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By: Dr. John Cai
Atrial fibrillation and it’s curative treatment options

Atrial Fibrillation (AF) is a heart rhythm disturbance (arrhythmia). It is the most common cause of adult arrhythmia and it is the most common cause of stroke. To understand atrial fibrillation we have to understand how the normal heart rhythm works. Everyone has a biological pacemaker called the SA Node where electrical impulse is generated, then it passes from the top chamber of the heart called atrium to the bottom chamber the heart called the ventricle where it pumps blood throughout your body.

In AF, because of electrical interference from blood vessels within lung circulation called pulmonary vein (PV), atrial rhythm becomes very rapid and irregular which suppresses the normal SA node function. Therefore, your heart rate becomes very rapid and irregular, but sometimes it can be very slow but also irregular. Very often patients with slow heart rates end up with a permanent pacemaker.

Because of the irregularity and rapid heart rhythm, many patients have palpitations, rapid heart rate and fatigue, even symptoms of lightheadedness and dizziness. Secondly, in AF, the atriums no longer have normal contraction and the blood swirls around the atrium causing blood clots which results in stroke. That’s why doctors often put patients on blood thinning medication called warfarin (Coumadin).

Although some AF patients may not have any symptoms, their risks of stroke are not less. As matter of fact, they may have a higher risk for stroke because of not seeking or being under medical care. In addition, long term AF will result in congestive heart failure (CHF).

Treatment of atrial fibrillation is very dependent on your presentation, comorbidity and the doctors you are seeing. However, all doctors agree that prevention of stroke is most important in managing and caring for AF patients. Two major treatment strategies are to control heart rate plus placing the patient on Coumadin, restore normal heart rhythm (rhythm control) through medications or a procedure called cardioversion which is a shock treatment to reset your heart back to normal rhythm. However, most patients will revert back to AF after the cardioversion if they are not on a medication to control AF. Very often medications used in treating AF are not very effective, having significant and even dangerous side effects.

New Treatment: During the last 20 years, efforts have been focusing on a cure for AF by finding a way of stopping the electrical interferences from the PV and therefore restoring SA node function. The procedure is called PV isolation (PVI) and it is a catheter based percutaneous procedure. Special trained cardiologists called electrophysiologists (heart rhythm specialists) perform such procedures and they insert catheters through the veins in patients’ groin and catheters then advance to the heart using radio frequency energy to destroy the tissue that causes atrial fibrillation. Well performed procedures have very high successful cure rates at about 80%. Sometimes patients may require a second procedure. However, the longer the patients are in AF, the lower the procedure success rates are. These patients often require several percutaneous procedures or need a combined mini-invasive surgical approach in conjunction with percutaneous electrophysiology procedure to increase success rates. There are numerous procedure options and they are available in Mercy Hospital of Buffalo. For more information please visit: johncaimd.com or call 716-844-8754.

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