physicians – Our physicians are known research leaders, authoring over 160 publications to advance care for patients with afib
- Team-oriented, patient-centered care – All of our experts work closely together to ensure a personalized approach to care with the patient’s interest first and foremost. We customize your care based on your unique symptoms, heart rate, and stroke and heart failure risk, among other factors
- Access to New Investigational Treatments – Our cardiologist are clinical trial leaders in studies shaping the future of AF treatment. See a list of open cardiology clinical trials and talk to your doctor to see if one may be the right option for you
What is Afib?
Atrial fibrillation is caused by abnormal electrical impulses in the atria (upper chambers of the heart). This can cause the atria to quiver (fibrillate) and beat fast and/or irregularly. It triggers the atria to beat out of coordination with the bottom ventricles and blood isn’t able flow as well as it should.
- Paroxymal afib (intermittent atrial fibrillation) is when episodes come and go. The heart returns to a normal rhythm by itself or with medicine, within seven days. People with this condition may have episodes only a few times a year or their symptoms may occur every day
- Persistent afib (continuous atrial fibrillation) is when the heart stays out of rhythm for longer than seven days. The heart will not return to a normal beat on its own and requires some form of treatment
Some people never have symptoms at all, while for others the symptoms can be debilitating:
- Fast, irregular heartbeat
- Fluttering, pounding or flip-flop feeling in the chest
- Weakness and fatigue
- Inability to exercise
- Lightheaded or dizzy feeling
- Shortness of breath or breathlessness
- Discomfort, pain or pressure in the chest*
*Chest pain or pressure is a sign you may be having a heart attack and you should call 911 immediately
Common Causes of Afib
Heart structural abnormalities or damage are the most common causes of atrial fibrillation. It is most commonly diagnosed in patients over 65 years old and is more frequent in men than women. It is also more common in people of Caucasian decent. Other common causes include:
- Prior heart attack or heart disease
- Congenital heart defects
- Heart valve issues
- Heart failure
- Heart inflammation conditions such as cardiomyopathy and pericarditis
- Prior heart surgery
- Hyperthyroidism (over-active thyroid)
- Sleep apnea
- Excessive caffeine or alcohol
- Chronic lung disease such as emphysema
- Viral infections
Your doctor will conduct a thorough physical exam and ask you about your symptoms. He or she will also review your health and family health history. Tests may also be ordered to confirm diagnosis:
- Electrocardiogram (ECG or EKG) to check for problems with the electrical activity of your heart
- Holter monitor or event recorder, portable devices you wear at home to measure and records heart rhythm over several days
- Echocardiogram to take a motion picture of your heart as it beats in your chest
- Blood tests to help rule out thyroid problems or other substances in your blood that may cause arrhythmia
There is no one size fits all approach to treatment of afib. At KCHRI, we develop a personalized treatment plan to lessen or cure your symptoms and reduce your risk of stroke. Combined with experienced electrophysiologists and advanced technology, we are able to deliver the most cutting-edge care with the best possible results.
Your physician will decide the best approach for long-term management and treatment based on your:
- Unique type of afib
- Stroke Risk
- Heart function
- Medical history
- Risk factors
There are two general approaches to treatment and management:
- A rhythm control strategy is used to restore your heart’s regular beat. Therapies may include:
- Antiarrhythmic drugs
- Catheter ablation
- Surgical ablation
- A rate control strategy can include medications to slow the conduction of electrical impulses across the atrioventricular (AV) node to the lower heart chambers. (The AV node controls how quickly or slowly the heart beats) Examples of these medications include:
- Beta blockers
- Non-dihydropyridine calcium channel blockers
Most newly diagnosed symptomatic patients will need the rate of their ventricles (lower heart chambers) slowed. Atrial fibrillation can cause the lower chambers of the heart to beat too fast. This condition is called afib with RVR (rapid ventricular response). This can cause serious complications and requires treatment with either medication or cardioversion. Patients will usually see a substantial improvement in their symptoms when the ventricular rate is slowed.
Medication is generally the initial treatment for afib. Drugs don’t cure the condition and they may not be effective in all patients. In some, medications may lose their effectiveness over time.
Many patients also need to take blood thinners to prevent blood clots from forming and prevent stroke.
Cardioversion is not a cure for AF, but is used to bring your heart rate back into a normal rhythm using an electric shock or medication. It can be performed in an emergency situation or can be scheduled as an outpatient procedure.
Electrical cardioversion has a high success rate and a low rate of complications.
A pacemaker is not used to treat atrial fibrillation. Pacemakers are used to treat a slow heart rate. Sometimes, a person with afib will have tachybrady syndrome (slow and fast heart rates). If this is the case, a pacemaker may be implanted to stop the slow heart rate and prevent the patient from fainting. However, the fibrillation will still be present.
A pacemaker may also be used if a patient is on medication to slow their heart rate. Then a pacemaker may be needed to prevent the heart from beating too slowly.
Left Atrial Appendage Closure
LAA occlusion is used to reduce the stroke risk in patients who are at a high-risk for bleeding and cannot take blood thinners. During the procedure, the left atrial appendage is closed to prevent blood from pooling and forming clots. There are several LAA closure devices used:
- WATCHMAN – A minimally invasive, catheter based procedure using a cap like device to seal the appendage from inside the heart
- LARIAT – A minimally invasive, catheter based procedure using a lasso like device to close the appendage from outside the heart
- AtriClip – A minimally invasive surgical procedure using a clip to seal the appendage from outside the heart
- Other investigational treatments are available through a clinical trials
Results: Left atrial appendage occlusion has been shown to reduce the risk of stroke. Talk to your physician about your individual stroke risk and the results you can expect.
Ablation for Afib
Atrial fibrillation is considered a complex arrhythmia. That means there is usually more than one site in the atria that is causing the irregular heartbeat. Complex ablation is considered one of the best solutions for this condition and may even be used as a first-line treatment.
Pulmonary Vein Isolation
Pulmonary vein isolation is a complex ablation procedure that is used to treat or cure AF. It is painless, minimally invasive and low-risk. It is performed using catheters that are inserted through a blood vessel in the groin and guided up to your heart and into the upper left chamber. Energy is then used to cauterize the tissue around where the four pulmonary veins connect. This is a relatively new procedure that can offer patients symptom relief within just a few months.
Results: The vast majority of patients, experience a significant improvement in their quality of life and substantial reduces their number of visits to the hospital. Many patients are able to stop taking their rhythm medications in about 2-3 months and their blood thinners in about 6 months. Talk to your physician about the results you can expect.
AV Node Ablation
For patients who have not responded to rate control medication, atrioventricular node ablation may be an option. This is a minimally invasive, catheter based procedure to control the ventricular rate of the heart. It is used to prevent the upper heart chambers from sending faulty signals to the lower heart chambers. However, the afib is still present. This procedure requires the placement of a pacemaker either at the same time as the ablation or before.
Results: Many patients, experience a significant improvement in their symptoms. The pacemaker will control the heart so there will not be a need for rate control medication. Blood thinners may still be needed to reduce the risk of stroke. Talk to your electrophysiologist about your expected results.
Maze – Surgery for Atrial Fibrillation
Maze is a surgical ablation procedure. It is for patients with AF who need open heart surgery for a coronary artery bypass, heart valve repair or replacement, or corrective surgery for congenital heart disease. This surgery is performed in collaboration with a cardiothoracic surgeon.
During the Cox-Maze IV, ablation is used to create several lines of scar tissue which forms a new “maze” for electrical impulses to travel through. The left atrial appendage is also removed.
Results: The maze surgery can potential cure atrial fibrillation. Patients report a significant improvement in quality of life following the procedure. Talk to your cardiologists about the results you can expect.
Mini maze is a minimally invasive version of the maze surgery. This surgery involves several smaller incisions and there is no needs to stop the heart.