Atrial
fibrillation is a serious medical condition characteristic of an abnormal
heartbeat. The irregular response is due to erratic electrical impulses in the
heart's upper chambers.
Atrial fibrillation (A-fib) is
an irregularity that can result in symptoms, such as heart palpitations, chest
pain, and dizziness. However, some people may not experience any symptoms at
all.
The Centers for Disease
Control and Prevention (CDC) estimate that up to 6.1 million people in the United States may have
A-fib. According to the World Health Organization (WHO), there are around 33.5 million
people living with A-fib worldwide.
There are different
treatment options for managing A-fib, including lifestyle changes, medications,
and other nonsurgical options. While these treatments may help some people,
they may not work for everybody and are not a cure. Doctors may consider
surgery if a patient's medications aren't working and when nothing else has
helped.
How is A-fib treated?
Treating A-fib involves
preventing blood clots and lowering stroke risk. Other goals
include controlling heart rate, restoring heart rhythm, and treating underlying
disorders.
Lifestyle changes are a
first treatment approach. People with A-fib should quit smoking, get active and stay
active, lose weight, and eat a healthful diet. Patients may also take
medications to prevent blood clots, control heart rate, and restore heart
rhythm.
Rate control involves
managing the per minute contraction rate of the ventricles (two large chambers
in the heart that help pump the blood).
The heart needs a certain
amount of time to circulate the blood and if it is able to work at a regular
pace, people will experience fewer symptoms and will feel better. Restoring the
heart's rhythm allows it to pump blood effectively throughout the body.
When medications aren't
helping to restore normal heart rates and rhythms, the next step is electrical
cardioversion.
Electrical cardioversion
involves giving a person an electric shock outside their chest wall while they
are under low-dose anesthesia. Like defibrillation, electrical cardioversion is
designed to reset the heart rhythm. The only difference is that lower levels of
electricity are used in electrical cardioversion than in defibrillation.
Whether this procedure is
successful or not depends on what is causing the A-fib symptoms and how long
the person has been having them. Most people get their heart rhythm back right
away, but cardioversion is not a cure.
If A-fib symptoms return,
another cardioversion is carried out. When cardioversion is combined with
medications, the heart rhythm can stay normal for longer, which could be up to a year or longer.
The risks of
cardioversion include skin burns, fluid buildup in the lungs, and an increased
risk of heart attack or stroke.
However, the success rates for returning the heart to a normal rhythm during
the procedure or shortly after are over 90 percent. The potential for success may outweigh
the risks, but people should still discuss any and all risks with their
doctors.
A doctor may recommend surgery to treat A-fib when lifestyle
changes, medication, and cardioversion are not helping. Surgical options
include catheter ablation, maze surgery, or the insertion of a pacemaker.
Catheter ablation
Catheter ablation is an
option for people whose medications are no longer effective and for those for
who electrical cardioversion did not work or was not an option. Before the
procedure, a doctor will do electrical mapping, which shows what areas of the
heart are causing complications to its rhythm.
The actual procedure
involves inserting a thin and flexible tube, called a catheter, into the blood
vessels and guiding it to the heart. The purpose of catheter ablation is to
destroy the faulty tissues that are sending irregular signals and causing the
irregular heart rhythm.
It does this in one of
three possible ways:
·
radiofrequency
·
laser
·
freezing
Once the faulty tissues
have been destroyed, scarred areas will be left behind. This scar tissue will
no longer send irregular signals and the heart will return to its normal
rhythm. In some cases, however, A-fib will return, and ablation will have to be
redone two or more times.
Catheter ablation is a
minimally invasive surgical procedure and recovery time is generally short. A
person will still need to take anti-arrhythmic drugs until the procedure takes
its full effect.
The success rates for
maintaining normal heart rhythms after catheter ablation is up to 90
percent. Success depends on how long an individual has had A-fib and
its severity.
For most people, quality
of life is significantly improved. A 2010 study found that 2 years after their
ablation procedure, 72 percent of the 323 people surveyed were no
longer taking A-fib medications.
The risk of
life-threatening complications is around 1-2
percent. Other side effects are not life-threatening and include
mild pain, bleeding, and bruising.
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