Atrial fibrillation (AF), the condition for which Vice President Dick Cheney was treated in late 2007, is the most common serious heart rhythm irregularity, affecting more than two million Americans.

What Is Atrial Fibrillation?

Atrial fibrillation (AF) is a common heart problem that increases risk for stroke and heart failure. During AF, the heart's two upper chambers (atria) beat out of sync with the two lower chambers (ventricles), often triggering a rapid and irregular heart rate. Heart disease and high blood pressure are among the most common causes of AF.

Long considered a relatively harmless condition, AF has now been recognized by doctors as a serious health risk. It increases stroke risk five- to sevenfold and may eventually lead to heart failure inadequate pumping action of the heart).

The standard treatments for AF are medications and procedures aimed at resetting the heart rhythm (electrical impulses in the heart that cause it to contract in a regular, rhythmic way) or controlling the irregular and accelerated heart rate that often characterizes the condition.

Latest development: Surgical techniques are now available for AF sufferers who need additional treatment to keep the condition under control.

What you need to know about AF…

Are You At Risk?

AF most commonly occurs in people age 60 and older who have high blood pressure and/ or a history of cardiovascular disease, including previous heart attack, heart surgery or heart valve problems...or lung disease, such as emphysema.

An overactive thyroid.sleep apnea (temporary cessation of breathing during sleep)...stress (most often due to other illnesses or surgery)... ingestion of a stimulant, such as caffeine...or excessive use of alcohol are among the other possible causes of AF.

Important: At least 10% of AF patients have no obvious underlying risk factors. For many people with AF, the condition is "silent." When symptoms do occur, a fast heart rate (up to 175 beats per minute, rather than the normal rate of 60 to 100 beats per minute), fatigue, dizziness, chest discomfort (pressure, palpitation and/or pain) and/or shortness of breath are most commonly reported.

If you think you may have AF, see your primary care physician for appropriate tests, such as an electrocardiogram (ECG), a procedure that measures the electrical impulses produced by the echocardiogram (an ultrasound of the heart)...and blood tests that may show thyroid problems or blood chemistry abnormalities that can lead to AF.

Treatment Options

Treatment for AF focuses on the use of heart medication to restore normal heart rhythm and/ or to control heart rate...and/or the use of warfarin (Coumadin) or some other blood thinner to reduce the risk for clots in the atria that can lead to a stroke.

Recent development: Because doctors have disagreed on whether control of heart rate or heart rhythm should take precedence, in 2006 the American Heart Association, the American College of Cardiology and the European Society of Cardiology jointly issued revised Guidelines for the Management of Patients with Atrial Fibrillation to help clarify the issue.

According to the new recommendations, patients age 70 and older with persistent AF (more than one episode) who have high blood pressure or heart disease are believed to benefit most when the heart rate is controlled (with a heart drug, such as a beta-blocker or calcium channel blocker). This is because older patients are at higher risk for stroke and therefore need more aggressive management of AF

For people under age 70-especially those with recurrent AF and no underlying heart disease-heart rhythm control may be better. Drugs commonly prescribed to control heart rhythm, such as propafenone (Rythmol), flecainide (Tambocor) and dofetilide (Tikosyn), are generally effective for the short term. But their effectiveness tends to diminish over time, and they may cause serious side effects, including increased arrhythmias irregular heartbeats), as well as thyroid, lung or liver problems.

For patients who continue to experience AF even while taking medication, electrical cardioversion a quick burst of electricity to the heart to help restore its normal rhythm) may be necessary. It is a relatively safe procedure, though it does require general anesthesia (for about five minutes). Often, patients undergo a couple of cardioversions over the course of a year, while also taking medication to control the heart rhythm.

However, cardioversion and medication are not a cure for AF. Also, many patients cannot tolerate the respiratory problems, vision difficulties, thyroid abnormalities and other side effects that can occur with long-term use of the drugs prescribed to manage the condition.

A Surgical Cure

A minimally invasive surgical procedure that doesn't simply control AF—but cures it—has become available in the US.

With the procedure, known as ablation, a heart surgeon or an electrophysiologist (a cardiologist who specializes in heart rhythms) makes tiny, strategic scars on the heart to block the misfiring electrical signals that occur with AF Ablation can be performed either with devices attached to catheters that thread through veins leading to the heart, or through a small surgical opening in the side of the chest.

Tiny burns (abouts of an inch long) are made on either the interior or exterior surface of the heart, typically using radio-frequency (lowvoltage, high-frequency electricity) or cryotherapy (freezing) tools

When the burns heal, thin scars are left that effectively block the chaotic electrical signals that cause AF, allowing the heart to restore its normal rhythm. About 80% to 85% of patients with intermittent AF (episodes lasting seconds to hours) are cured after one ablation procedure...most of the other patients are cured after a second ablation.

As with any heart procedure, there is a small risk for stroke during the surgery, but serious complications (such as heart attack or perforation of the heart) occur in fewer than 2% of all ablations that are performed by experienced physicians.

For many patients, the small risks associated with ablation are more than outweighed by the benefit of being able to discontinue their medications, usually within a year of undergoing the procedure.

The FDA has not yet approved use of the devices to perform ablation on AF patients, so all such uses remain "off-label" (the term used to describe medical treatments not approved by the FDA). However, the American College of Cardiology and the American Heart Association list ablation as a treatment option for AF patients who don't respond to drug therapy.

The current lack of FDA approval means that some insurers may balk at covering the procedure, which costs about $25,000 to $50,000. It's also a technically challenging procedure, so smaller hospitals with limited staff and resourc es may not offer it.

Important: If you're considering ablation, ask your doctor for a referral to a hospital where a relatively high volume of these procedures is performed each year. Even if it means trayeling, you'll be better off if you're treated by a physician who has had experience with the procedure

Wow! A New Kind of Heart Treatment

Heart patients who don't improve with medIcations and/or are not good candidates for surgery may want to consider enhanced external counterpulsation (EECP). This noninvasive procedure improves the ability of the coronary arteries to dilate, which promotes blood flow and can reduce chest pain caused by angina. With EECP, a series of inflatable cuffs (similar to blood pressure cuffs) are wrapped around a patient's legs. While the patient lies down, the cuffs are quickly inflated and deflated sequentially with each heartbeat, "milking" blood upward to the heart. The treatment lasts about one hour and is repeated three times a week for five weeks. It's not yet known if patients who undergo the procedure will have fewer heart attacks-but they have less chest pain and can more readily exercise without discomfort.

Caution: EECP is not recommended for patients with heart valve disease, thrombophlebitis (formation of blood clots and inflammation of the veins) or uncontrolled hypertension.

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