New research and treatments for atrial fibrillation raise hopes for a cure for this irregular heart rhythm that affects millions.

For years, atrial fibrillation (ATRIAL FIBRILLATION) was considered just an annoying, chaotic heartbeat that people could live with. But experts would learn that atrial fibrillation is not benign and raises risk of cardiovascular problems, including stroke and heart failure.

Gaining understanding of atrial fibrillation has led to better ways to treat the disorder, the most common irregular heart rhythm (arrhythmia) in the U.S. Recent advances in cardiology have allowed doctors to cure atrial fibrillation in many patients.

WHAT IS ATRIAL FIBRILLATION?
Errant electrical impulses in the heart’s top chambers, the atria, spark atrial fibrillation. Instead of traveling along their normal routes, these impulses chaotically spread through the atria, causing them to beat rapidly and erratically instead of contracting and relaxing normally.

This causes the top and bottom chambers of the heart beat out of synchrony with each other making the pumping function of the heart less effective. atrial fibrillation may, therefore, contribute to heart failure and raise the risk of death from heart disease.

In addition, atrial fibrillation can cause blood to pool in the atria, where it can clot. The major concern with atrial fibrillation is that a clot can break free, travel to the brain and cause a stroke.

Atrial fibrillation often causes such symptoms as:
• Sudden pounding in the chest or a fluttering feeling.
• Feeling in the chest that the heart is racing or skipping a beat.
• Pressure or discomfort in the chest.
• Unusual tiredness.
• Shortness of breath or leg swelling.
• Dizziness.
• Anxiety.
• Some patients have no symptoms at all.
People with atrial fibrillation often suffer from:
• Strokes (most often caused by blood clots).
• High blood pressure.
• Lung disease.
• Thyroid disease.
• Depression.
• Leaky heart valves.
• Congestive heart failure.
• Coronary artery disease.
• Inflammation within the heart.

The risk of atrial fibrillation increases with age – up to 5 percent of people over age 60 and 10 percent of those in their 80s have atrial fibrillation.

THE FUTURE OF ATRIAL FIBRILLATION TREATMENT
Until recently, treatment options for patients suffering from atrial fibrillation have been limited to medications. They included:

1. Blood thinners to prevent strokes.

2. Beta-blockers or calcium channel blockers that do not allow the heart to go too fast when atrial fibrillation develops.

3. Antiarrhythmic medications that keep the heart in normal regular rhythm. Unfortunately, antiarrhythmic medications are effective in preventing atrial fibrillation in only a limited number of patients. Sooner or later, most of the patients develop permanent atrial fibrillation despite of all our efforts with different medications.

Overall, medications treat the symptoms of atrial fibrillation, but they cannot cure the condition. Therefore, the patient has to continue taking them long-term with subsequent side effects (for example, blood thinners have a high risk of bleeding and are not tolerated by all patients).

However, now there is hope. A special cardiac procedure (radiofrequency ablation) cures atrial fibrillation in a significant percentage of patients. Ablation is a non-surgical procedure when catheters (tiny wires) are placed through the groin veins and guided by x-ray into the heart to create a three-dimensional map of the heart chambers responsible for atrial fibrillation. After that, one of those catheters is used to deliver heat (radiofrequency energy) to create small lines of scar in certain parts of the affected heart chamber. These scars act as “barriers” for abnormal electrical impulses known to cause atrial fibrillation. Successful catheter ablation cures atrial fibrillation and eliminates the need to take blood thinners or other medications for that condition.

The atrial fibrillation ablation has been shown to be effective in over 80% of patients and has a relatively low risk of side effects. Most patients who receive this treatment find that they are back in normal sinus rhythm (have a regular heartbeat) within 3 to 6 months, if not much sooner. The usual hospital stay is 1-2 days. The procedure is more often done under general anesthesia to provide maximal patient comfort for the duration of the whole procedure (usually 3-5 hours). The procedure is usually recognized and covered by Medicare/Medicaid and most other major health insurance plans.

Just who is a candidate for ablation remains a subject of debate. Most experts used to recommend the procedure only when medicinal treatment has failed or when a patient suffers a stroke from atrial fibrillation. However, in a 2005 study, Cleveland Clinic researches concluded that radiofrequency ablation is feasible as a first-line treatment for carefully selected atrial fibrillation patients and may become a first-choice therapy for most of patients with atrial fibrillation. Atrial fibrillation guidelines issued in September of 2006 by American Heart Association consider radiofrequency ablation as a reasonable first-line therapy if the patient does not want to take the risks or inconvenience of long-term antiarrhythmic medications and blood thinning therapy.
This approach has allowed to improve the quality of life for many patients with this very common condition.

Dr. Alexander Ivanov, a board certified electrophysiologist in our practice, was one of the first electrophysiologists in this area of the country who added this procedure to other kinds of complex radiofrequency ablations done by top-notch specialists. Actually, he spent a few weeks in Milan (Italy) working with famous Dr. Carlo Pappone who is considered the most experienced physician in the world in the area of atrial fibrillation ablation. Dr. Ivanov says "What makes me excited and satisfied performing this complex procedure is happiness on the patient's face when approximately six months after the ablation I tell the patient that he or she may stop taking Coumadin and other drugs".

To learn more about the treatment of atrial fibrillation and comprehensive cardiovascular care available at our office – please call (908) 722-6410 or visit our web site at www.MyHeatDocs.org.