This approach has been shown to be effective and leads to improved quality of life for patients. However, this approach does not address the fibrillating atria, and such patients still require systemic anticoagulation for thromboembolism and stroke prevention. Several features of pacemaker systems may be useful for patients with AF. A pacemaker that has the capability to change automatically into a nontracking pacing mode at the onset of an episode of AF known as mode switching is essential to avoid the rapid heart rate that might otherwise occur when the pacemaker responds to rapid atrial activity by pacing the heart inappropriately fast in the ventricles.
Implantable atrial defibrillators have been developed, either as a stand-alone device or in combination with a ventricular defibrillator. However, the atrial defibrillator has not been widely accepted by patients or physicians. In general, patients have difficulty tolerating even the low-energy internal cardioversion shocks or frequent antitachycardia pacing sequences without the deep sedation provided during conventional external cardioversion.
Catheter ablation has emerged as a safe and effective alternative to antiarrhythmic drug therapy for the maintenance of sinus rhythm. However, as is the case with antiarrhythmic drug therapy, it has not demonstrated a reduced risk of mortality, stroke, or heart failure and thus is not regarded as a substitute for stroke prevention strategies.
Postablation, spontaneous electrical impulses originating from within any of the 4 PVs cannot propagate into the atrial body to initiate or trigger AF. Pulmonary vein isolation is thus a stand-alone treatment approach, but has also been incorporated into larger ablative efforts aimed at non-PV triggers and substrate modification.
Substrate modification or ablation of non-PV triggers are often incorporated into procedures for patients with persistent or long-standing persistent AF. Outcomes data suggest that PVI alone without substrate modification works best in patients with paroxysmal AF.
The role for more extensive ablation for patients with persistent AF remains unclear after the recent STAR AF II trial showing no reduction in the rate of recurrence after extensive ablation. Experienced centers have reported high rates of successful AF ablation resulting in discontinuation of antiarrhythmic drug therapy. In virtually all studies involving catheter ablation, efficacy rates are lower among patients with persistent AF and long-standing persistent AF.
The degree of atrial myopathy, scar burden and comorbidities may also influence outcomes. Weight loss strategies for patients with obesity and treatment of sleep apnea are recognized as increasingly important in clinical outcomes.
There are currently 2 different energy sources in use for the purposes of catheter ablation. The more commonly used radiofrequency current leads to tissue death by heating and is applied using a point-by-point method.
Cryoablation uses cryogenic energy delivered in a single step by means of a balloon resulting in tissue necrosis by freezing. The FIRE and ICE trial comparing the 2 energy sources concluded that cryoablation was not inferior to radiofrequency ablation with respect to efficacy in patients with drug refractory paroxysmal atrial fibrillation. However phrenic nerve injury was more common 2.
While such phrenic nerve injuries typically resolve spontaneously, it may take up to 1 year and can be associated with significant morbidity. Other procedure-related complications include serious events such as stroke 0. Procedures typically take 4 to 6 hours, involve the use of radiation X-ray, and have an expected hospital course of overnight observation with planned discharge the next day.
Recurrence of AF after a blanking period of 3 months postablation may indicate recovery of pulmonary vein conduction and can be an appropriate indication for repeat ablation or antiarrhythmic therapy. Oral anticoagulation is recommended for at least 3 months following ablation and thereafter based on the individual patient risk for stroke.
The original Cox-Maze surgical procedure for the treatment of AF has substantially evolved from its initial form. In general, it involves a series of incisions or lesions in the atria. These are carefully placed to compartmentalize the atrial tissue to channel atrial activity and prevent the re-entry required for the maintenance of AF.
To a certain extent, there has been a confluence with some of the lesions sets delivered during catheter ablation techniques. For example, achieving anatomic PVI is now considered standard with both approaches. Non-incisional lesions may be placed using bipolar radiofrequency, cryothermy, or microwave energy. Outcomes associated with surgical approaches are comparable with catheter ablation reported higher in some series and offer the advantage of concomitant exclusion of the left atrial appendage.
The incidence of perioperative complications has been low but perhaps higher than catheter ablation. The invasiveness of this approach makes it a less desirable option for patients with AF alone, but it might be attractive for patients undergoing cardiac surgery for another indication eg, valve replacement or coronary bypass surgery or for patients with a particularly strong indication for exclusion of the left atrial appendage ie, recurrent thrombus despite antithrombotic therapy.
Surgical approaches have continued to become less invasive. Several centers have been using minimally invasive incisions and even thoracoscopic approaches with robotic equipment.
Some surgical centers incorporate electrophysiologic testing and even catheter-based techniques with the procedure known as hybrid procedures. The prevalence of AF, already at epidemic proportions, is expected to continue to increase as the population ages and more patients with heart disease live longer. This is especially true for patient with heart failure. The rapid growth of catheter-based and surgical ablation procedures is promising and has already relieved many patients of the burden of AF and the side effects and toxicities of antiarrhythmic medications.
However, these approaches are invasive and inherently destructive, and associated with a small but important risk of serious complications. Technological innovation in mapping systems, catheter design including the use of contract force sensors , and novel energy sources are further expected to improve the safety and perhaps effectiveness of these procedures.
Additional research informing the genetic aspects of AF is also expected to impact the management of AF. Genetic approaches to AF have identified common genetic variants like chromosome 4q25 locus that modulate susceptibility to AF and response to contemporary therapy.
Further research into the underlying molecular and genetic causes of AF may lead to novel methods of disease prevention. Atrial Fibrillation Daniel J. Future Directions Summary References. Definition Atrial fibrillation AF is a common heart rhythm disorder caused by degeneration of the electrical impulses in the upper cardiac chambers atria resulting in a change from an organized heart rhythm to a rapid, chaotic rhythm.
Back to Top Prevalence Atrial fibrillation is the most common sustained cardiac tachyarrhythmia encountered by clinicians worldwide. Back to Top Pathophysiology Atrial fibrillation may be acutely associated with physiologic stressors such as surgical procedures, pulmonary embolism, chronic lung diseases, hyperthyroidism, and alcohol ingestion.
Figure 2: Click to Enlarge. Figure 3: Click to Enlarge. Figure 4: Click to Enlarge. May exacerbate reactive airway diseases; cause fatigue, depression, and impotence. Abrupt withdrawal may cause rebound tachycardia, hypertension and myocardial ischemia.
Drug Dose Onset of Action Duration of effect Propranolol Intravenous 1 mg bolus, repeat every 5 minutes as needed to achieve goal 5 minutes 1 to 4 hours Oral immediate release 10 to 30 mg every 6 or 8 hours daily 1 to 2 hours 6 to 24 hours depending on form Oral extended release 80 to mg daily 1 to 2 hours 6 to 24 hours depending on form Metoprolol Intravenous 2.
Useful in combination with other atrioventricular nodal agents. Not recommended as monotherapy under practice guidelines. J Am Coll Cardiol ; — Estimates of current and future incidence and prevalence of atrial fibrillation in the U.
Am J Cardiol ; — JAMA ; — Atrial fibrillation: Epidemiology, pathophysiology, and clinical outcomes. Circ Res ; — Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med ; — Focal impulse and rotor modulation ablation of sustaining rotors abruptly terminates persistent atrial fibrillation to sinus rhythm with elimination on follow-up: A video case study. Heart Rhythm ; — Efficacy of cardiac autonomic denervation for atrial fibrillation: A meta-analysis.
J Cardiovasc Electrophysiol ; — A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. Incidence of atrial fibrillation in heart transplant patients: Long-term follow-up. Acute and early outcomes of focal impulse and rotor modulation FIRM -guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation. J Interv Card Electrophysiol ; — Atrial fibrillation: A major contributor to stroke in the elderly.
The Framingham Study. This is very common in women. You may feel as though you are having an anxiety attack, which many doctors will diagnose from your symptoms. Also, an echocardiogram can show prolapse and abnormal rhythms.
You need to assert yourself, you know what you feel, and there are a variety of options to treat the distressing symptoms. My husband had his first AFib in while digging a post hole for a fence and ask for a glass of ice water. He immediately felt his heart and I took him to patients first Who called and took him to the hospital. This is when we learn it was AFib. The doctor gave him the pill in the pocket and said take this and you do not have to go to the emergency room.
While we were digging and working on a new deck and he got some ice tea and immediately felt the a fib, on immediately felt the a fib coming on. We went in the house and I gave him one mg propafenone. But my husband said no Iam suppose to take all four. In a hour he felt uncomfortable. I said we are going to the emergency room He ask for his shoes and the. He was completely still and he started turning gray I was on the phone with I attempted cpr And blew in his month nothing I did it again not knowing the exact way to do it a pushed on his chest and blew in his mouth this time he made moaning noises and.
Paramedic was the coming by this time. My husband become alert and ask for a towel because he said he wS sweating. They did his vitals and he was normal. Do you think the meds did this to him? Did he have. Seizure Or was it worst did his heart stop? Only 6 attacks in 6 years. Thank you. In my personal experience with AFib 9 out of my 10 episodes involve cold drinks. From my admittedly questioable internet research this has something to do with the vagus nerve.
I just was hospitalized after an episode of kayaking followed by a snow cone… so I just want to let you know I experienced this work plus cold drink issue also. This is interesting. It always happens after he has been working and drinks something cold rather fast… This has been the trigger every single time and it lasts for HOURS sometimes even into the next day.
He would never go to the hospital or the doctor. Anyways, I find it interesting that so many people report going into A FIB after drinking something cold. If your ventricular rate does not respond to medications, you may need to have a pacemaker surgically installed. A pacemaker is an electronic device that regulates the heartbeat to correct RVR.
Pacemakers are most often used for people who have Afib and a slow heartbeat. Well , done. It is explained excellently. I never could call it heart is racing. Though I am suffering from it. I passed out at work. It was supra ventricularTachycardia so i has a cardiac ablation done on May 3. But since then i having developed a fib with rvr.
Another cardiac ablation scheduled for October 25th. What are my chances of needing a pacemaker?? It all depends on the location and aggressiveness of the ablation. This can be discussed with the EP prior who would typically ask you how aggressive you would want them to be to cure the arrhythmia.
I was just diagnosed with AFIB. I was admitted to the Emergency room with a heart rate of over That was because I went to one Cardiologist who took me off of Metroprolol. After the Emergency room released me, the hospital Cardiologist gave me Xaltra, and 25mg of Metroprolol. I am overweight, and have a nightly Scotch drink. I know that I should lose weight, but what about the Scotch drink…can I still have it every night? Some people are more prone to afib with alcohol, if you improve without it i would abstain, if not then theres no clear guidance.
Her heart rate got as high as and paused at 0 for four seconds, several times. The medication they gave her through IV took an hour and forty five minutes to work, but when it finally kicked in, her heart rhythm became normal. She is being released from the hospital today and will see a cardiologist in the near future. Is it safe for her to be alone right now? Of course i cant comment on the specific case without knowing all the details.
In general with patients with afib if the rate is controlled and she is not having significant symptoms there is no specific concern. I have been on BP meds for about 10 years now. I am 48yr old female. Overweight, but was on meds prior to weight issue. His mother also died from stroke at I used to take labatelol and then was changed to atenolol which controlled my heart rate and bp fairly well for 1 yr. Then atenolol was increased and again, things were good for just over a year, then HR increased again with some episodes of extreme high rates for a few to several minutes.
A doctor may or may not prescribe the following medications to begin the long process of treating AFib with RVR:. However, it is very important to consult a cardiologist before taking any kind of medication. Even if one suffers from this condition, it is possible to lead a healthy life for decades given you avoid alcohol, smoking, junk food, and red meat. Furthermore, treatments are effective but bear this in mind, the condition can return. Medications are typically the first step toward controlling the ventricular rate.
Some common medications used to slow the ventricular rate in people with this condition include:. For some people, medications may fail to restore a normal ventricular rate. In this case, an artificial pacemaker can be installed. This electronic device regulates the beating of the heart. Another option can also include ablation. Controlling the heart rate is necessary to maintain good blood and oxygen flow to the heart, brain, and body.
Talk to your doctor to learn more about the prognosis for your specific condition. Nearly three million Americans live with atrial fibrillation. If you're one of them, we'll show you how you can improve your overall prognosis.
The four types of atrial fibrillation can have different symptoms and treatment options. Learn their similarities and differences.
From medications and surgery to other procedures, you have several treatment options for atrial fibrillation. We'll go over them in detail. AFib is a progressive condition that may become more serious over time. Find out how you can control it through medications and lifestyle changes.
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