Friday, November 11, 2011

Don?t ignore signs of A-Fib

St. Luke?s Health Watch

by DR. MARCOS DACCARETT

Atrial fibrillation, sometimes called A-Fib, is the most common heart rhythm disorder, yet thousands of people in the United States who suffer from atrial fibrillation may not be aware of the dangers.

A-Fib is best defined as an irregular and often rapid heart rate. During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly—out of coordination with the two lower chambers (the ventricles) of the heart.

unfortunately, many people may not be aware that they are suffering from atrial fibrillation, so the condition may go untreated, which can potentially lead to significant medical complications, including risk of stroke, heart failure and reduced quality of life.

the disorder is very common in people with cardiovascular disease. In combination with age, factors like high blood pressure, diabetes and heart failure lead to structural changes in the upper and lower heart chambers which trigger and foster atrial fibrillation.

There are an estimated 2.5 million cases of atrial fibrillation in the United States. It is strongly age-dependent; about 25 percent of people age 40 and older will develop A-Fib during their lifetime. those diagnosed with A-Fib are typically 65 or older, or are survivors of a heart attack and may suffer from conditions such as diabetes, obesity, high blood pressure and heart failure. the disorder causes a very fast, irregular heartbeat, leading to symptoms of weakness, fatigue, chest pain, shortness of breath and a sensation of a rapid heart rate or heart palpitations.

the biggest risk for those suffering from A-Fib is the danger of stroke. because the blood is not circulating in the upper chamber of the heart, it can pool, forming a blood clot that can potentially cause a stroke. A-Fib patients are about three to five times more likely to have a stroke. Left untreated, A-Fib can also lead to heart failure because the fast heartbeat can weaken the heart and eventually cause the heart muscle to fail. Each year in the United States more than 60,000 deaths are attributed to atrial fibrillation. A-Fib can come and go in some people, but others may be faced with a chronic case.

To treat A-Fib, doctors alter the heart’s electrical system with treatment that may include medication therapy, catheter ablations (nonsurgical treatment), minimally invasive and advanced surgical options and other interventions. See your primary care physician if you are concerned about A-Fib. There are multiple treatment options available that offer individualized care, specific for each patient’s need. A-fib symptoms can be similar to those of a heart attack. If symptoms are strong and persistent, call 911 immediately.

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Cardiologist Dr. Marcos Daccarett is a member of the team of cardiologists, surgeons and staff at St. Luke’s Center for Heart and Vascular Health.

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The new recommendations, published in Circulation: Journal of the American Heart Association, the Journal of the American College of Cardiology, and HeartRhythm Journal, are updates of the American College of Cardiology/American Heart Association/European Society of Cardiology 2006 Guidelines for the Management of Patients with Atrial Fibrillation. The 2010 focused update allows experts to swiftly incorporate significant new findings into the guidelines.

Atrial fibrillation is an irregular heart rhythm that occurs when the heart’s two upper chambers beat erratically, causing the chambers to pump blood rapidly, unevenly, and inefficiently. Blood can pool and clot in the chambers, increasing the risk of stroke or heart attack. more than 2 million Americans live with the condition.

The heart rate recommendation, one of several in the update, states that strict treatment to control a patient’s heart rate (at less than 80 beats per minute at rest and less than 110 during a six-minute walk) is not beneficial over a more lenient approach to achieve a resting heart rate of less than 110 in patients with persistent, or continuous, atrial fibrillation with stable functioning of the ventricles, (the heart’s lower chambers).

“The evidence showed rigid control did not seem to benefit patients,” said L. Samuel Wann, M.D., chair of the focused update writing group and director of cardiology at the Wisconsin Heart Hospital in Milwaukee. “We don’t need to be as compulsive about absolute numbers, particularly doing exercise tests and giving multiple drugs based solely on heart rate. Patients with symptoms due to rapid heart action need treatment, and the long term adverse effects of persistent tachycardia on ventricular function are still of concern.”

The evidence-based updates, which reflect major advances in disease management, include:

Clopidogrel

A combination of aspirin and the oral antiplatelet drug clopidogrel “might be considered” to prevent stroke or other types of blood clots in atrial fibrillation patients who are poor candidates for the clot-preventing drug warfarin. although warfarin remains effective, it requires patients to have regular testing to monitor its effectiveness and dosage adjustment. “It’s a minor inconvenience for most, but a major inconvenience for some,” Wann said.

Dronedarone

New research showed dronedarone, which is administered as a pill, could reduce hospitalizations for cardiovascular events related to atrial fibrillation. Dronedarone should not be given to patients with NYHA class IV heart failure or patients who have had an episode of decompensated heart failure in the past 4 weeks, especially if they have depressed ventricular function.

Dronedarone is associated with less hospitalizations and less side effects than amiodarone.

Catheter Ablation

Several new or revised recommendations support the role of catheter ablation as a treatment to maintain normal heart rhythm. in catheter ablation, a tube is inserted into a blood vessel and guided to the heart, where radiofrequency energy is applied that can destroy small areas of tissue responsible for an arrhythmia.

Ablation is useful when performed for selected patients at experienced centers (in which more than 50 cases are performed annually). For those patients with symptomatic paroxysmal atrial fibrillation (comes and goes on its own), who have not had success with drug treatment, do not have severe lung disease, and have a normal or mildly dilated left atrium and normal or mildly reduced function of the left ventricle, catheter ablation “is useful in maintaining sinus rhythm.”

The treatment option is also reasonable for patients with symptomatic persistent atrial fibrillation, and it may be reasonable to treat symptomatic paroxysmal atrial fibrillation in patients with significant enlargement of the left atrium or with significant left ventricle dysfunction.

“Catheter ablation is one of the most rapidly growing procedural areas in cardiology right now, and the evidence does support that,” Wann said.