Atrial Fibrillation

Atrial Fibrillation or “A-Fib” is a type of sustained arrhythmia  where the heart beats irregularly or fast. It is often described as a “fish jumping in my chest.” Although many people feel no symptoms.

A-Fib is a fairly common heart problem affecting nearly 3 million people in the U.S. There are four types of A-Fib:

• Paroxysmal. This is where the irregular heartbeat lasts less than seven days, usually less than 24 hours and has recurred at least twice.
• Persistent. When the irregular heartbeat lasts longer than seven days, but the abnormal rhythm can be stopped with treatment.
• Permanent. When the arrhythmia lasts longer than one year and does not respond to treatment or treatment has not been attempted.
• Lone. When the irregular heartbeat is paroxysmal or persistent, and occurs in people without any other form of heart disease.

The risk factors for A-Fib include:

• High blood pressure
• Coronary heart disease
• Previous heart attack
• Sleep Apnea
• Heart valve problems
• Congenital heart defects (you are born with these)
• Diabetes
• Other arrhythmias, including atrial flutter and ventricular fibrillation
• Inflammation such as after heart surgery (CABG)
• Lung diseases including pulmonary embolism
• Excessive alcohol use
• Viral infections
• Obesity
• Age: three to five percent of people over age 65 have A-fib, up to 10 percent of people over age 80 have A-fib

To determine if you have A-Fib, several different tests may be performed including:

• Electrocardiogram (ECG). This test draws a picture on graph paper of the electrical impulses traveling through the heart. The test is done in a doctor’s office, and uses stick-on small patches attached to the chest.
• Holter monitor. This is a small recorder that is worn for one to three days. Electrodes (sticky patches) are attached to your chest, and wires run to the monitor, which is worn for the chosen time.
• Portable event monitor or loop recorder. This monitor device is worn like a pager for up to four weeks. This kind of monitor can record electrical activity when a patient indicates he or she is experiencing symptoms, or if certain kinds of arrhythmias are recognized by the monitor’s computer.
• Trans-telephonic monitor. This monitor transmits heart activity by telephone using a special monitor made for this type of test.

A-Fib has dangers.

While A-Fib itself is not life threatening, it can have serious consequences. People with A-Fib are at a much higher risk of stroke. Left untreated, A-Fib can lead to heart failure .

If you would like information on how to recognize stroke or take our stroke risk quiz, please click here .

Types of Treatment for A-Fib:

• Medicines- Aspirin, Warfarin, beta blockers, calcium-channels blockers and anti-arrhythmic medicines to control heart rate and prevent stroke.
• Cardioversion- A procedure for people who are having A-fib for the first time or need treatment right away.
• Ablation- For people with symptoms who have failed or not tolerated medicines.
• Surgery- For people who do not respond to medical therapy or ablation. Often done in conjunction with other heart surgery.

What to do if you think you might have a-Fib:

• Make and appointment with your regular doctor or cardiologist to confirm that you have A-Fib
• If you need to find a doctor who can help you or need a second opinion, contact DOCSline at MedStar Washington Hospital Center by calling 202-877-DOCS (3627), or online by clicking here .

With more than 1,600 physicians and specialists in the database, DOCSline can help find a doctor who is right for you.

Why Choose MedStar Washington Hospital Center to treat A-Fib:

• Recognized as a leader in heart services. Not only is the Hospital Center routinely recognized by organizations such as U.S.News & World Report as a top quality cardiovascular program, but is also recognized locally by Consumer’s Checkbook and other publications.
• The Hospital Center treats more people in the Washington region than any other hospital. And, more people are transferred to MedStar Washington Hospital Center from other hospitals than any other hospital in the Washington region.
• Independent research concludes that MedStar Washington Hospital Center is the most preferred hospital for cardiac care by area patients and physicians.
• Hospital Center electrophysiologists have performed cardiac ablation procedures for nearly 20 years, with a 95+ percent success rate in correcting traditional arrhythmias, such as supraventricular tachycardia and typical atrial flutter.
• More than 600 catheter ablations are performed at the Hospital Center each year. This puts the program among the top five for volume in the country for these procedures among adults.
• Hospital Center electrophysiologists now perform more than 100 atrial fibrillation ablations each year. Success rates are about 70 percent overall for initial ablation.
• Surgical correction of A-Fib has a success rate of approximately 75-95 percent.
• MedStar Washington Hospital Center offers the full spectrum of surgical and non-surgical treatment options in one facility. All the expertise, all the latest advances, all the experience.

Click here if you need an appointment with an experienced doctor to diagnose or treat your A-Fib. Or order our A-Fib information kit by clicking here.

Frequently Asked Questions about Atrial Fibrillation (A-Fib)

1. Will A-Fib go away on it own?
   Generally not. When a person has A-Fib more than once, the arrhythmia usually keeps coming back and usually becomes more longstanding

2. What are the dangers of the ablation procedure?
   The risks are those of any heart catheter procedure such as rare injury of the blood vessels or heart, bleeding, bruising, and even the remote risk of unforeseeable complications like stroke, heart attack, or esophageal injury. The risk of a major complication of an ablation procedure is probably about 1 in 100.

3. If my family members have had A-fib is there increased risk I’ll get it too?
   A-Fib has been shown to have a genetic contribution, although this is not completely understood. Having a family member with A-Fib may increase one’s risk of developing it as well.

4. What causes an A-Fib attack?
   Classic triggers for a A-Fib episodes include heavy alcohol consumption, caffeine, stress, excitement, fear, lung problems, heart problems, and often, no obvious triggers at all.

5. What can you do when you have an attack?
   If an attack lasts more than 24 hours, you should contact your doctor.

6. How long does ablation last?
   A typical atrial fibrillation ablation takes anywhere from 1 to 4 hours to perform, depending on the complexity of the procedure.

7. What is the “watchman”?
   The “Watchman” is a prosthetic device that is inserted by catheter into the left atrial appendage, the small sac-like structure in the left atrium that is probably the most frequent site of blood clots that form in atrial fibrillation. Occluding this sac with a “Watchman” may be a way to prevent blood clots.

8. Is stress a factor in getting A-Fib?
   Stress may be a trigger for bouts of A-Fib.

9. Is it better to have a cardioversion done sooner or later after A-fib is diagnosed?’
   A cardioversion is a rapid resetting of the heart to restore sinus rhythm. It does not, however, “cure” the A-fib if the triggers for this arrhythmia remain. Talk to your doctor about cardioversion.

10. What are the goals for treatment for A-fib?
    There are three goals:
    a) To control the risk of blood clot (with medications)
    b) To control the heart rate (with medicines or a pacemaker)
    c) To control the actual heart rhythm by suppressing atrial fibrillation (in patients with symptoms of atrial fibrillation)

11. Are there problems with the drugs that treat A-fib like those concerns for Heparin?
    Anti-arrhythmic drugs, like all drugs, have some risks and potential side effects. Speak with your doctor to understand these risks fully for each possible drug option.

12. What are the side effects for warfarin?
    Although generally well tolerated, warfarin can have side effects, including easy bleeding/bruising, nausea, vomiting, bloating, skin discoloration, and other effects. Talk to your doctor if you experience any unusual symptoms while on warfarin.

13. What is a CHADS score?
    A CHADS score is a simple way of estimating the risk of stroke in patients with A-Fib. The higher the total score, the higher the risk of stroke. Patients with scores of 2 or greater benefit from warfarin therapy. Points are assigned as follows:

1. When is aspirin prescribed and when is warfarin prescribed to help prevent stroke?
   Aspirin OR warfarin may be used in patients with atrial fibrillation and fewer than two moderate and no major risk factors for stroke. Moderate risk factors include structural heart disease,age>75, diabetes, hypertension, congestive heart failure. Major risk factors include prior stroke or transient ischemic attack, prosthetic heart valve, mitral stenosis.

2. What is the level of blood pressure that may put a person at risk for A-fib?
   Hypertension is a risk factor for A-Fib. The higher the blood pressure, the higher the risk.

3. If you are on blood pressure medication are you still at increased risk for A-Fib?
   Even patients with well controlled high blood pressure are at increased risk of A-fib compared to patients without a history of high blood pressure.

4. How long would you need to have A-fib before it turns into heart failure?
   This can vary from person to person. A-Fib worsens heart failure, and heart failure worsens A-Fib. Having both conditions can be a vicious circle. Therefore, effective therapy for both heart failure as well as A-fib is necessary in patients with both conditions.

5. If a person has no symptoms, how would they know to get checked for A-fib?
   Periodic checks of one’s own pulse are helpful. The definitive diagnosis can come with an ECG, which can be performed by your doctor.

Click here if you need an appointment with an experienced doctor to diagnose or treat your A-Fib. Or order our A-Fib information kit by clicking here.

If you have atrial fibrillation (AF or A-Fib), you may be frustrated by treatments that offer only temporary relief. MedStar Heart Institute at MedStar Washington Hospital Center is the only hospital in the region offering an innovative new procedure called Convergent Atrial Fibrillation Ablation. Convergent A-Fib Ablation may offer you long-lasting, possibly permanent, relief, of the symptoms and complications of this common arrhythmia. Meet our cardiac specialists or contact us for more information.

Convergent A-Fib: Atrial Fibrillation Treatment in Washington, D.C.

Atrial fibrillation, also called AF or A-Fib, is a type of heart arrhythmia, a condition in which the heart beats irregularly or too slow or too fast. A-Fib affects nearly five million people in the U.S. While A-Fib is not life threatening, it increases your risk of stroke; if left untreated, it can lead to heart failure.

Existing treatments for A-Fib include medication and catheter ablation, but physicians and patients have been searching for more effective, longer-lasting treatment options. Patients with chronic A-Fib often need to undergo treatment after treatment, as the symptoms tend to return.

Cardiac experts at the MedStar Heart Institute are excited to offer Convergent Atrial Fibrillation Ablation to patients with difficult-to-treat A-Fib. Convergent A-Fib Ablation is a minimally invasive hybrid procedure, combining the unique capabilities of interventional cardiac electrophysiology with those of cardiac surgery to aggressively treat this frequently frustrating heart rhythm disorder.

Benefits of Convergent A-Fib Ablation

Cardiac specialists at the Heart Institute are specially trained in performing this complex procedure. An interdisciplinary medical team will plan every step of your procedure and answer any questions you may have.

Benefits of Convergent AF Ablation include:

• Minimally invasive. Provides both endocardial and epicardial ablation without the need for chest incision or bypass
• Intra-operative testing. We are able to ascertain the effectiveness of the therapy during the procedure itself.
• Multidisciplinary care. Experts in many areas of cardiac care are involved in your treatment.
• Shorter hospital stay. You experience less pain, a shorter hospital stay, and faster recovery times than traditional surgical methods.

Convergent A-Fib Ablation: Why Choose MedStar Heart Institute

We are one of only a handful of health care centers in the nation to offer Convergent A-Fib Ablation, and the only hospital in the region to do so. The MedStar Heart Institute includes the largest team of heart rhythm specialists in the Washington metropolitan area as well as the largest and most sophisticated cardiac electrophysiology laboratory in the mid-Atlantic region, and among the premier electrophysiology facilities in the world . We are pleased to be able to continually remain at the cutting edge of technology to offer our patients the world’s very best care.

Convergent A-Fib Ablation: What to Expect

During your treatment, your medical team will work together to perform the hybrid procedure. A cardiac surgeon and a cardiac electrophysiologist will each perform part of your procedure.

1. Your surgeon will make a a small incision below the breastbone to create access to the heart.
2. The surgeon will also make two smaller incisions to serve as ports, through which instruments are passed, to see inside the chest and guide the ablation. The beating heart is visualized and treated in real time.
3. Radiofrequency energy is used to heat heart tissue and remove the triggers of atrial fibrillation.
4. Once the surgeon is finished, the electrophysiologist takes over. He or she advances a catheter through a vein in your thigh and, under x-ray guidance, delivers it to your heart. From this point, further ablation is done to ensure that the triggers of atrial fibrillation are silenced and the heart tissue that sustains atrial fibrillation is treated to minimize further arrhythmia.
5. The procedure is supported by state-of-the-art imaging technology that creates high-resolution 3-D images of the heart. This guides the procedure and ensures the therapy is highly precise and safe.

Normal rhythm is restored, the procedure is completed, and you will spend 2-3 nights in the hospital. Most patients are back to their usual routine within days and experience long-lasting arrhythmia relief.

Contact Us

Call 202-877-DOCS to make an appointment with an A-Fib specialist or to order an information kit.