Innovation

• AFib can increase stroke risk, even in patients who have few or no symptoms.
• Because every patient is different, stroke prevention plans should be tailored to an individual's health, risk factors and goals.
• Understanding your options and working with a multidisciplinary care team can help you make informed decisions about managing AFib.

For many people, an atrial fibrillation (AFib) diagnosis initially feels like a heart rhythm issue. But for physicians, one of the most important considerations is something patients may not see or feel: stroke risk.

AFib is more than an irregular heartbeat

AFib occurs when the upper chambers of the heart beat irregularly and out of sync with the lower chambers. While symptoms may vary, the condition can have effects that extend beyond an abnormal heart rhythm.

"Stroke prevention is a fundamental part of AFib treatment and needs to be considered separately from controlling the rhythm or symptoms," says Cristiano Spadaccio, MD, UC Health cardiac surgeon. "A patient may feel perfectly well and still have a meaningful stroke risk. That risk should be assessed individually and revisited over time."

AFib is also associated with other potential long-term health concerns.

"AFib is associated not only with stroke, but also with progressive heart failure, worsening atrial and ventricular function, and the development or progression of valvular disease," Dr. Spadaccio says.

Because of these potential consequences, experts increasingly view AFib as a condition that benefits from ongoing evaluation and proactive management. 

Understanding your individual stroke risk

Not every person with AFib has the same stroke risk. Factors such as age, medical history, heart function and other health conditions can all influence an individual's risk level.

That's why AFib care begins with a comprehensive assessment rather than an automatic treatment plan.

"The right plan takes into account the type and duration of AFib, symptoms, previous treatments, the anatomy and function of the heart, stroke risk, other medical conditions and, importantly, the patient's goals," Dr. Spadaccio says. "Success means developing a strategy that makes sense for the whole patient rather than simply treating an ECG."

A meaningful discussion about stroke prevention should also evolve over time. As health conditions change and new treatment options become available, a patient's management plan may need to be reviewed and adjusted.

How care teams create a personalized plan

Because AFib affects patients differently, many specialists believe the best care comes from a collaborative approach that considers the full range of treatment options.

"AFib is not the same disease in every patient, and there is no single treatment that is right for everyone," Dr. Spadaccio says. "Having electrophysiology and cardiac surgery working together allows us to consider the entire spectrum of treatment and choose the approach that best fits that individual patient."

When evaluating a patient, the care team may consider:

• The type and duration of AFib
• Current symptoms and their impact on quality of life
• Stroke risk factors
• Heart structure and function
• Previous treatments or procedures
• Other medical conditions
• Personal goals and preferences

Rather than focusing on a single solution, the goal is to develop a care plan tailored to the individual's needs today while also considering long-term health.

Nonsurgical treatment options

For many patients, treatment begins with nonsurgical therapies designed to manage symptoms, reduce stroke risk and support long-term heart health.

Common options include:

• Lifestyle and risk factor management to address factors that may contribute to AFib progression, including high blood pressure, obesity and sleep apnea.
• Medications to control heart rate, maintain a normal heart rhythm and reduce stroke risk through blood-thinning therapy.
• Catheter ablation, a minimally invasive procedure performed by electrophysiologists to target the abnormal electrical pathways responsible for AFib.
• WATCHMAN™ and other left atrial appendage occlusion (LAAO) devices, which may be appropriate for selected patients who have an elevated stroke risk and need an alternative to long-term blood thinners. These devices are placed through a catheter to seal the left atrial appendage, where many AFib-related blood clots form.

Surgical and hybrid treatment options

Some patients, particularly those with persistent or long-standing AFib or those whose symptoms continue despite previous treatments, may benefit from more advanced therapies.

Options may include:

• Robotic Hybrid AF Convergent treatment, a collaborative approach that combines minimally invasive surgical ablation with catheter-based ablation. By treating the heart from both the outside and inside, specialists can reach areas that may be difficult to access with catheter ablation alone.
• Cox-Maze procedures, are surgical treatments designed to interrupt the abnormal electrical signals that cause AFib. Using radiofrequency and/or cryoablation, the surgeon creates a carefully defined pattern of lesions in the atria to help restore and maintain normal rhythm. Cox-Maze procedures may be considered for patients with persistent or long-standing AFib, those undergoing another cardiac operation, or patients who have not achieved the desired results with other treatments.
• Surgical left atrial appendage closure (LAAO clip), which excludes the left atrial appendage from circulation and may help reduce one source of AFib-related stroke risk in appropriately selected patients.

Dr. Spadaccio often explains the left atrial appendage as a small pouch connected to the left atrium where blood can collect during AFib.

"When the atrium is fibrillating, blood can stagnate there and form a clot," he says. "If that clot leaves the heart and travels to the brain, it can cause a stroke."

He notes that closing or excluding the appendage can be an important stroke prevention strategy for some patients, but it is not a one-size-fits-all solution.

“Placing a clip does not automatically mean that every patient can stop anticoagulation. However, in selected patients, discontinuation of anticoagulation may subsequently be considered based on individual stroke and bleeding risk, AF burden and rhythm status, and confirmation of adequate appendage closure.”

Why a multidisciplinary approach matters

"AFib is not the same disease in every patient, and there is no single treatment that is right for everyone," says Dr. Spadaccio. "Having electrophysiology and cardiac surgery working together allows us to consider the entire spectrum of treatment and choose the approach that best fits that individual patient."

At academic medical centers such as UC Health, patients have access to specialists who work together to evaluate the full range of contemporary AFib therapies, from medications and catheter-based procedures to hybrid and surgical approaches. This collaborative model allows treatment recommendations to be driven by the patient's needs rather than a single specialty's perspective.

Questions every AFib patient should ask

Understanding your condition can help you play an active role in your care. Dr. Spadaccio encourages patients to have open conversations with their providers and ask questions such as:

• What type of AFib do I have?
• What is my individual risk of stroke?
• What could happen if my AFib is left untreated or undertreated?
• Could AFib affect my heart function over time?
• Do I need anticoagulation medication?
• What treatment options are available to me?
• Should we be taking a more proactive approach now to prevent future complications?

These discussions can help patients better understand both the immediate and long-term implications of AFib.

When is a second opinion worth considering?

Patients sometimes assume they have exhausted their options after an unsuccessful treatment or recurring symptoms. However, advancements in AFib care continue to expand the available approaches.

According to Dr. Spadaccio, a second opinion can be valuable when symptoms persist despite treatment, AFib returns after an ablation procedure or a patient is making decisions about another intervention.

It can also help patients better understand whether newer or alternative options may be appropriate for their situation.

Why experience and collaboration matter

As AFib treatment continues to evolve, access to multiple specialties can help ensure patients receive recommendations based on the full spectrum of available options.

"For me, it is having the full range of expertise available and having those specialists actually work together," Dr. Spadaccio says. "Patients benefit when their case can be evaluated collaboratively and the treatment is selected from all of these options rather than from the perspective of only one specialty."

Many patients are surprised to learn how much AFib treatment has changed in recent years.

"Many patients are surprised to learn how many treatment options now exist and that treatment is about more than simply controlling the heart rate," Dr. Spadaccio says. "We can address the rhythm itself, symptoms, stroke prevention and the factors that contribute to AFib progression."

Managing AFib with confidence

Living with AFib does not mean simply accepting the condition and hoping for the best. Understanding your stroke risk, knowing the potential long-term effects of AFib and learning about the full range of available treatment strategies can help you make informed decisions with your care team.

Dr. Spadaccio offers this advice to patients: "Do not assume that living with AFib means simply accepting it. Understand what type of AFib you have, understand your stroke risk and the other potential consequences of the disease, and make sure you have been able to discuss the full range of treatment options."

The most effective AFib care starts with a clear understanding of your condition and a personalized plan designed around your unique needs, goals and long-term health.

If something feels off with your heart — don’t wait. UC Health’s electrophysiology team is ready to see you, evaluate your symptoms, and give you the answers and treatment you need.  Schedule online or call 513-475-8521.