Atrial Fibrillation and Ejection Fraction
What is a normal heart vs. an atrial fibrillated heart?
Atrial fibrillation is an abnormal rhythm from the upper two chambers of the heart. The upper two chambers of the heart are the atria. Ordinarily, the atria beat about 60 to 100 beats a minute. The lower two chambers, the ventricles, will follow up the upper two chambers so a heart beat in the upper chambers is followed by a heart beat in the lower chamber and that's what causes a heart beat. When atrial fibrillation occurs, it's an abnormal rhythm where the upper chambers quiver. The rate in the upper chambers is about 500 beats per minute and they just quiver, they don't really pump any blood flow. And that causes a very irregular, rapid pulse in many patients.
Am I having atrial fibrillation?
One way to tell if you are having atrial fibrillation or not, to be sure, is to do an EKG. There's a few other ways you can know. Many patients, if they are younger, will have a very rapid irregular pulse and they know for sure. They feel it everytime they are in a-fib because they get very symptomatic. Another easy way to know, and we can do this in almost everybody, is you can just check your pulse. If somebody knows how to check their pulse with their wrist, if its regular, its generally not a-fib. Atrial fib in all patients tends to produce a very irregular, a very rapid pulse. Irregularity is the key.
Catheter Ablation Procedure
Even just 10 years ago, in order to do this type of surgery, where you try to actually eliminate abnormal parts of the heart that are causing the arrhythmia, in order to do it, you had to open the chest, find those parts, and actually cut them out with a scalpel. Now, all this can be done minimally invasively with just a couple small punctures in the patient's groin with the catheter which you can move and control rather precisely in a three dimensional place. While the patient is likely going to go home tomorrow, and hopefully will be fixed of his a-fib when we are done. times be relatively slow and they don't know they are in it. That's a problem because these patients are at a high risk of stroke and don't know until they have an EKG.
What causes atrial fibrillation?
Atrial fibrillation can be caused by a number of different things, but it's generally caused by something which stretches the upper two chambers of the heart. In particular, the left upper chamber of the heart. If it's subject to stress or stretched, atrial fibrillation can occur. When the upper chambers of the heart are stretched, they become sort of ticklish and they start to quiver. So, patients who have atrial fibrillation will often times have high blood pressure or a leaky heart valve or a combination of those things and cause the upper chambers to become stretched and that's what causes atrial fibrillation. In many patients, atrial fibrillation occurs for unknown reasons. Those patients are called
Meet the Experts:
You can't just have a doctor who knows how to do the ablation or has the surgical skill to do the ablation. You can't just have a four million dollar electrophysiology lab with state of the art x-rays, with state of the art mapping systems. You can't just have an anesthesiologist who knows how to deliver cardiac anesthesia, or a staff of nurses who know how to set up the room and assist the doctor. You need to have it all. You need to have a critical mass of people in order to successfully and safely do this procedure. At JFK Medical Center, we have it all. We have everything we need to safely and hopefully effectively fix a-fib in most patients who have atrial fibrillation.
What are the signs and symptoms of atrial fibrillation?
Atrial fibrillation tends to cause an irregular rapid pulse. In many patients, what they feel is palpitations, shortness of breath, lightheadedness, and dizziness. When patients are in atrial fibrillation, they may often have palpitations, feel short of breath and feel a rapid and irregular pulse. During atrial fibrillation the upper chamber is not pumping blood, it's quivering. So, when the upper chamber quivers, blood can pool and clot, so patients who have atrial fibrillation are at higher risk of stroke. If somebody doesn't have symptoms and they have a-fib, it is worse because they can be in a-fib for long periods of time and not know it and can lead to an increased risk of stroke. Older patients tend to have slower pulses, so when atrial fibrillation occurs, the pulse will often "lone atrial fibrillators." They have lone atrial fibrillation and there is no obvious identifiable cause for A Fib. They just have it.
How do you treat atrial fibrillation?
There's a number of options you have for patients but one of those options should include, for many patients, a blood thinning drug to help prevent stroke if they have atrial fibrillation. If you want to treat the arrhythmia, there's a number of different options that you have for treating atrial fibrillation. One is medications. And medications are antiarrhythmic medications. The other alternative for patients with atrial fibrillation if medications fail, is catheter ablation. With catheter ablation, a catheter is inserted through a vein in the leg and can be traced up into the heart under x-ray, using three dimensional guidance systems. We can actually map the electrical system of the heart and identify these usual suspect cells, the areas in the heart where atrial fibrillation tends to come from. Once we have identified, mapped, and identified areas where atrial fibrillation tends to come from, we can then apply the catheter to these areas. There are other treatments available for atrial fibrillation aside from the catheter ablation. One of the treatments is a procedure called the Maze Procedure. With this procedure, the chest is opened surgically, the heart's exposed and the areas causing atrial fibrillation are basically destroyed with a scalp. The heart is then sewn back together, the chest is closed, and these abnormal areas which cause atrial fibrillation have been taken out with a surgeon's scalpel. This procedure will work very well for atrial fibrillation.