Atrial Fibrillation - Questions and Answers
FINDING A PHYSICIAN
How do I find doctors with the most experience in performing atrial ablation procedures?
You can seek advice from your regular primary care physician, cardiologist or cardiac electrophysiologist (rhythm specialist).
ATRIAL ABLATION PROCEDURES
How many types of atrial fibrillation are there?
There are 3 types of atrial fibrillation:
(1) Paroxysmal – atrial fibrillation comes and goes
(2) Persistent – atrial fibrillation lingers on and it is difficult to keep away
(3) Permanent – atrial fibrillation is always present
What is meant by a “lesion” being created with an ablation procedure? Do you mean cutting or scaring the inside of the heart? How big (long) are they? How long does it take to heal?
Lesions can refer to a variety of different things in medicine. When described in the setting of catheter or surgical ablation, they refer to the process of destruction of the areas or spots that are responsible for triggering atrial fibrillation.
What are the survival rates for an atrial ablation procedure?
Neither of the procedures improve the survival; their aim is to improve the quality of life. The mortality complication of each procedure is extremely low, at around 0.05%.
What kinds of atrial fibrillation do not require an ablation procedure?
Patients who do not have symptoms from atrial fibrillation, generally do not require surgery or catheter ablation.
When I asked my doctor if I had atrial fibrillation, he said I had a heart flutter. Is there a distinction? What if any?
Atrial flutter is different from atrial fibrillation. Catheter ablation is also used for cure of atrial flutter. The success of catheter ablation for atrial flutter is much higher than for atrial fibrillation.
Can ablation be used to treat dual heart rates? Is a heart rate of 120 too high?
Ablation can be utilized to treat other cardiac arrhythmias such as atrial flutter, atrial tachycardia, etc. A heart rate of 120 beats per minute is considered too high and suggests inadequate control of the heart rate during atrial fibrillation.
Are ablations recommended a second time for irregular flow of heart beat or slow beat?
Ablation does not help a slow heart rate. But if a patient has had a prior ablation and requires a repeat procedure to help cure atrial fibrillation, a second procedure may be feasible.
Are ablation procedures indicated for permanent atrial fibrillation?
Permanent atrial fibrillation is generally harder to cure. But all the above procedures may also be used for this type of atrial fibrillation.
Is age of person a consideration for surgical procedure for atrial fibrillation?
No. Age, by itself, is not a criterion for one type of procedure or another.
Do you remove the atrial appendage during the ablation procedures done by an electrophysiologist in the EP Lab?
No the left atrial appendage has to be removed surgically by a cardiac surgeon.
Does atrial fibrillation get worse with age?
I currently have occasional atrial fibrillation. The occurrence and recurrence of atrial fibrillation rises with age and time.
OTHER CARDIAC PROCEDURES WITH ATRIAL FIBRILLATION
How long does electrocardioversion treatment last? (Cardioversion is the application of an low dose electrical shock to the chest to change the heart rhythm to a normal rhythm)
It varies on the patient. It may last a few seconds or it may last up to many years.
Does a coronary stent or defibrillator effect atrial fibrillation and put the heart in a normal rhythm?
The role of a coronary stent is to keep the heart arteries open. A defibrillator treats certain abnormal rhythms that arise from the lower chambers of the heart (the ventricles). But neither play a direct role in treatment of atrial fibrillation.
What would the rate of atrial fibrillation reoccurrence be if pacemaker is implanted immediately after catheter ablation?
Implantation of a pacemaker does not impact the success of ablation of atrial fibrillation.
ATRIAL FIBRILLATION AND HEART RHYTHMS
I have SVT (supraventricular tachycardia) all my life and it has not bothered me. I could make it go away but now I believe because of menopause I get it more frequently and it last many hours. Is it okay to let it continue up to two days? Is it true letting my heart beat that long at a high rate will cause an enlarged heart? What other risks are there with prolonged heart rate?
If a patient has a history of SVT and stays in this abnormal rhythm for days, the heart can tire out from the rapid heart rates. In some people this can eventually result in feeling very poorly and even lead to more serious problems such as heart failure.
Is a fast or a slow heart rate more dangerous? What are the rates that are dangerous?
A fast or a slow heart rate during atrial fibrillation can result in different types of symptoms and problems. There are no absolute ‘dangerous’ cutoff values, as these numbers may differ from patient to patient. But a normal heart rate should range between 60 and 100 beats per minute.
Why does my heart continue to beat fast at night when I’m resting?
This is because the heart is in an “arrhythmia” – that is, an abnormal heart rhythm.
Is it unusual for someone with low blood pressure to have atrial fibrillation?
While high blood pressure is a known risk factor for atrial fibrillation, a low blood pressure is not at all unusual. In fact, in some patients the blood pressure drops when they are in atrial fibrillation.
What is the bundle branch area that is sometimes referred to by physicians?
The bundle branches conduct electrical energy through the bottom chambers of the heart (ventricles) and make the ventricles contract. When the electrical signals do not travel down the bundles properly, a bundle branch block is seen on an ECG recording.
MEDICATIONS
How effective is a beta blocker without coumadin for atrial fibrillation in regards to having a stroke?
A beta-blocker plays no role in preventing stroke in atrial fibrillation. A beta-blocker only helps to keep the heart rate from going rapidly in atrial fibrillation. Coumadin is the only acceptable therapy shown to reduce the risk of stroke in atrial fibrillation.
What are the side affects of the coumadin over time? Can you stay on coumadin forever?
Coumadin is a medication that is prescribed for a wide variety of conditions, one of which is atrial fibrillation. As with many other medications, coumadin can result in a variety of different rare side effects. The most common side effect of coumadin is excessive bleeding, particularly during surgery or traumatic accidents. But most people tolerate coumadin very well without major problems. Many patients take coumadin life-long without any bad outcomes.
Do atrial fibrillation medications make people worse long term?
Certain medications known as antiarrhythmic medications – that is, medications prescribed to regulate the heart rhythm – can have serious side effects. When prescribed, this should be done under close observation of a cardiologist or a cardiac electrophysiologist (rhythm specialist).
Is Toprol XL a good drug to control arrhythmias?
Toprol Xl is a long acting beta blocker. Its main role in a fib is to control the heart rate. We do not usually think of it as controlling the rhythm (getting the patient back to sinus)
Can you eat fish and take fish oil? If so, how many fish oil capsules replace eating fish? Can you take too much fish oil? How much fish is recommended?
Yes, you can eat fish and take fish oil. The number of capsules you take depends upon the brand and the amount of each capsule. Fish is recommended at a minimum of two times per week, but you can certainly eat more and/or take fish oil capsules. The only time fish would be harmful is if it is poisoned with mercury.
TRIGGERS FOR ATRIAL FIBRILLATION
Does anxiety cause atrial fibrillation?
Anxiety by itself does not cause atrial fibrillation. That is, the heart needs to have the abnormal predisposition for developing atrial fibrillation.
Does a positive attitude affect the success of procedures to rectify atrial fibrillation?
There are many studies showing that a positive attitude or mind set on the part of the patient can help his/her outcome. But there have been no such studies looking at the outcome in atrial fibrillation.
Why does my heart go into atrial fibrillation when leaning over or when sleeping on my left side?
Some arrhythmias may be triggered with shifts in position.
Has there been any studies regarding the use of caffeine that can cause atrial fibrillation?
Caffeine may trigger arrhythmias in some patients but it is not a consistent observation.
DIET AND EXERCISE
Are there any other diet recommendations for atrial fibrillation?
In general, a moderate heart healthy diet is recommended. Consult your physician for a dietary consult if possible.
Does cardio exercise strengthen the heart?
Cardiovascular exercises are good for an individual’s overall well-being. In patients with “weak” hearts, exercise (when performed correctly) can be very beneficial.
Does a heart rate monitor help to exercise more safely?
It is unnecessary for most people to use a heart rate monitor during exercise for safety reasons. The role would be to assess if there is appropriate age-related increases in heart rate with exercise.
Are there any exercise limitation with an implanted pacemaker, such as weight lifting?
For the first 6 weeks, you will be instructed to avoid lifting objects heavier than 5 to 10 pounds. There are no physical activity limitations beyond that time.
ATRIAL FIBRILLATION SEMINAR
When will you hold another symposium on atrial fibrillation?
Mercy General Hospital plans to hold another symposium in Spring 2009.
