SR smallFor 50 years Lown Group physicians have managed thousands of patients with atrial fibrillation (AF), a common sustained heart rhythm abnormality (arrhythmia). Over that time, we developed an individualized, patient-centered model of care focused on improving long-term outcomes and quality of life.

Being diagnosed with a cardiac condition can be an overwhelming experience. We take time to help our patients understand their condition, and reassure them that AF is very manageable and that the vast majority of people with AF are able to lead full lives.

Understanding AF

Atrial fibrillation is an irregular, frequently rapid heart rhythm originating in the heart upper chambers (atria). It might be present intermittently (paroxysmal) or permanently. It may present with palpitations, breathlessness, fatigue and exercise intolerance, light-headedness, or congestion. Many AF patients have no symptoms and AF is discovered incidentally. The majority of AF patients are older than 70 and frequently have a history of high blood pressure or other heart conditions. Potentially reversible causes of AF include hyperactive thyroid, alcohol consumption or ingestion of other stimulants, and stress, both physical and emotional, in susceptible individuals.

The most fearful complication of AF is stroke, caused by blood clots that originate in the atria and travel in the circulation to the brain (embolism). The annual incidence of stroke varies – about 3-5% in patients over 70. About 20% of all strokes are caused by AF. Weakening of the heart muscle and heart failure (fluid retention) due to sustained rapid pulse may occur. Occasionally, fainting spells result from slow AF.

Individualized Treatment

We don’t treat AF but the patient with AF. Through careful listening and examination, we identify variables that guide treatment. These include underlying heart disease, symptoms, level of physical activity, emotional state, medications, potential side effects of therapies, cost of care and, importantly, individual preferences.

Maximizing Non-invasive Medical Therapies

Our patient-centered model of care utilizes proven, minimally invasive therapies. Our treatment goals are to prevent complications, minimize symptoms, and improve long-term quality of life. We opt for invasive procedures only as a last resort. Atrial fibrillation is not a life-threatening condition and calling 911 is not necessary unless severe light-headedness, shortness of breath, or chest pain are present.

Blood thinners are a mainstay for treating patients with a higher stroke risk. For decades Coumadin (warfarin) was the only option. In recent years new, “novel” blood thinners became available (such as Pradaxa, Xarelto, and Eliquis). There are a number of benefits to these newer medications, however their cost might be prohibitive to some patients. Patients at low risk for AF related stroke might be treated with aspirin.

Meticulous heart rate control with medications (beta blockers, calcium blockers, and digoxin) is a central component of alleviating AF symptoms. For new onset of AF, 1-2 doses of antiarrhythmic drugs can be an effective treatment option in restoring normal rhythm in patients with infrequent episodes of paroxysmal AF. However, antiarrhythmics should be used cautiously because of potentially significant side effects, especially when used over prolonged periods of time.

Performed under short-term IV anesthesia, electrical cardioversion is the procedure of choice to restore normal rhythm for new onset sustained AF. Effective and safe, it may be attempted in most patients with permanent AF at least once.

Atrial fibrillation ablation is a heavily promoted catheter-based technique to cure AF. However there is risk of major complications, the success rate is 80% at best, and repeat procedures are occasionally necessary. While ablation may be a viable option for a select few AF patients, we see it as a last resort.

For decades, the majority of our patients with AF have led full lives thanks to our individualized treatment. If you have AF or experience any of its symptoms, come in for a visit and we can work together to develop a treatment plan that is going to work for you.

 

Click here to read more posts from Dr. Ravid