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The Medical Minute: You’ve been diagnosed with AFib. Now what?

It may start with a rapid heartbeat, a fluttering feeling in your chest or a heightened awareness of your own heartbeat. Sometimes you feel it for yourself. Other times you don’t feel any symptoms. But no matter how you learn you have the heart rhythm disorder called atrial fibrillation (AFib), you should take it seriously.

“While AFib itself isn’t life-threatening, it can lead to a blood clot forming in the heart,” said Dr. Christopher Rogers, a cardiac electrophysiologist with Penn State Health Medical Group – Berks Cardiology. “If a blood clot leaves the heart and goes to the brain, it can cause a stroke.”

How doctors find AFib

While people of any age can have AFib, it’s most common in older adults, with 70% of all cases diagnosed in people between the ages of 65 and 85. If you feel any symptoms, you should see your primary care provider, who may perform an electrocardiogram (EKG), a test that measures your heart rhythm. If the EKG doesn’t bring clear results, your provider may recommend you wear a heart monitor, a small device that will track your heart rate for 24 to 48 hours.

“AFib has distinguishing characteristics,” Rogers said. “It’s a very irregular rhythm that’s both fast and inconsistent.”

How medication can control AFib

Once you receive an AFib diagnosis, medical management is typically the first line of treatment. For most people, that will include two types of medications.

Blood thinners such as apixaban (Eliquis), rivaroxaban (Xarelto), warfarin (Coumadin) or dabigatran (Pradaxa) help prevent blood clots from forming and traveling to the brain. If you’re relatively healthy, you may only need blood thinners short-term. But older adults and people with high blood pressure, diabetes or a history of prior strokes, mini-strokes, heart or vascular disease may need blood thinners long-term.

While blood thinners reduce your stroke risk, “they won’t keep you out of AFib or make you feel better,” Rogers said. That’s why your health care provider will also likely prescribe medications such as flecainide (Tambocor), dronedarone (Multaq), amiodarone (Cordarone) or sotalol (Betapace) that control the heart’s rhythm.

Procedures that may help reverse AFib

For some people, medication alone helps to manage AFib. But if medical management isn’t successful, you may find relief through non-surgical and minimally invasive electrophysiology procedures.

Three of the most common:

Cardioversion – This procedure uses electric current delivered through paddles on the chest and sometimes the back to “shock” your heart into a normal rhythm. You will receive anesthesia prior to a cardioversion.

Ablation – Initially viewed as a last resort, ablation is now often recommended earlier to people with AFib thanks to advances in both technology and technique. During an ablation procedure, an electrophysiologist inserts a catheter through the groin and threads it up to the left atrium, the chamber of the heart where AFib typically originates.

At Penn State Health St. Joseph Medical Center, electrophysiologists use a device called cryoballoon to disable the heart tissue that causes AFib. “Cryoballoon touches tissue all the way around the vein and freezes all the tissue at once, allowing us to accomplish ablation more efficiently,” Rogers said.

It typically takes three months for providers to see clear evidence of an ablation’s effectiveness. “Initial procedures carry a success rate of about 80%,” Rogers said, although some patients may need more than one ablation for successful treatment.

WATCHMAN People who can’t take blood thinners long-term due to risks of bleeding or falling may benefit from a procedure to install a WATCHMAN device. It’s an implant—measuring about the size of a quarter—that’s inserted into the left atrial appendage of the heart, the area where blood clots most often form. “People with WATCHMAN can eventually discontinue blood thinners and still have the same level of protection from clotting,” Rogers said.

Patients receive these procedures inside an electrophysiology (EP) laboratory under the guidance of an electrophysiologist, radiation technologists, nurses and an anesthesia team. EP labs combine imaging technologies like fluoroscopy (moving X-rays of the heart) and 3D mapping that give caregivers a clear, virtual view the heart’s structure and its electrical signals during treatment. St. Joseph Medical Center features a newly renovated and expanded EP lab that opened in December.

Procedures to treat AFib are elective, so patients considering them should talk with their healthcare provider and weigh the benefits and risks. People with weaker hearts, chronic and persistent AFib, or enlarged hearts may have less chance of a successful outcome.

“AFib is a progressive disease, and as it advances, it’s harder to treat,” Rogers said. “That’s why we recommend people get diagnosed and treated sooner than later.”

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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