Expert Care For Those Suffering From Atrial Fibrillation

Atrial fibrillation is the most common arrhythmia and affects individuals of all ages. We recognize that atrial fibrillation is an epidemic health care problem in the United States and getting worse. Almost 3 million Americans suffer from it today, a number that is predicted to increase to over 14 million by 2050.

Initial Evaluation

The initial evaluation is performed by your physician with the goal of excluding any potential reversible causes for atrial fibrillation (AF). Frequently, an echocardiogram is performed to look for cardiac abnormalities which may be contributing to your arrhythmia. At the Maimonides Heart & Vascular Center, we use a variety of monitors (Holter, event monitor, etc.) to ensure that the correct diagnosis is made.

Often, patients present with a very rapid heart beat. Initial treatment usually includes medication to slow the heart rate and prevent the arrhythmia from returning. In addition, many patients require an anticoagulant (blood thinner) and some may require an electrical cardioversion to return the heart to normal rhythm. Long-term management may also include an ablation procedure to prevent the arrhythmia from returning.

Rhythm Control therapy

Antiarrhythmic Drug Therapy: Numerous medications may be used for the prevention of atrial fibrillation. Only a few medications for rhythm control are currently approved by the FDA. The more commonly used drugs are Sotalol, Propafenone, Flecainide, Tikosyn (Dofetilide) and Multaq (Dronedarone). Other medications are available and may be used in appropriate situations. Antiarrhythmic drugs must be used carefully and only after consultation with your physician.

Ablation therapy: Catheter ablation technology has rapidly advanced in the past decade to allow successful control or elimination of atrial fibrillation. The procedure is most frequently performed in our state-of-the-art, newly-designed Electrophysiology Laboratory. Advanced three-dimensional mapping, rotational CT scan angiography, and intra-cardiac echocardiography are used to enhance procedural success and safety. These approaches also minimize radiation exposure to the patient. Catheter ablation is used to treat AF, as well as a number of other arrhythmias, including atrial flutter or atrial tachycardia, which commonly accompany atrial fibrillation.

While ablation of atrial fibrillation has traditionally been performed utilizing a surgical or catheter ablation approach, we are proud to be able to offer Maimonides patients the latest “convergent” or hybrid approach, which combines a minimally invasive surgical procedure with a catheter-based “touch-up.” This technique allows us to offer ablation therapy to patients who have long-standing atrial fibrillation and who previously would have been difficult to treat and may have required multiple ablation procedures. At Maimonides, cardiac electrophysiologists work closely with cardiothoracic surgeons to tailor an approach which best fits your needs. Procedures, when necessary, are offered to provide the greatest possible success in controlling the arrhythmia in the safest possible fashion.

Additional therapies

Rate Control:  Medications which slow your heart rate are important in controlling symptoms related to atrial fibrillation. Rate-slowing drugs include beta-blockers, calcium channel blockers, and digoxin.

Cardioversion: At times, an electrical shock is used to convert the atrial fibrillation to a normal rhythm. This procedure is performed under sedation to assure patient comfort. Frequently, this procedure is accompanied by a trans-esophageal echocardiogram, which enables the doctor to ensure that there are no blood clots in your heart which might dislodge and cause a stroke. After cardioversion, medications may be prescribed to help prevent future episodes of arrhythmia.

Stroke prevention: Atrial fibrillation is a common cause of stroke, and protection against stroke is most commonly provided with the use of anticoagulants (blood thinners). In the past (and presently, as well), many patient were treated with Warfarin. Today, alterative options are available, such as Pradaxa (Dabigatran) or Xarelto (Rivaroxaban). In some situations, aspirin may be the preferred therapy. The best choice of anticoagulant should be made based on your specific clinical situation after consultation with your physician.

Pacemaker: Patients with atrial fibrillation frequently have slow heart rate problems when in a normal rhythm. This may be due to abnormalities of your heart's own pacemaker or due to medications you may be taking. An artificial pacemaker can be inserted to maintain a normal heart rhythm. In some situations, this is performed in conjunction with ablation of the hearts electrical system, to allow for better heart rate control. While the vast majority of pacemakers can last for many years without problems, some patients may need to have their leads removed for various reasons, such as cases in which there is infection, breakdown or malfunction of the lead. The Maimonides Lead Extraction Service is staffed by specialists who are specifically trained in lead removal. For more details on lead extraction, click here.