January 2021 Health Matters

Don’t Miss a Beat: NCH has Cutting-Edge Treatments for A-fib By Jean Amodea

Atrial fibrillation, or A-fib for short, is an irregular heart rhythm caused by the heart’s upper chambers pumping blood out of sync with the lower chambers.

“With A-fib, the upper chamber of the heart starts quivering, explained NCH Electrophysiologist Dinesh Sharma, M.D., M.P.H, FHRS. “If it’s quivering and not beating, the blood flow is sluggish and starts to form clots.” Although symptoms can range from vague feelings of fatigue, weakness, and breathlessness to dizziness, lightheadedness, chest discomfort, and heart palpitations, up to 20 percent of those afflicted never experience any symptoms at all. An EKG can be conducted to detect the presence of A-fib.

If left untreated, A-fib can lead to blood clots, stroke, and heart attack, which can be potentially fatal. The good news is that A-fib is manageable.

“One of the most important aspects of managing A-fib is decreasing the stroke risk,” said Dr. Sharma. “To decrease that risk, we prescribe blood thinners like Eliquis, Xarelto, Pradaxa, or Coumadin, which can all help decrease the risk of stroke by 60 to 70 percent.”

For patients who cannot take blood-thinning drugs due to a higher risk of bleeding from falls, gastrointestinal problems, polyps, or who have a history of major bleeding, nosebleeds, or bladder bleeding – the Watchman device is considered as an option. The device is implanted through the leg into the heart and blocks the area in the left upper chamber where 90 percent of clots form. Studies show that it is potentially superior to Warfarin and non-inferior to newer medications, like Eliquis.

Dr. Sharma stressed that early diagnosis and treatment are ideally the best course of action since waiting too long to bring the patient back to a normal heart rhythm sometimes lowers the success rate.

“While cardioversion is a temporary way of restoring normal rhythm with an electric shock, for long- term relief we prescribe antiarrhythmic drugs or do a catheter ablation, where we try to cauterize or freeze the tissue believed responsible for most of the A-fib,” explained Dr. Sharma. “For those with intermittent A-fib that is detected early, the success rate is up to 80 percent with one ablation and 90 percent with the second ablation.” The NCH Heart Institute also uses cutting-edge ablation technologies such as radiofrequency and cryoablation, which provide higher success rates. Conventional cardiac ablation does have limitations for patients who have been experiencing A-fib asymptomatically for longer periods of time. However, Dr. Sharma says current research is seeking new technologies to treat patients with long-term atrial fibrillation.

“There are many new technologies and clinical trials to advance atrial fibrillation management,” he explained. “We are participating in some landmark trials to advance the field.”

For more information, call NCH Heart Institute at (239) 624-4200 .

Lifestyle changes to improve heart health: • Lose weight, which helps control blood pressure • Monitor and avoid activities that trigger irregular heart rhythm and report it to your doctor • Quit smoking • Limit alcohol intake • Limit the use of caffeine (colas, coffee, tea, and some over-the-counter medications like cough and cold medications)

See a doctor if you suspect A-fib and experience: • Lightheadedness, fainting, or dizziness • Lack of energy or feeling fatigued • Sudden pounding, fluttering, or racing sensation in the chest • Pain, pressure, or chest discomfort • Shortness of breath Treatments used to manage A-Fib: • Medication such as blood thinners and beta-blockers • Electric shock (cardioversion, a temporary treatment) • Minimally invasive surgery (catheter ablation)

Risk factors

• Those over age 60 • Sleep apnea • COPD • Heart conditions like heart failure • Bowel problems

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