Atrial Fibrillation

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Atrial Fibrillation is often associated with heart disease or other conditions such as Diabetes, high blood pressure, age greater than 65y/o, acute lung infection or surgery; yet in 1 out of  3 people it presents alone. During the initial stages it may resolve on its own, however it tends to recur and with the passing of time treatment is required. Likewise, 1 out of 4 people may present with no symptoms, particularly initially, but not infrequently the first sign is a catastrophic stroke. While the symptoms and disruption associated with AF are the usual focus of attention, its associated stroke is far more devastating, causing death in 1 out of  3 cases, with 2 out of  3 never recovering fully. Of the 700,000 strokes suffered each year in the US, costing an estimated $56 billion, 15% or 105,000 occur in those who suffer AF. Mortality from heart causes is increased 2-3 times in patients with a previous heart attack.

AF is the most common sustained arrhythmia, affecting more than 2.3 million people, or close to 1% of the US population. It is involved in nearly half a million hospitalizations and an average cost of more than $15 billion per year. AF is said to be a “disease of aging”, with 7 out of 10 patients being between the ages of 65-85 years. By the year 2050, 4.7 million Americans will suffer AF, not counting patients younger than 65 years. 

Treatment

• Prevention and treatment of heart disease and other associated conditions.
• Prevention of stroke, with the appropriate blood thinner selected based on the presence or absence of specific risk factors.
• Drugs to control the heart rate and drugs to terminate and prevent its recurrence. Drugs are initially straight forward and easy to use, at a reduced expense and recommended for the initial management, however they are riddled with intolerable and at times deadly side effects, and 8 out of 10 patients will be back in AF at two years. Drugs must be selected carefully for each particular patient, to avoid potentially deadly consequences.
• Since the first pioneering surgery for AF in the early1980’s,  efforts have been directed to treat this arrhythmia without drugs, and a potential permanent cure. Surgery for AF has advanced greatly over the years, and now it may be done at the time of other necessary open heart surgery (concomitant), but it is also being performed solely for the purpose of curing AF (stand-alone) via steadily smaller chest incisions, in what is called “minimally invasive”.

Recent medical research discovered that certain cells firing randomly from within a certain structure attached to the heart (Pulmonary Veins) initiate AF, particularly during its early stage. These cells may be accessed via a specialized type of heart catheterization, where catheters are inserted from the groin, and under the guidance of computers and ultrasound imaging the cells are cauterized and “isolated” from within the heart, without the need for surgery. In the qualified individual (which may be up to 6 out of 10 patients with AF) this “catheter-based” procedure has resulted in elimination of AF in roughly 8 out of 10 people, with an overnight hospital stay, and most without the need for other drugs, including Coumadine.

Both catheter–based procedures and surgery for AF are complex and sophisticated approaches that require a high degree of expertise and laboratory equipment, to obtain the most benefit and success, and avoid major potential complications.

The alternatives to the management of AF do not exclude each other, but rather play a dynamic role, and are all available as part of the comprehensive approach of our Atrial Fibrillation Center.