What is Atrial Fib?

Oh My Beating Heart!

Pam wasn’t sure if she was having palpitations from stress or if it was something worse. Her heart had been beating erratically for years and she’d had testing in the past that didn’t show any problem, so though she wasn’t too worried, she thought she should mention it at her physical exam.

Her primary care provider made a long list of all the things Pam had to do to stay healthy, from taking Vitamin D and getting some weight bearing exercise to having labs drawn and seeing a cardiologist.

How it’s diagnosed

 Pam saw the cardiologist a few months later and was surprised to learn that they had a nifty new way of monitoring the heart for 2 weeks. All she had to do was wear a patch around her left collarbone for 2 weeks. I looked it up and found out it was a Zio®XT Patch. She could exercise, shower and go to work, while the little chips inside the patch recorded every one of her heart beats 24 hours/day for 2 weeks. Then she would just mail it in! Not bad, she thought.

In the past, we had EKG’s that could capture 30 to 60 seconds of a person’s heart rhythm, but we all knew that we needed more time. Then along came the Holter monitor, where 24 hours was the maximum time captured and a person had to wear a cumbersome set of electrodes and carry around a device the size of a 5x7 picture frame. Now, with new technology, we have the opportunity of peaking into a person’s heart activity for much longer time and making it easier to be monitored. Now, seemingly rare events can be seen with continuous monitoring for weeks not hours.

Pam found out that her irregular heart beat was actually Atrial Fibrillation and not from looking at this photo! Some people have symptoms, many don’t. For some the symptoms are constant and for others the symptoms are erratic.Having an opportunity to be monitored for 2 weeks helped her cardiologists figure out that she had Atrial fib a few times a week.

What causes Atrial Fibrillation?

Basically, with atrial fibrillation the 2 atria or top chambers of the heart beat rapidly and irregularly and don’t send synchronized signals to the 2 lower ventricles in the heart. What happens is that the 2 top chambers are beating so fast, they almost vibrate and that means that the blood doesn’t get pumped to the 2 lower chambers or ventricles of the heart efficiently. In addition, the electrical signals from the atria are also transmitting erratic signals to the ventricles causing them to beat out of the normal steady rhythm. It all adds up to a number of different consequences, including a higher risk of developing a blood clot and an increased risk of stroke.

Increased risk of Stroke 

 When I asked her what was most surprising about her diagnosis, she said that she had no idea that she was only noticing a few irregularities, but that the monitoring showed that it was happening a lot more often. Pam was shocked to learn that without treatment, one of the most common consequences of Atrial Fib is developing a clot that could lead to a stroke. She’s a person who hates taking medication, but after hearing that she changed her mind and started on the recommended meds.

Treatment options

 There are many different treatment options available for patients that depend upon each person’s unique situation.

• Medications to reduce the risk of blood clots
• Medications to help alter the heart’s electrical rhythm
• Electrophysiology and Ablation

With ablation, highly trained cardiologists, known as electrophysiologists are able to thread a special catheter to the area where the nerve cells that are causing the irregular heart beat are treated with a short pulse of electricity. This ablates or deactivates those cells. This is a very precise procedure and new developments with 3-D mapping combined with CT scanning (known as a merging process or registration) makes this a much safer procedure.

•  Maze procedure – a type of heart surgery that interrupts the electrical signals that are causing the 2 upper chambers of the heart to beat so fast.

So far, Pam is doing well with her medication and barely notices her heart beat. She’s too busy enjoying her life.

This video explains heart beat irregularities known as arrhythmias.

For more comprehensive information, this link will take you to the Health Library at El Camino Hospital.

Disclosure: I’m working with El Camino Hospital to help spread the word about important and life-saving innovations in cardiology through the Norma Melchor Heart and Vascular Institute at El Camino Hospital.