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Comprehensive Atrial Fibrillation (AF) Management

The team at Queen’s Heart at The Queen’s Medical Center takes a multidisciplinary, patient-centered approach to provide patients with the specialized atrial fibrillation care they require. We believe this is essential for optimal management of Atrial Fibrillation. We tailor therapy to each individual patient and utilize the latest technologies.

AF Management may include:

  • Lifestyle modification such as weight loss, exercise, dietary modification, and decrease in alcohol consumption
  • Treatment of Obstructive Sleep Apnea
  • Management of other conditions such as Diabetes and High Blood Pressure
  • Drug therapy to maintain a normal heart rhythm
  • AF ablation to reduce or sometimes eliminate AF

Your multidisciplinary care team may include:

  • Advanced nurse practitioners
  • Cardiologists
  • Electrophysiologists
  • Imaging specialists
  • Nurses
  • Pharmacists
  • Sleep apnea experts
  • Weight management professionals

Not everyone who is referred to our center for AF ablation undergoes the procedure. For some patients, weight loss or management of sleep apnea is the best treatment strategy. Even if ablation is warranted, we will routinely screen for sleep apnea and work closely with our weight management colleagues to maximize the likelihood of successful ablation. We also encourage practices such as yoga and meditation, which we believe may be useful in the management of this disease.


What is Atrial Fibrillation?

Illustration of normal flow of electrical signalsAtrial fibrillation, also called AF or A-fib, is an abnormal rhythm of the heart. It is relatively common, affecting more than 2 million people in the United States.

A highly organized electrical system causes the human heart to beat.

When the body’s natural pacemaker, known as the SA node, is functioning, an individual is said to be in “normal sinus rhythm” with a heart rate between 60 and 80 beats times each minute. Illustration of Arrhythmia Origin

When AF occurs, the electrical activity of the heart is disorganized, causing an irregular heartbeat.

When someone is in AF, the top chambers of heart (the atria) beat at approximately 300-600 times per minute. Under certain circumstances, the bottom chambers of the heart (the ventricles) beat at a very fast pace as well. This condition is known as “atrial fibrillation with rapid ventricular response.”

 

 


Frequently Asked Questions

What are some of the risk factors for atrial fibrillation?

It is estimated that one out of every four individuals will develop AF in their lifetime. Certain risk factors are associated with a greater likelihood of developing AF including:

  • Advancing age
  • Congenital Heart Disease
  • Coronary Artery Disease
  • Diabetes
  • Excessive alcohol or stimulant use
  • Heart Failure
  • High Blood Pressure
  • Lung disease
  • Obesity
  • Serious illness or infection
  • Sleep apnea
  • Surgery (particularly open-heart surgery)
  • Thyroid disease
  • Valvular Heart Disease

What are the symptoms related to atrial fibrillation?

Symptoms of AF can range from almost non-existent to disabling.

Mild symptoms include:

  • Unpleasant palpitations or irregularity of the heart beat
  • Mild chest discomfort (sensation of tightness) or pain
  • A sense of the heart racing
  • Lightheadedness
  • Mild shortness of breath and fatigue that limits the ability to exercise

Severe symptoms include:

  • Difficulty breathing
  • Fainting or near fainting
  • Chest discomfort
  • Any symptom associated with stroke - weakness, slurred speech, numbness, confusion

Some of the consequences of AF include heart failure and stroke.

How is atrial fibrillation detected?

AF is usually diagnosed with an electrocardiogram (ECG or EKG), which records the heart’s electrical activity.

Other tests that may be performed:

  • Ultrasounds to look for heart failure or heart valve problems
  • Blood tests to screen for thyroid disorders
  • Sleep studies to look for sleep apnea
  • Lung function tests to detect underlying lung disease

What are the treatment options for atrial fibrillation?

Fortunately, there are many treatment options for AF, focused around two strategies:

  • A “rate control” strategy focuses on reducing the symptoms of AF by controlling a patient’s heart rate.
  • A “rhythm control” strategy focuses on keeping patients in a normal sinus rhythm.

You should discuss with your doctor which treatment plan makes sense for you.

The goals of AF treatment may include:

  • Returning the heart to a normal rhythm, often via a procedure known as AF ablation, through the use of medications, or a combination of the two options.
  • Reducing symptoms related to AF and improving quality of life.
  • Controlling the heart rate.
  • Preventing blood clots from forming in the heart.

Does atrial fibrillation increase the risk for stroke?

Patients with AF are 5 to 7 times more likely to have a stroke.

Strokes in AF patients occur when a blood clot, caused by blood pooling when the top chambers of the heart (atria) beat rapidly, is dislodged from the heart and travels to the brain. Approximately 90% of these clots are formed within the area of the heart known as the left atrial appendage.

An individual’s risk of stroke due to AF is dependent on many factors, such as:

  • Age
  • Coronary Artery Disease
  • Diabetes
  • Heart Failure
  • High Blood Pressure
  • Prior History of Stroke

To assist with stroke prevention in AF patients for medium- to high-risk individuals: 

Medium-risk patients may be required to take blood thinners to help prevent blood clots from forming in the heart
High-risk patients who cannot tolerate anticoagulants may be eligible to have a non-surgical procedure, called a Left Atrial Appendage Occlusion, designed to reduce the risk of stroke related to AF.