What Heart Rhythm Experts Want You to Know About AFib

September is AFib Awareness Month — a great time to boost your understanding of the most common type of irregular heartbeat, Atrial Fibrillation (AFib).

The condition increases your risk for stroke, heart failure, and other heart-related problems, according to heart rhythm experts at the AFib Center, part of Doylestown Health’s Woodall Center for Heart and Vascular Care.

About AFib

Your heart has its own electrical conduction system that coordinates your heartbeat. AFib happens when “faulty wiring” in this electrical system causes problems with the way your heart contracts, leading to a chaotic rhythm in the heart’s top chambers (atria). This irregular heartbeat interferes with the heart’s ability to pump, so blood begins to pool inside your heart where it can form clots. This puts you at risk for stroke and other life-threatening conditions. AFib can also damage and weaken your heart muscle, causing fluid to back up into the lungs, making it hard to breathe.

What Does AFib Feel Like?

AFib symptoms can be tricky. Some people describe a feeling of a skipped heartbeat, followed by a thump and a prolonged sensation of a racing heart, according to John Harding, MD, a cardiac electrophysiologist. “Episodes of AFib can come and go or be so subtle you do not realize you are experiencing AFib. On the other hand, AFib can progress to a point where you can feel your heart racing all the time. This can lead to decreased exercise tolerance, diminished stamina, and poor quality of life.”

According to the American Heart Association, some people with the condition have no symptoms, and their AFib is only detectable through a physical exam. Others may have one or more of the following symptoms:

• General fatigue
• A rapid, irregular heartbeat
• Fluttering or “thumping” in the chest
• Dizziness
• Shortness of breath and anxiety
• Weakness
• Faintness or confusion
• Fatigue with exercise
• Sweating
• Chest pain or pressure (You may be having a heart attack. Call 9-1-1 immediately)

If you experience any of these AFib symptoms, it is essential to see your primary care provider or cardiologist for testing.

Don’t Wait to Treat AFib!

“The longer you wait to get your AFib corrected, the harder it is to fix. Early diagnosis is particularly important for patients with congestive heart failure or weakening of the heart," says Irfan Khurram, MD, a cardiac electrophysiologist. “The sooner a care plan is in place, the better the outcomes can be.”

Treatment goals for AFib include:

• Resetting the heart's rhythm
• Controlling heart rate
• Preventing blood clots
• Medication and lifestyle changes

Adopting a Heart-Healthy Lifestyle

Many people manage their AFib through a combination of medication and lifestyle changes. A heart-smart lifestyle includes exercising regularly, not smoking, lowering cholesterol, maintaining a healthy weight and blood pressure, and managing diabetes or prediabetes.

Cardioversion Therapy

When lifestyle changes are not enough to control your AFib, you have several treatment options starting with cardioversion therapy. Though cardioversion is not a permanent solution for AFib, it can help restore a normal heart rhythm by sending electric shocks to the heart through electrodes placed on the chest.

Treating with Ablation

Ablation delivers different forms of energy to create scar tissue that isolates the faulty signals that are causing the AFib, according to Dr. Khurram. 

Treatments include:

Cryoablation – A minimally invasive procedure that freezes the heart tissue that is causing the erratic electrical signals.

Radiofrequency ablation – Uses electrical current (heat) to scar tissue in the heart to isolate the errant electrical signals that cause AFib.

Convergent ablation – Also known as the convergent maze procedure, this minimally invasive treatment is for patients whose AFib is resistant to current therapies. The electrophysiologist (EP) and cardiac surgeon simultaneously operate on the heart, isolating faulty electrical signals with radiofrequency ablation. Working through a small incision in the chest, the surgeon ablates tissue from outside the heart, as the EP threads a catheter through a vein in the groin to the heart, filling in any gaps in the ablation pattern.

Innovation and Research — Pulsed Field Ablation

Electrophysiologists at Doylestown Hospital were among the first in the United States to test a new, breakthrough ablation technology — pulsed field ablation. Pulsed ablation delivers very short-duration (nanoseconds to milliseconds) energy pulses, eliminating only the targeted tissue with the goal of avoiding unwanted injury to surrounding structures — a risk of current ablation technologies, according to Robert Sangrigoli, MD, a cardiac electrophysiologist who participated in the trials along with Dr. Harding.

Doylestown Hospital is one of only a few centers in the country to have enrolled patients in both the PULSED AF and ADVENT — two pivotal U.S. trials of pulsed field ablation systems. 

Both trials are complete; however, the technology is not yet approved for use outside of medical research. That’s because pivotal trials are performed to demonstrate the safety and efficacy of a technology. The results provide clinical evidence that the U.S. Food and Drug Administration (FDA) will evaluate as part of the regulatory approval process.

“We are pleased to have been a part of these pivotal trials to help establish a safe and effective new, potential treatment option for our patients with AFib,” says Dr. Sangrigoli.

Pacing for a Normal Heart Rate

Traditional pacemakers are surgically implanted devices about the size of a half dollar, according to cardiac electrophysiologist Stephen Sloan, MD. “They have wires called leads that run from the pacemaker’s generator box to the heart where they deliver electric energy pulses to help preserve, and in some cases, improve the heart's pumping function.

”We also offer wireless (leadless) pacemaker options. A leadless pacemaker does everything a regular pacemaker does, but it’s one-tenth of the size and can be implanted directly into the heart wall without invasive surgery, according to Dr. Sloan. The leadless design may reduce infection risk and allows you to resume regular activities sooner. The leadless pacemaker is particularly beneficial for patients who have had prior procedures involving veins of the upper extremities.

Protecting Against Blood Clots

A small opening in the heart called the left atrial appendage (LAA) serves no known purpose, but clots tend to form there in people with AFib, increasing the risk of stroke. If you cannot tolerate blood-thinning medications, LAA closure offers an alternative. Options include:

Left atrial appendage (LAA) closure – A procedure to seal the LAA

WatchmanFLX - A parachute-shaped device implanted into the heart to close the LAA opening in a minimally invasive procedure

Regional Center for AFib Treatment

Our AFib Center features include:

• One of the highest volume ablation centers in the Philadelphia region and the highest for cryoablation
• A center of excellence for cryoablation
• Success rates better than the national average
• National physician training site for cryoablation
• Groundbreaking research investigating new therapies for atrial fibrillation
• Electrophysiology Accreditation, American College of Cardiology

Learn more

• Visit the Doylestown Hospital AFib Center, or call 267.880.DHAF (3423).

Further Reading

You can read more about AFib by visiting the American Heart Association.