Afib: A Heart Out of Sync

Aseem Desai, MD, FHRS, Electrophysiology
Jay E. Tiongson, MD, Electrophysiology

Two heart rhythm specialists talk about what atrial fibrillation is, why it can be dangerous and what your treatment options are.

As many as 6.1 million Americans have atrial fibrillation—more commonly known as afib. It’s a condition in which the heart beats irregularly and often much too fast.

Although you’d think you would be able to feel it, afib’s characteristic quivering (fibrillation) and racing heart may not be something you notice. In fact, experts estimate that 60% of people with afib aren’t aware they have it, but they are still at much higher risk for stroke than those without the condition.

On average, stroke risk for people with afib is five times greater, which is why it’s important to get afib diagnosed and treated. “Early detection and intervention is critical,” says Aseem Desai, MD, a cardiac electrophysiologist at Mission Heritage Heart Rhythm Specialists. “Once you have an episode, the heart wants to go into afib again. There is a saying, ‘Afib begets afib,’ which means each episode is changing the heart’s electrical system to make it easier to have more afib.”

When afib leads to stroke, it’s because the upper left chamber of the heart, known as the atrium, doesn’t empty completely. The blood left behind can form a clot, which may then move through the blood vessels into the brain. Once the clot blocks blood circulation in the brain—this is what’s known as an ischemic stroke—the lack of fresh oxygen to the brain tissues can cause permanent brain damage, disability or even death.

“Providence Mission Hospital has one of the most advanced electrophysiology programs including afib treatment,” says Dr. Desai, who is the author of Restart Your Heart: The Playbook for Thriving with Afib.

Afib is not a one-treatment-fits-all condition. It’s important to work closely with a specialist to assess, treat and monitor your unique condition, and to address controllable risk factors like obesity and high blood pressure. “Atrial fibrillation is a multiplier for stroke risk in everyone,” says Mission Director of Cardiac Electrophysiology Jay Tiongson, MD. “But some patients have a higher baseline risk due to preexisting medical problems. Older patients with high blood pressure, diabetes or coronary artery disease, among other factors, are at higher risk than younger patients who don’t have these medical issues.”

There are several different drugs that are typically given to reduce the risk of stroke or alleviate symptoms. For stroke prevention, doctors prescribe an anticoagulant such as warfarin, while beta-blockers or calcium channel blockers may be used to control the irregular heartbeat. Beyond that, your cardiologist may suggest electrical cardioversion. This procedure shocks the heart to reset it to a normal rhythm to correct afib’s characteristic irregular and rapid heartbeat. “The success rate of cardioversion varies depending on how long the patient has been in afib, the size of the left atrium and associated risk factors and triggers,” notes Dr. Desai.

There are also surgical options, such as catheter ablation, that can permanently alter the heart rhythm. Dr. Desai says that science is on the side of choosing catheter ablation early on: “Several large clinical studies have shown early intervention with catheter ablation results in a reduced recurrence rate compared to treatment with medication followed by ablation,” he says.

The convergent procedure is another option for permanently altering the heart rhythm. The procedure is a collaborative effort between a cardiac surgeon and an electrophysiologist. At Mission, the electrophysiologists team up with cardiothoracic surgeon and Chief of Cardiothoracic Surgery Sevak Darbinian, MD, and have had great success. As always, it’s important to explore all your options with a specialist.

“Symptoms like the heart racing or skipping beats do occur,” says Dr. Desai. “However, many patients simply feel tired. The symptoms can be nonspecific, such as fatigue, malaise, feeling foggy or not feeling well, and there is no clear way to describe it in words.”

For those with symptoms, they may notice:

  • a flopping or pounding feeling in the chest
  • lightheadedness (and, less commonly, fainting)
  • shortness of breath

The risk of developing afib increases with age. “Scar tissue deposits in the heart as a body ages,” explains Dr. Desai. “This scar tissue next to normal tissue can set up the right environment to trigger afib.”

Other risk factors include:

  • diabetes
  • drinking alcohol regularly
  • high blood pressure
  • intense stress
  • obesity
  • sleep apnea
  • smoking
  • thyroid disease
  • other types of heart problems, such as coronary artery disease or heart failure

If you have multiple risk factors and are experiencing any of the symptoms Dr. Desai describes, you may want to talk to your doctor. Afib can be dangerous if left untreated. According to the American Stroke Association, people who have an afib-related stroke typically fare worse than stroke patients without afib, experiencing greater disability and a higher probability of death.

“Ideally, patients with afib should see a cardiologist or cardiac electrophysiologist,” says Dr. Tiongson. “But starting the conversation with your primary care provider will allow them to start treatment (especially blood thinning when appropriate) and refer you to specialists.”

To make an appointment with the Heart Rhythm Specialists of Mission Heritage Medical Group, call 949-347-2822. Depending on your insurance, you may need a referral from your primary care provider.

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