Transcript A Fib Information ()

Atrial fibrillation
J Heinsimer MD
Atrial fibrillation (“A Fib”)
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What is it ?
Why do we care if I have A Fib?
How common is A Fib ?
What causes A Fib?
How do we get rid of Afib?
If we cannot get rid of afib, how do we
control it?
Atrial fibrillation (“A Fib”)
• What is it ?
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•
•
•
•
Why do we care if I have A Fib?
How common is A Fib ?
What causes A Fib?
How do we get rid of Afib?
IF we cannot get rid of afib, how do we
control it?
atrial fibrillation (top chambers- the atria - going 400-600 beats/
minute) – too fast to pump blood
Atrial fibrillation vs atrial flutter
Atrial fibrillation (“A Fib”)
• What is it ?
• Why do we care if I have A Fib?
•
•
•
•
How common is A Fib ?
What causes A Fib?
How do we get rid of Afib?
If we cannot get rid of afib, how do we
control it?
Atrial fibrillation (“A Fib”)
• What is it ?
• Why do we care if I have A Fib?
• How common is A Fib ?
• What causes A Fib?
• How do we get rid of Afib?
• IF we cannot get rid of afib, how do we
control it?
Atrial fibrillation (“A Fib”)
• What is it ?
• Why do we care if I have A Fib?
• How common is A Fib ?
• What causes A Fib?
• How do we get rid of Afib?
• If we cannot get rid of afib, how doe we
control it?
Causes of Atrial fibrillation
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High blood pressure (probably 50% of afib)
Caffeine - coffee, tea, energy drinks, cocoa
Excess Alcohol
Aging
Nicotine
Fluid around the heart (“pericarditis”)
Low potassium, low oxygen, overactive
thyroid
• Any disease damaging heart muscle
including heart attack (“Myocardial infarction”)
Drug-induced heart rhythm
Bradycardia (too slow), tachycardia (too fast – over 100)
Dietary Supplements Causing Palpitations
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Chocolate
Ephedra/Diet pills
Ginseng
Bitter Orange
Valerian
Hawthorn
Atrial fibrillation (“A Fib”)
•
•
•
•
What is it ?
Why do we care if I have A Fib?
How common is A Fib ?
What causes A Fib?
• How do we get rid of Afib?
• If we cannot get rid of afib, how do we
control it?
Four ways to deal with A Fib
1. Fix underlying cause !
2. Use drugs or shock to convert afib back to
normal sinus rhythm and hope that the rhythm
stays regular
3. Allow the patient to stay in atrial fibrillation and
give drugs to control the ventricular rate and
prevent stroke or clot from going to body
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib
Four ways to deal with A Fib
1. Fix underlying cause !
2. Use drugs or shock to convert afib back to
normal sinus rhythm and hope that the rhythm
stays regular
3. Allow the patient to stay in atrial fibrillation and
give drugs to control the ventricular rate and
prevent stroke or clot from going to body
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib
Fixing the underlying cause of A Fib
• This should be the cornerstone of all
treatment – involves measuring labs for
potassium, thyroid and doing an echocardiogram
(ultrasound test to look for fluid around heart, look
at valves, look at heart chambers and heart
pumping)
• Stop all caffeine, cut down on alcohol to less
than 2 drinks/day, get blood pressure below
130/85 with meds measuring bp at home, stop
smoking, care with drugs that may cause A Fib
such as some inhalers for lung disease
Four ways to deal with A Fib
1. Fix underlying cause !
2. Use drugs or shock to convert afib
back to normal sinus rhythm and
hope that the rhythm stays regular
3. Allow the patient to stay in atrial fibrillation and
give drugs to control the ventricular rate and
prevent stroke or clot from going to body
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib
Shock “cardioversion” for new onset atrial fibrillation
(usually done after at least 3 weeks of anticoagulation
unless A Fib is known to be present for <48 Hours)
Patient is put to sleep for a few seconds with IV meds so he does not feel shock
Four ways to deal with A Fib
1. Fix underlying cause !
2. Use drugs or shock to convert afib back to
normal sinus rhythm and hope that the rhythm
stays regular
3. Allow the patient to stay in atrial fibrillation and
give drugs to control the ventricular rate and
prevent stroke or clot from going to body
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib
The AV node (3 in diagram below) determines how many of the 400-600
beats from the fibrillating atrium get to the ventricle
Four ways to deal with A Fib
1. Fix underlying cause !
2. Use drugs or shock to convert afib back to
normal sinus rhythm and hope that the rhythm
stays regular
3. Allow the patient to stay in atrial fibrillation and
give drugs to control the ventricular rate and
prevent stroke or clot from going to body
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib
Atrial Fibrillation – top chamber (atrium) at 400-600 beats/minute
(too fast to pump blood)
A Fib ablation done in the cath lab - takes 2 -10 hours
Catheter ablation with catheter going from leg to right atrium then to left
atrium to sites in left atrium around pulmonary veins
Catheter ablation with catheter going from leg to right atrium then to
left atrium to sites in left atrium around pulmonary veins
Pulmonary vein in L atrium
Risks of A Fib ablation
• Usual risks with catheterization: bleeding,
injury to blood vessel, dye allergy, death
(all <1%)
• Long procedure (2-10 hours)
• 70% success rate with initial procedure
(sometimes drugs or redo are needed)
• Usually only done in selected patients who
cannot tolerate the A Fib without severe
symptoms
How do we deal with my A Fib
1. Fix underlying cause ! If we can
find a cause (lab tests, echo) we will
fix it – fix bp, caffeine, alcohol
2. Use drugs or shock to convert afib back to normal
sinus rhythm and hope that the rhythm stays
regular
3. Allow the patient to stay in atrial fibrillation and
give drugs to control the ventricular rate and
prevent stroke or clot from going to body
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib
How do we deal with my A Fib
1. Fix underlying cause !
2. Use drugs or shock to convert afib back to normal
sinus rhythm and hope that the rhythm stays
regular (if 1st episode of A Fib, fix underlying
cause and if heart rhythm still does not convert to
normal, then consider medications and/or shock)
3. Allow the patient to stay in atrial fibrillation and
give drugs to control the ventricular rate and
prevent stroke or clot from going to body
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib
How do we deal with my A Fib
1. Fix underlying cause !
2. Use drugs or shock to convert afib back to
normal sinus rhythm and hope that the
rhythm stays regular
3. Allow the patient to stay in atrial fibrillation
and give drugs to control the ventricular
rate and prevent stroke or clot from going to
body (if recurrent episodes of afib and
over 60 years old)
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib
How do we deal with my A Fib
1. Fix underlying cause !
2. Use drugs or shock to convert afib back to normal
sinus rhythm and hope that the rhythm stays
regular
3. Allow the patient to stay in atrial fibrillation and
give drugs to control the ventricular rate and
prevent stroke or clot from going to body
4. Surgical or catheter techniques to interrupt
abnormal pathways to “ablate” A Fib (if no
underlying cause and recurrent episodes of A
Fib associated with severe symptoms or
patient <60)
Why not get everyone back in normal
sinus rhythm with drugs or ablation ?
• Drugs all have toxicity and the potential to make things
worse
• Procedures such as ablation are difficult, do not work
in 1/3 of the time, the A Fib returns at a rate of 3-5%
per year even after initially successful ablation
• The AFFIRM study was a large study in patients over
60 that showed that long term treatment with blood
thinners together with drugs to control the ventricular
rate (“rate control strategy”) was as good if not better
than a “Rhythm control strategy” designed to keep in
normal rhythm (see next 2 slides)
Conclusions - Atrial Fibrillation
1. Fix underlying cause !
2. Use warfarin (Coumadin) to control clots
(newer drugs are emerging since
Coumadin is a dangerous drug). Aspirin
(instead of Coumadin) may be acceptable
for patients at low risk for stroke. Learn
everything you can about Coumadin if on it.
3. Control the ventricular rate if in atrial
fibrillation
4. Control rhythm or do ablation if severe
symptoms or age under 60