More than 2 million Americans have atrial fibrillation, the most common type of abnormal heart rhythm in the U.S.
Atrial fibrillation makes you five times more likely to have a stroke, but a minimally invasive procedure can help your heart beat regularly again,
And may reduce your risk for a stroke.
Selected Podcast
A Minimally Invasive Treatment Option for Atrial Fibrillation
Featured Speaker:
Organization: UVA Atrial Fibrillation Center
Dr. John Ferguson
Dr. John Ferguson is an electrophysiologist at the UVA Atrial Fibrillation Center. Along with atrial fibrillation, he cares for patients with a variety of abnormal heart rhythms, including ventricular tachycardia, supraventricular tachycardia and atrial flutter.Organization: UVA Atrial Fibrillation Center
Transcription:
A Minimally Invasive Treatment Option for Atrial Fibrillation
Melanie Cole (Host): More than two million Americans have atrial fibrillation, the most common type of abnormal heart rhythm in the US. Atrial fibrillation can make you five times more likely to have a stroke, but a minimally invasive procedure can help your heart beat regularly again and may reduce your risk for stroke. My guest is Dr. John Ferguson. He is a electro-physiologist at the UVA Atrial Fibrillation Center. Welcome to the show, Dr. Ferguson. First, explain to the listeners, if you would, what is atrial fibrillation.
Dr. John Ferguson (Guest): Good morning, Melanie. Good to be with you. Atrial fibrillation is an abnormal rhythm. It's an electrical abnormality in the heart, and it occurs at the atria, which are at the top chambers of the heart. The heart's got four chambers, and the atria are the top two chambers. Atrial fibrillation particularly affects the left atrium. Instead of beating with a nice, regular rhythm of somewhere between 60 and 100 beats a minute, and atrial fibrillation produces an electrical storm, which effectively just makes the atria quiver. These rapid electrical impulses are conducted from the atria, the top chambers, to the ventricles, the lower chambers, which are the main pumping chambers. The effect of this is that it causes the ventricle to beat irregularly and very, very quickly. The symptoms that the patient commonly would experience would be palpitations and irregular sensation of heartbeats in the chest, shortness of breath, lightheadedness and, occasionally, chest pain.
Melanie: Who is at risk for atrial fibrillation? So, you've explained the symptoms and
pretty much even the causes. I love that you used the term "electrical storm," because the heart really is an electrical muscle. It's really an electrical device in our body. Who is at risk? Is there anything we can do to decrease that risk?
Dr. Ferguson: Well, atrial fibrillation predominantly affects older people. Almost one in 10 patients are all people over the age of 75. It can affect the much younger age groups as well. It may occur without any other cardiac or co-morbidities, but it's more common in people who have high blood pressure, coronary artery disease, heart failure, heart valves disease, and also in patients who have other severe illnesses or undergoing heart surgery. We don't have very good data on preventing atrial fibrillation, but we certainly think that the same healthy lifestyle for preventing coronary artery disease is very good for preventing atrial fibrillation.
Melanie: What are the treatment options if someone is diagnosed? They feel that fluttering. They go to see a doctor. It gets diagnosed as AF. What are the treatment options available?
Dr. Ferguson: Well, as you mentioned in your segment before the interview, one of the important risks of atrial fibrillation is stroke. So before we even start thinking about treating symptoms, we think first about preventing stroke. We look at certain clinical risks to tell us how high an individual patient's risk of stroke would be. Those clinical factors that we look at, we look at the presence of heart failure, hypertension, aged over 75, diabetes, and a prior history of stroke. For all of those clinical factors, if you have those, they all raise your risk of stroke. Depending on how high the risk of stroke is, we give blood thinners to prevent stroke, with either aspirin, for those who have relatively low risk of stroke. But as the risk increases, we use stronger blood thinners or anticoagulants such as warfarin, Pradaxa, Xarelto, or Eliquis. Those are some of the main blood thinners we use. That's the first component of treating atrial fibrillation is preventing stroke, and it's very, very important. The second component is managing patient symptoms. There are broadly two strategies for treating patient symptoms. The first is that in patients who are elderly, not very active, and who may not be very symptomatic from the atrial fibrillation, we can simply leave them in atrial fibrillation that gives them medications to slow down their heart rate. That is fine for elderly people who are not very symptomatic. But those who are symptomatic and the rate control strategy doesn't alleviate symptoms very well, and we may, well consider what we call a rhythm control strategy to try and restore regular fineness rhythm and keep people in fineness rhythm. The treatments for restoring rhythm are electrical cardio version, a short anesthetic with an electrical shock while the patients are asleep. That's very effective in getting people back into rhythm. That is not effective with keeping people in regular rhythm. We frequently need to consider medications such as anti-arrhythmic drugs, or catheter ablation.
Melanie: Okay. Catheter ablation. We don't have a lot of time, Dr. Ferguson, and we want to make sure to get to this as quickly as we can. What are the benefits of ablation therapy versus other options?
Dr. Ferguson: Anti-arrhythmic drugs are only effective in about 45 percent of cases of atrial fibrillation, whereas catheter ablation is effective in a higher proportion of cases. In the best candidates, it is effective in up to 90 percent of patients. A great advantage is that after having this procedure, you do not need lifelong medication.
Melanie: That's fantastic. So, who is a candidate? In the last minute or so, give us your best advice why someone would choose UVA for their heart rhythm treatments.
Dr. Ferguson: The best candidates are patients who are early in the disease process of the atrial fibrillation. The more years that people have atrial fibrillation and the less successful catheter ablation or anti-arrhythmic drugs are in treating that.Catheter oblation has evolved since 1999, and UVA was actually one of the first hospitals—one of the very early hospitals, not only in this country, but in the world—to investigate catheter ablation for atrial fibrillation. We've done more than 6,000 cases over the last 10 years and have developed a team to treat atrial fibrillation and do this with a high success rate and a very, very low complication rate. UVA has about as much experience as anywhere else in the country, and we've had some very good results over the years.
Melanie: Thank you so much, Dr. Ferguson. You are listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening.
A Minimally Invasive Treatment Option for Atrial Fibrillation
Melanie Cole (Host): More than two million Americans have atrial fibrillation, the most common type of abnormal heart rhythm in the US. Atrial fibrillation can make you five times more likely to have a stroke, but a minimally invasive procedure can help your heart beat regularly again and may reduce your risk for stroke. My guest is Dr. John Ferguson. He is a electro-physiologist at the UVA Atrial Fibrillation Center. Welcome to the show, Dr. Ferguson. First, explain to the listeners, if you would, what is atrial fibrillation.
Dr. John Ferguson (Guest): Good morning, Melanie. Good to be with you. Atrial fibrillation is an abnormal rhythm. It's an electrical abnormality in the heart, and it occurs at the atria, which are at the top chambers of the heart. The heart's got four chambers, and the atria are the top two chambers. Atrial fibrillation particularly affects the left atrium. Instead of beating with a nice, regular rhythm of somewhere between 60 and 100 beats a minute, and atrial fibrillation produces an electrical storm, which effectively just makes the atria quiver. These rapid electrical impulses are conducted from the atria, the top chambers, to the ventricles, the lower chambers, which are the main pumping chambers. The effect of this is that it causes the ventricle to beat irregularly and very, very quickly. The symptoms that the patient commonly would experience would be palpitations and irregular sensation of heartbeats in the chest, shortness of breath, lightheadedness and, occasionally, chest pain.
Melanie: Who is at risk for atrial fibrillation? So, you've explained the symptoms and
pretty much even the causes. I love that you used the term "electrical storm," because the heart really is an electrical muscle. It's really an electrical device in our body. Who is at risk? Is there anything we can do to decrease that risk?
Dr. Ferguson: Well, atrial fibrillation predominantly affects older people. Almost one in 10 patients are all people over the age of 75. It can affect the much younger age groups as well. It may occur without any other cardiac or co-morbidities, but it's more common in people who have high blood pressure, coronary artery disease, heart failure, heart valves disease, and also in patients who have other severe illnesses or undergoing heart surgery. We don't have very good data on preventing atrial fibrillation, but we certainly think that the same healthy lifestyle for preventing coronary artery disease is very good for preventing atrial fibrillation.
Melanie: What are the treatment options if someone is diagnosed? They feel that fluttering. They go to see a doctor. It gets diagnosed as AF. What are the treatment options available?
Dr. Ferguson: Well, as you mentioned in your segment before the interview, one of the important risks of atrial fibrillation is stroke. So before we even start thinking about treating symptoms, we think first about preventing stroke. We look at certain clinical risks to tell us how high an individual patient's risk of stroke would be. Those clinical factors that we look at, we look at the presence of heart failure, hypertension, aged over 75, diabetes, and a prior history of stroke. For all of those clinical factors, if you have those, they all raise your risk of stroke. Depending on how high the risk of stroke is, we give blood thinners to prevent stroke, with either aspirin, for those who have relatively low risk of stroke. But as the risk increases, we use stronger blood thinners or anticoagulants such as warfarin, Pradaxa, Xarelto, or Eliquis. Those are some of the main blood thinners we use. That's the first component of treating atrial fibrillation is preventing stroke, and it's very, very important. The second component is managing patient symptoms. There are broadly two strategies for treating patient symptoms. The first is that in patients who are elderly, not very active, and who may not be very symptomatic from the atrial fibrillation, we can simply leave them in atrial fibrillation that gives them medications to slow down their heart rate. That is fine for elderly people who are not very symptomatic. But those who are symptomatic and the rate control strategy doesn't alleviate symptoms very well, and we may, well consider what we call a rhythm control strategy to try and restore regular fineness rhythm and keep people in fineness rhythm. The treatments for restoring rhythm are electrical cardio version, a short anesthetic with an electrical shock while the patients are asleep. That's very effective in getting people back into rhythm. That is not effective with keeping people in regular rhythm. We frequently need to consider medications such as anti-arrhythmic drugs, or catheter ablation.
Melanie: Okay. Catheter ablation. We don't have a lot of time, Dr. Ferguson, and we want to make sure to get to this as quickly as we can. What are the benefits of ablation therapy versus other options?
Dr. Ferguson: Anti-arrhythmic drugs are only effective in about 45 percent of cases of atrial fibrillation, whereas catheter ablation is effective in a higher proportion of cases. In the best candidates, it is effective in up to 90 percent of patients. A great advantage is that after having this procedure, you do not need lifelong medication.
Melanie: That's fantastic. So, who is a candidate? In the last minute or so, give us your best advice why someone would choose UVA for their heart rhythm treatments.
Dr. Ferguson: The best candidates are patients who are early in the disease process of the atrial fibrillation. The more years that people have atrial fibrillation and the less successful catheter ablation or anti-arrhythmic drugs are in treating that.Catheter oblation has evolved since 1999, and UVA was actually one of the first hospitals—one of the very early hospitals, not only in this country, but in the world—to investigate catheter ablation for atrial fibrillation. We've done more than 6,000 cases over the last 10 years and have developed a team to treat atrial fibrillation and do this with a high success rate and a very, very low complication rate. UVA has about as much experience as anywhere else in the country, and we've had some very good results over the years.
Melanie: Thank you so much, Dr. Ferguson. You are listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening.