While all of us may experience occasional bouts of shortness of breath or fatigue, these symptoms should not be ignored, especially if they coincide with an irregular heartbeat. It could be a sign that your heart is in atrial fibrillation.
What is Atrial Fibrillation?
Atrial fibrillation, known commonly as A-fib, is an irregular heart rhythm that leads to erratic heart contractions, which happens when the heart’s upper chamber, or atria, beats out of rhythm with the lower chambers, or ventricles. This results in poor blood flow, which can cause a wide range of complications, including death.
“The longer we live, the higher the chance that we develop atrial fibrillation,” Alexandru Costeau, MD, UC Health electro-cardiologist, director of the Center for Electrophysiology, Rhythm Disorders and Electro-Mechanical Interventions, and professor of medicine for the University of Cincinnati College of Medicine said. A-fib is more common than you think—10% of people over the age of 80 have a chance of developing atrial fibrillation.
In addition to age, common risk factors include high blood pressure, diabetes, sleep apnea, previous heart attacks and heart failure. More recently, researchers have discovered that excessive alcohol use and very intense endurance events can also put your heart into atrial fibrillation. Maintaining a healthy lifestyle can increase your chances of preventing the development of A-fib.
Atrial fibrillation begins by occurring from time to time, but if left untreated, it can occur persistently—in which case, the chance of reversal is slim. Be mindful of the warning signals as they cannot be ignored.
If you think you may have an irregular heartbeat, your primary care physician can check through a physical examination. If your doctor discovers something concerning, you will be directed to receive an electrocardiogram (EKG).
“If the heart does not contract normally, a certain amount of blood is pooling in the top left chamber of the heart, which leads to clots,” Dr. Costeau explained. These clots can move from the heart to the brain causing a stroke, and can occur because the heart is not functioning properly. Clots can cause strokes, so if an irregular heartbeat is discovered, UC Health cardiologists first assess how likely it is a stroke will occur.
If there is a high likelihood of stroke, you will likely be prescribed anticoagulants, or a blood thinning medication. If medications are not the right solution for you, surgeons can often apply a permanent heart implant device that reduces the risk of stroke. The device is applied to the outside surface of the left atrial appendage, sealing it off from the rest of the heart.
“It is basically a filter that blocks the lower chamber of the heart where clots can form,” Dr. Costeau explained. “Ideally, we have to do the best we can to keep patients in normal rhythm. Preventing a stroke is our No. 1 priority.”
Historically, maintaining a normal rhythm has been accomplished through medication. However, these prescriptions can come with side effects, including lung thrombosis, or a pulmonary embolism, which occurs when a clump of material, such as a blood clot, becomes wedged into an artery in the lungs. This can also lead to an increased risk of cardiac death.
“Some patients benefit from these medications, but for the most part, it has become less of a desirable approach which brings us to where we are today, which is managing these atrial fibrillation patients invasively,” Dr. Costeau said.
Cardiac Ablation Is a Viable Solution
Cardiac ablation is a minimally invasive surgical procedure that scars the heart tissue to block irregular electrical signals. With the ablation procedure, surgeons can routinely correct a paroxysmal irregular heartbeat and can sometimes repair a permanent one.
“With the technology we have today, we are able to manage nearly every type of atrial fibrillation,” Dr. Costeau said. Ablation procedures have dramatically improved in the last 15 years at UC Health. What used to take an entire day and use excessive amounts of X-ray exposure can now be completed within an hour.
“We don't use x-rays anymore,” Dr. Costeau said. “We have a mapping system that allows manipulation of these catheters with a system that functions like the GPS in your car. The major benefit for the patients is the procedure is much more successful, it takes less time and therefore exposes them to fewer complications. That's a major shift from before.”
The mapping system available at UC Health allows for increased accuracy which leads to better outcomes. Additionally, UC Health only uses cardiac anesthesiologists who have advanced training.
“Once a cardiac anesthesiologist enters the room, I know I can focus on my part of the job and I don't have to worry about other hemodynamic or respiratory stability,” Dr. Costeau said. UC Health also sends patients home the same day as their procedure. “That's huge on the satisfaction index because our patients can sleep in their own bed that night,” he added.
The multidisciplinary care approach means that UC Health experts from different specialties work together to ensure patients receive the care they need. UC Health now offers a hybrid atrial fibrillation ablation, which means an electrophysiologist and a cardiac surgeon work together in the operating room.
“This is a relatively novel approach that addresses patients who have long-standing persistent atrial fibrillation who otherwise would have no hope,” Dr. Costeau said. Additionally, specialists from cardiology and radiology assist in diagnosing and treating UC Health heart patients.
As the region’s only academic health system, Dr. Costeau says that UC Health cardiologists are often asked to treat patients who have failed procedures at other medical facilities.
“We take on more challenging cases, and our success rates are above the national average,” Dr. Costeau stated. While complication rates nationwide are at 4% for heart ablation, they are only at 1% at UC Health.
Many people are not aware they are experiencing A-fib. Dr. Costeau says some signs to look for include sudden weight gain, shortness of breath, lack of energy, dizziness or fainting.
Dr. Costeau advises to listen to your body—and listen to your watch. With current technology, you can monitor your heart rate at home on a smart watch, and some smart watches will even alert you if your heart has an irregular heartbeat.
Outpatient medication management services are available on the West Chester Campus. UC Health also has plans to open an atrial fibrillation clinic on the West Chester Campus in the future.
To receive the name of a cardiologist on the UC Health West Chester Campus, please call 513-298-DOCS (3627).