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GOODMEDICINE | ATRIAL FIBRILLATION

WHEN IT COMES TO MATTERS OF THE HEART, IGNORANCE IS NOT BLISS.SYMPTOMS SUCH AS HEART PALPITATIONS, SHORTNESS OF BREATH,LIGHT-HEADEDNESS AND DIZZINESS SHOULD NOT BE DISMISSED, ANDREQUIRE A CHECK-UP WITH YOUR DOCTOR.

atrial Fibrillation —Causes and Cures -- with ablation

BY ALICIA DOYLE

Such symptoms could indicate a heart arrhyth-mia (irregular heartbeat) such as atrial fibrilla-tion (A-Fib), involving the two upper chambersof the heart, or tachycardia, a heart rate of morethan 100 beats per minute. Considered theworld’s most common cardiac arrhythmia, A-Fibis not in itself life-threatening, however, “it canlead to complications such as stroke or conges-tive heart failure (CHF) without proper diagnosisand treatment,” says cardiac arrhythmia special-ist Dr. Leo Polosajian, Director of Cardiac RhythmSpecialists, Inc.

“The chaotic beating of the atrium does notallow the blood to be properly pumped. Instead,it quivers, causing blood to stagnate in the atri-um,” explains Dr. Polosajian. “The stagnation ofthe blood can lead to blood clot formation if thepatient is not on a blood-thinning medicationsuch as Warfarin or Coumadin and is in A-Fib for48 hours or longer. If the blood clot reaches thebrain, it can lead to a stroke, which can beextremely debilitating or even fatal.”

>>

Atrial fibrillation occurs when the heart muscles

of the two upper chambers(atria) beat in a chaotic and

unorganized manner, uncoordi-nated with the bottom cham-bers (ventricles) of the heart.

| 39NOVEMBER 2010 yhcMAGAZINE.COM 38 | yhcMAGAZINE.COM NOVEMBER 2010

GOODMEDICINE | ATRIAL FIBRILLATION

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Other forms of tachycardia, especially ventricular tachycardia (rapidheart beat in the ventricles), can be life-threatening. The most seriouscardiac rhythm disturbance is ventricular fibrillation, where the lowerchambers quiver and the heart cannot pump sufficient volume ofblood. Collapse and sudden death follow unless medical help is pro-vided immediately.

What is Atrial Fibrillation and Congestive Heart Failure?

Atrial fibrillation occurs when the heart muscles of the two upperchambers (atria) beat in a chaotic and unorganized manner, uncoor-dinated with the bottom chambers (ventricles) of the heart. Theyquiver, or “fibrillate,” rather than beat rhythmically and effectively,resulting in decreased blood circulation to the body.

A-Fib can occur for minutes, hours or all the time. A-Fib and CHF arecommonly linked to one another and either condition can predisposethe patient to the other. CHF and A-Fib share common risk factorssuch as hypertension, valve disease, coronary heart disease (such as ahistory of a heart attack resulting in weakening of heart muscle)and/or genetic predispositions.

“Persistent and permanent A-Fib patients are at thehighest risk for likely developing CHF or having exacerba-tions of CHF,” says Dr. Polosajian. “Likewise, in patientswith chronic CHF, A-Fib is likely to occur secondary to the dilation of the left atrium in the event that thepatient has developed mitral valve regurgitation (valve leakage).”

A-Fib may cause palpitations, fatigue and stroke. In somepatients, it may lead to fainting, chest pain and/or CHF. Itcauses up to 20 percent loss of cardiac output, known asthe “atrial kick,” which is the pumping of the blood out ofthe atrium and into the ventricles. Sinus rhythm is therhythm of the heart produced by impulses from thesinoatrial node. “Once sinus rhythm is restored in sympto-matic A-Fib or atrial flutter patients, they may immedi-ately feel an improvement in their energy and are able toperform activities they were no longer able to do while inthe arrhythmia,” explains Dr. Polosajian.

“A-Fib or flutter with rapid ventricular response can alsocause weakening of the heart muscle, known as tachycar-dia-induced cardiomyopathy,” says Dr. Polosajian. “WithA-Fib, the atrium is beating at an extremely rapid rate ashigh as 300 to 400 beats per minute, which causes theheart muscle to become tired and weak. Cardiomyopathyitself can increase morbidity due to the decrease in ejec-tion fraction (EF) and the greater risk for sudden cardiacdeath from the weakened heart muscle.” Ejection frac-tion is the ratio of the volume of blood the heart emptiesto the volume of blood in the heart — usually between 55and 70 percent.

“Your heart will actually go through remodeling if youhave A-Fib. The fast, erratic rhythm causes electricalchanges and stretching in the atria,” explains Dr. Polosajian, further noting that the heart can alsodevelop fibrosis, the formation of fibrous tissue in theheart. “The A-Fib episodes then start to occur more frequently with longer durations and can lead to chronicA-Fib. However, this remodeling of the heart can be partially or completely reversed with a curative procedureknown as an A-Fib Ablation. Once the patient restoressinus rhythm, the heart begins to remodel itself back toits original state with more efficient cardiac output.

What causes A-Fib?

A-Fib is most commonly caused by an underlying heartcondition such as mitral valve disease, hypertension, coronary artery disease, cardiomyopathy leading to con-gestive heart failure or sick sinus syndrome (improper conduction of the sino-atrial node, the natural pacemak-er of the heart).

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GOODMEDICINE | ATRIAL FIBRILLATION

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“However, A-Fib may also occur without evidence of heart disease.This is mostly common in young patients and is called lone atrial fib-rillation,” says Dr. Polosajian. Some causes may be genetic; however,other reversible causes may be hyperthyroidism, excessive alcohol useor pulmonary embolism.

Which therapy is best for A-Fib?

Medical therapy may include heart rate-controlling or anti-arrhythmicdrugs, or a combination of both. Ablation therapy is a curative thera-py with an extremely high success rate, especially in patients whohave paroxysmal atrial fibrillation (episodes that come and go spo-radically). In these patients, the success rate ranges from 80 percentto 85 percent.

“A-Fib ablation is usually an outpatient procedure; this can be per-formed at your local community hospital,” says Dr. Polosajian. “Thelength of stay for hospitalization may include an overnight stay. Therisk of complication — or major adverse effects — is approximately 1percent to 2 percent or less.”

Catheter Ablation

A minimally invasive procedure, catheter ablation is a procedurewhere flexible, thin tubes (catheters) are guided into the cardiacchambers through the blood vessels using fluoroscopy. Electrical sig-nals are then recorded and mapped with a 3-dimensional elec-troanatomical system. Intra-cardiac ultrasound is also used during theprocedure to visualize the cardiac chambers and pulmonary veins. Thethree-hour procedure is performed while the patient is under con-scious sedation or general anesthesia.

Cardiac CT Scan Prior to A-Fib Ablation

Patients require a cardiac CT scan prior to the ablation inorder to delineate the left atrium and pulmonary veins.“This allows the physician to have a thorough understand-ing of your heart anatomy, specifically, the left atrial volume and pulmonary vein anatomy and size,” Dr. Polosajian says. “The imaging data can then be used asadjunct to the 3-dimensional electroanatomical map created during the ablation to find the abnormal nervefibers triggering the arrhythmia.”

To learn more about A-Fib, visit the Heart Rhythm Societywebsite at www.HRSonline.org.

Designated among the “Patient’sRank of Top Cardiologists” inCalifornia, Leo Polosajian, MD, MS,FACC, of Cardiac RhythmSpecialists, Inc., is board certified inInternal Medicine, Cardiology, AdultComprehensive Echocardiography,and sub-specialized in ClinicalCardiac Electrophysiology.

Committed to providing the highest quality care for hispatients, Dr. Polosajian’s clinical areas of expertise includecomplex arrhythmia management and ablation, atrial fib-rillation ablation, supraventricular tachycardia ablation,heart failure management and cardiac resynchronizationtherapy. He also specializes in pacemaker and cardiacdefibrillator implantation, including implantation ofCardiac Resynchronization (Bi-Ventricular) Devices forpatients with congestive heart failure. For more details,you may contact:

Leo Polosajian, MD, MS, FACC805.230.2626 in Thousand Oaks or818.718.1600 in Northridgewww.crsmdinc.com

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