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No matter how many greens you eat or hours of sleep and exercise you get, you can’t stop the aging process—and aging is the No. 1 driver of atrial fibrillation (AFib), which increases the risk of stroke and is the most common type of arrhythmia.
However, forming healthy habits can reduce your risk of developing AFib. And a newly FDA-approved treatment—which uses technology that MedStar Health experts have mastered for 10 years—is 70% effective at stopping AFib symptoms if you do develop it.
AFib is a change in the way your heart beats. Your heart has two upper chambers and two lower chambers. To keep your blood circulating, these chambers contract in a specific rhythm: the upper chambers first, followed by the lower ones.
When AFib develops, instead of contracting normally—slowly while you rest and more quickly during activity—the upper chambers get hijacked by chaotic electricity that makes them quiver rapidly. This causes the bottom chambers to contract abnormally.
AFib affects one in four adults over 40, but many people don’t even know they have it. To help you avoid a surprise diagnosis, we’ll discuss how AFib develops, symptoms to look out for, life-changing treatments we offer—and why it’s important to be treated as soon as possible.
How does AFib affect your heart?
AFib is progressive over time, which is why age is the biggest contributor. The progression is similar to the growth of dandelions in your yard: These weeds often appear in just a couple of places and are fairly easy to manage. If you neglect your yard, they multiply until you eventually have no healthy lawn left.
As episodes come and go, they stretch and alter your heart muscle tissue. We classify AFib into four types:
- Paroxysmal: Irregular contractions, or “episodes,” come and go, never lasting longer than a week.
- Persistent: Episodes last longer than a week at a time—even up to a year.
- Long-standing persistent: Irregularities continue for over a year.
- Permanent: Treatment can reduce episodes, but they’ll never go away.
Restoring rhythm earlier can prevent downstream changes—and extend life expectancy. Patients with AFib who are over 65 have a worse five-year survival trajectory than patients with colon cancer or Hodgkin's lymphoma.
What causes AFib?
Along with aging, internal and external factors can drive AFib. The condition is exacerbated by medical conditions such as:
- Alcohol
- Caffeine
- Dehydration
- Poor sleep patterns
- Stress
How is AFib diagnosed?
Diagnosis often begins with a patient’s awareness of an irregularity in their heart rhythm. Nobody shares identical symptoms, but we see common themes such as lightheadedness, neck or chest discomfort, shortness of breath, or what is often described as the feeling of a fish flipping in the chest.
As we treat patients for other cardiovascular risk factors, we also consider their risk for AFib. If you might be at risk, we’ll use an electrocardiogram (EKG) to record your heart’s electrical signal and detect irregular rhythm.
We don’t currently have recommendations for asymptomatic screening. Fortunately, heart rhythm monitoring is becoming much easier and more common because of the ability to do it through phone- or watch-based apps. As more people use these tools to track their heart’s electric activity, we are seeing many more episodes of arrhythmia occurring in patients without symptoms.
Can AFib be cured?
With AFib, it’s important to not get stuck on the term “cure.” Literally a lifetime of changes within your heart led to this condition, so our goal isn’t to eliminate every episode but to keep the burden of AFib lower than 1%.
Regardless of the type of AFib you have, we need to restore your heart’s rhythm. When determining the best treatment for your condition, we focus on:
- Risk of stroke
- Current symptoms
- Future symptoms
Our first and foremost goal is to treat what’s most dangerous. With AFib, that’s stroke risk. Not every patient with AFib has the same risk, but AFib elevates the risk of stroke in everyone, regardless of any other health conditions they have.
Stroke prevention is primarily done in two ways: medicine (daily aspirin or a blood thinner) or an implantable device that detects rhythm irregularities. Once we address stroke prevention, we focus on symptom management.
Patients may be minimally symptomatic early on, but we must think of the long-term effects of your heart persistently being out of rhythm. Previously, treatment options were primarily drugs that either controlled blood clotting or heart rate. But we’ve learned many other treatment options can effectively get rid of AFib or reduce its burden significantly, which has huge implications for length and quality of life.
Based on how advanced your AFib progression is, we start with simpler approaches and work our way up to more complex, invasive strategies.
We typically start with medication to slow your heart rate and calm the chaos by suppressing the rapid quivering of your upper chambers—a chill pill, if you will. It can work reasonably well but usually not long term.
Our next best step is pulmonary vein isolation, also known as a catheter ablation. We perform this same-day procedure by inserting a thin tube into your heart through the large vein in your thigh.
Delivering radiofrequency energy through this tube, we create scar tissue within your heart to block the chaotic electric signals. This method can be effective for persistent AFib, but it usually needs to be performed more than once. Long-standing persistent AFib often requires a more advanced procedure.
If catheter ablation isn’t effective, we will consider Hybrid AF™ Convergent Therapy, which was recently FDA approved. This type of ablation is hybrid because it combines two specialties—electrophysiology and cardiac surgery—to treat both the inside and outside of the heart.
During this minimally invasive surgery, a cardiac surgeon makes a small incision below the breastbone and three small incisions in the ribs to access the outside of the heart and create scar tissue on its back walls. Then, an electrophysiologist accesses the inside of the heart through the groin and delivers radiofrequency energy that eliminates the abnormal electrical activity. This procedure is available at MedStar Washington Hospital Center and MedStar Union Memorial Hospital.
Convergent therapy is best suited for patients with long-standing persistent AFib, which can be incredibly frustrating. Returning to the dandelion example, at this point the heart is so overrun by “weeds” that drugs and catheter ablation are not enough.
The convergence of technology, specialties, and expertise in a physical location on the heart tissue blunts the progression of AFib and restores normal rhythm, which improves symptoms, helps patients feel better, and improves quality of life.
This hybrid procedure is the perfect example of our collaborative approach at MedStar Health. We keep your best interest as our focus as we bring different experts into the same room to solve complex problems. We have seen tremendous progress in patients who were told they had no treatment options in the past.
