Richard J. Frink, MD Retired Cardiologist 12 year ORPS Owner
ATRIAL FIBRILLATION (AFIB) Afib is the most common heart rhythm irregularity and is associated with increasing age. Many people in ORPS have Afib. In brief, “Atrial,” refers to the upper two chambers of the heart and “fibrillation” means the atria are not contracting synchronously, but erratically, producing a very fast irregular, heart beat, upsetting to the patient. Blood still flows to the lower chambers, which are still contracting normally, maintaining the blood pressure. Importantly Afib is not a death sentence and is perfectly compatible with long life, but it does carry risk and requires close observation by the patient and the physician. The most important thing about Afib is its association with stroke. A stroke associated with Afib is commonly caused by a small blood clot from the fibrillating atria passing to the brain. Numerous large clinical trials over the past 20 years have shown that these strokes can be prevented by taking anticoagulant drugs as long as the patient is in Afib. Anticoagulant drugs include Coumadin/Warfarin that require regular blood tests, or newer drugs like Eliquist or Prodaxa that do not require regular blood tests, but are very expensive. Both are equally effective in preventing stroke. The heart can be returned to normal regular rhythm by “Cardioversion” or “Ablation.” Cardioversion involves putting the patient to sleep for a few minutes and then delivering a shock with a defibrillator. Cardioversion is often successful, but is often not a permanent cure of Afib. Ablation is an invasive method using catheters inserted from the groin into the heart to map out the electrical activity in the atria and then delivering an electrical charge to destroy tiny “trigger” points that are producing the Afib. Ablation is also not 100% perfect, but a definite advance. The success rate in curing Afib using Ablation ranges from 60% to 80%. The patient needs to have a full discussion with a cardiac electrophysiologist on the pros and cons of Ablation before proceeding. Summary: Afib is very common in older patients, but very manageable. The patient needs a physician to manage/ advise on the various treatment options available because of the risk of stroke. Do NOT ignore Afib even though you feel well. The most important thing to remember is its association with stroke and a stroke can be prevented by taking long term anticoagulant drugs.
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