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Atrial Fibrillation

Atrial fibrillation (A-Fib or AF) originating in the atria, the upper part of the heart, is the most common arrhythmia. It is estimated that currently 2.7 million Americans have this arrhythmia and the American Heart Association estimates that 12 million people will have the condition by 2050.

In atrial fibrillation, the electrical impulse that causes the heart to beat in a normal rhythm becomes overridden by chaotic signals causing the heart to beat in a disorganized, irregular manner. This reduces the pumping efficiency of the heart. Atrial fibrillation increases a person’s risk of stroke by 4 to 5 times and can lead to blood clots, heart failure or other heart-related conditions. At Baylor Scott & White Heart and Vascular Hospital – Dallas, we have the expertise to critically manage and alleviate or in many cases, eliminate atrial fibrillation in this special patient population. Our goal is to partner with patients who have atrial fibrillation to help them overcome the negative effects of the arrhythmia, improving their quality of life. The multidisciplinary team focused on the diagnosis and treatment of atrial fibrillation at Baylor Scott & White Heart and Vascular – Dallas uses advanced healthcare technology and evidence-based techniques as well as access to clinical research trials and other investigational treatments.

To reduce the risk of developing atrial fibrillation, maintaining a heart-healthy lifestyle is the best defense against this condition. Avoid drinking excessive amounts of alcohol or caffeine, quit smoking, exercise regularly, maintain a healthy weight, and manage your stress levels to reduce the chance of developing a-fib.



Possible Causes of Atrial Fibrillation

  • Drinking excessive amounts of alcohol or caffeine
  • Recent Operation
  • Cardiomyopathy
  • Coronary Artery Disease (Heart Disease)
  • Valvular Heart Disease
  • Hypertension
  • Congenital heart defect
  • Chronic Obstructive Pulmonary Disease (Lung Disease)
  • Thyroid Disease
  • Viral Infection
  • Sick Sinus Syndrome
  • Wolff-Parkinson-White Syndrome (WPW)
  • Congenital Predisposition

Risk Factors for Atrial Fibrillation

  • Age
  • Sex
  • Ethnicity
  • Genetic
  • Diabetes Mellitus
  • Congestive Heart Failure
  • Obesity
  • Sleep Apnea
  • Hypertension

Diagnosing Atrial Fibrillation

In order for an electrophysiologist to diagnose an arrhythmia, one of more of the following tests may be ordered:
  • Electrocardiogram (ECG or EKG) – a test that records the electrical activity of your heart.
  • Holter Monitor – a portable device that allows for continuous monitoring of the electrical activity of the heart. Patients wear this device under their clothing. Typically ordered for 24-72-hour periods.
  • Event Recorder – a portable device that typically records the heart beat while the patient is experiencing symptoms. This information is then transmitted to the patient’s doctor.
  • Echocardiogram – sound waves are utilized to produce a video image of the heart. This test is used to diagnose various structural abnormalities of the heart.
  • Blood Tests – blood is drawn to rule out electrolyte imbalances and other illnesses that may exacerbate the condition.
  • Chest X-Ray – test that is commonly used to detect abnormalities in the heart and lungs.
  • CT Scan – test that provides invaluable, detailed information about the heart. It renders 3-D images that are used to direct treatment.
  • Magnetic Resonance Imaging (MRI) – a technique that uses a magnetic field and radio waves to create a detailed image of the heart.

Atrial Fibrillation Treatment

Medications

Once diagnosed with atrial fibrillation, the patient’s physician may prescribe rate controlling or rhythm controlling medicines or anticoagulants. Rate controlling medications are used in an effort to slow the heart rate down to a more normal level while rhythm controlling medications are giving in an attempt to maintain a normal rhythm by preventing atrial fibrillation relapses. For patients who experience atrial fibrillation, the risk of developing a blood clot may be extremely high. For this reason, many patients will require medicine to prevent these clots from forming. Anticoagulants can thin your blood or inhibit platelet function.

Atrial Fibrillation Procedures

Cardioversion
Cardioversion is a non-invasive procedure during which an electrical shock is delivered to the heart. The heart is reset and most times will restore a normal rhythm. Cardioversion does not cure atrial fibrillation – it is part of a treatment approach in many patients. This procedure is performed under sedation so that the patient does not feel or remember anything.

Radiofrequency Ablation
Radiofrequency (RF) ablation is a procedure that can cure many types of arrhythmias such as AF. A low voltage, high frequency electrical energy, RF energy is used in many applications including electrocautery. Using special catheters to deliver the energy to specific locations within the heart, the electrophysiologist is able to provide curative interventions for AF.

Cryotherapy Ablation (Cryo)
Cryotherapy ablation provides is a similar procedure to radiofrequency ablation (RF) except in the type of energy used for treatment. Instead of using RF (heat) energy, cryotherapy uses extremely cold temperature applied through specialized catheters to alter the cardiac cell’s capacity to conduct electrical impulses. The latest technology for the treatment of paroxysmal AF, the cryoballoon, is an efficient approach in the treatment of AF and is associated with successful ablation and low complication rates. Baylor Scott & White Heart and Vascular Hospital - Dallas electrophysiology department was the leading research site in the United States for the cryoballoon and performed the first procedure in North Texas.



Laser lead extraction
A laser lead extraction is the removal of one or more leads from inside the heart that is connected to the implantable device. A lead may be removed for any of the following reasons:
  • Damage to the inside or outside of the lead
  • Large amounts of scar tissue forming at the tip of the lead
  • An infection at the site of the device and/or lead
  • Blockage of the vein by a clot or scar tissue
The lead is extracted through the subclavian vein. A laser light is attached to a sheath to serve as a guide to the lead. Once there, the light will break up the scar tissue and the lead will be removed.

Left Atrial Appendage Occlusion Therapy
The Left Atrial Appendage (LAA) is the main source of blood clots in patients suffering from AF. LAA occlusion is supported by research to significantly reduce a patient's risk of having a stroke. Closure methods include surgical and catheter based approaches. One of these approaches is using the Watchman™ device. This quarter-sized device is inserted through a catheter and placed on the left side of the heart permanently sealing the LAA, preventing clots from entering the circulatory system.



Surgical Maze Procedure
This procedure is performed in the operating room and requires one or more incisions. During this procedure, the surgeon will apply energy to the outer surface of the heart and pulmonary veins in an effort to eliminate the conduction pathways of AF. Some patients may be candidates for a minimally-invasive approach while others may have other heart disease that will necessitate surgical treatment. For more information about the Maze procedure, visit Arrhythmia Surgery.

More Information About Atrial Fibrillation

Educational sessions are scheduled regularly and titled Living with Atrial Fibrillation. Visit our Living with Series webpage for more information on registering for our next class. To learn more about atrial fibrillation treatment or to find a physician, call 1.844.BSW.DOCS. To refer a patient, contact the Heart Rhythm Center at Baylor Scott & White Heart and Vascular Hospital – Dallas.

Heart Rhythm Center
621 N. Hall St., Ste. 108
Dallas, TX 75226
214.820.5306


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