Atrial fibrillation (AFib) impacts more than 5.1 million people in the United States, with expectations of 15.9 million by 2050.
These numbers, from Mayo Clinic, only reflect those with AFib confirmed by an electrocardiogram, and do not include many more with symptoms but who cannot be confirmed. There are possibly many more who do not yet know they have it.
Pikeville Medical Center (PMC) Electrophysiologist, Chase Reynolds, MD said, “AFib is an abnormal heart rhythm coming from the top chambers of the heart. It is a situation where the top chambers, which are called the atria, simply quiver or fibrillate.”
Dr. Reynolds says that is where they came up with the name. Instead of having a nice steady heartbeat, you have an erratic, irregular, typically very fast heartbeat that causes the sensation of a high heart rate, and is often called palpitations.
AFib causes a variety of other symptoms as well, including fatigue, shortness of breath and dizziness. If not appropriately managed, AFib can lead to a variety of other medical conditions including stroke and heart failure.
“Everyone is at risk. AFib is, unfortunately, something that occurs at random,” said Dr. Reynolds. “We do see a much higher prevalence as we get older and in patients with hypertension, diabetes or tobacco abuse. We also see an increased prevalence in patients who have, for a variety of reasons, a dilated heart.”
Signs and symptoms can vary among patients.
“Most people commonly mention, what we call palpitations, the sensation of an irregular heartbeat,” said Dr. Reynolds. “That is, by far, the most common complaint that leads to a work-up and ultimately finding out the patient has atrial fibrillation.”
He says by no means are palpitations the only symptoms.
“AFib can also cause shortness of breath, fatigue or dizziness. It can also cause patients to pass out or chest discomfort. AFib may cause all of these symptoms or patients may have no symptoms at all,” stated Dr. Reynolds.
He says the patients with no symptoms are often the ones who are most difficult to identify because they do not complain of anything. They are also at the highest risk, because atrial fibrillation may not be identified until they arrive at the hospital having a stroke.
“AFib raises so many concerns. We worry about several different problems but the most concerning is a significant stroke risk,” said Dr. Reynolds.
According to Dr. Reynolds there are other factors that play into how high that stroke risk is. The stroke risk of a patient with AFib is often close to 500 times the stroke risk of someone in the general population.
He said, “The strokes with AFib, unfortunately, are not typically minor strokes. Not that any stroke is a good stroke but there are often scenarios where someone has a stroke and does recover. With atrial fibrillation, the strokes that we see are most of the time, truly life altering and patients generally, do not recover, or at least not completely.”
Treatment of AFib can take the form of medical management.
“We have a class of medications called anti-arrhythmic drugs, which are very effective in some patients,” said Dr. Reynolds. “We often start with a medication approach and then advance to higher level therapy’s if medications fail.”
Another treatment option for patients, who either cannot tolerate the anti-arrhythmic drugs or they simply do not work, is an ablation procedure.
“There are a couple different types of ablation procedures,” said Dr. Reynolds. “Classically, we have done what is called a pulmonary vein isolation, which is the basic AFib ablation procedure. At PMC, we are also proud to offer the hybrid AFib procedure for our more difficult to control patients. This is a team approach between electrophysiology and cardiothoracic surgery that is ideal for patients who have persistent AFib even after the standard AFib ablation.”
For additional information about afib or to schedule an appointment with the Pikeville Medical Center Heart and Vascular Institute, call 606-218-2201.