Atrial fibrillation, or Afib, is the most common arrhythmia in the United States and is estimated to affect upwards of 5 million Americans. Every year a greater number of patients are diagnosed with this condition because of several factors. While there are a few non-modifiable factors – those that cannot be helped (like age and genetics), we can go a long way in reducing the likelihood of developing Afib by making simple but meaningful lifestyle changes. Unfortunately, many of us have developed bad heart health habits over the course of years or even our entire lifetime, so while straightforward, we understand how difficult these changes can be to implement.
By now, we’ve all seen the incredible technological advances modern society has made. While we routinely see new devices on the market in medicine, especially in electrophysiology, our specialty, in particular, relies on advanced software to map the heart, guide the catheter, identify treatment areas and ultimately evaluate the effectiveness of the ablation or other arrhythmia treatment.
Currently, the technology we use relies on our best judgment to identify where the arrhythmia originates and ultimately treat the appropriate areas during an ablation. Once the treatment has been completed, we use the same technology to evaluate whether the treatment has been successful.
Pacemakers have been the gold standard in treating slow heart rhythms known as bradycardia for decades. Most of us know someone with a pacemaker. This tiny device offers patients a life-changing and lifestyle-restoring option for what would otherwise be a debilitating and chronic condition like congestive heart failure. Implanted in a very safe and straightforward procedure, traditional pacemakers have few risks. However, one of the most significant concerns of a conventional pacemaker is the malfunction or breakage of the wires that connect the pulse generator/battery to the heart itself. Further, while traditional pacemaker technology has improved to the degree that they are smaller than ever, it still requires a bulky implant under the skin.
Regarding lifestyle issues and the heart, metabolic disease and obesity are some of the most concerning issues we, as cardiologists, face. While the specialty of cardiology and subspecialty of electrophysiology have made leaps and bounds over the years, the treatment of many cardiovascular concerns is hampered by our decidedly less healthy society. We’ve seen a rise in cardiovascular problems in ever younger patients, and irregular heart rhythms are becoming more common. Certain arrhythmias like atrial fibrillation or Afib come with some severe potential follow-on consequences, not least of which is a five times increased risk of stroke and a significantly increased risk of heart attack or congestive heart failure.
Cardiac arrhythmias can vary dramatically in their presentation, frequency, intensity, and symptoms. Electrophysiologists like Dr. Tordini see heartbeat irregularities ranging from very slow to extremely fast. While cardiac arrhythmias have been a concern since the dawn of humanity, they have become decidedly worse in recent decades as our overall health, and our hearts have declined.
When we think of cardiac arrhythmia, our minds may think of a racing heart and other standard symptoms. These should not be discounted by any means. However, these heart palpitations, flutters, and feelings of pounding in the chest are not the only symptoms that arrhythmia patients will feel. Chronic fatigue is a widespread concern associated with some fast and alternately slow heartbeats. The diagnosis is made even more challenging to diagnose when patients suffer from, for example, silent atrial fibrillation or Afib. When diagnosing chronic fatigue, the possibility of arrhythmia, especially one that does not have outward symptoms, may not be top of mind for most medical professionals.
Let’s get right to it and say that while chest pain, known as angina, can have many causes, it should never be ignored due to the possibility of it being a precursor for severe cardiovascular events. As such, if you are experiencing a medical emergency, be sure to dial 911 immediately or get to your nearest emergency room. If you have a non-emergent, persistent chest pain that cannot be explained away, be sure to visit your primary care specialist or cardiologist urgently to have it evaluated. Let’s explore some of the non-cardiac-related chest pain many of us will experience:
While the diagnosis of atrial fibrillation or Afib at your most recent ER visit may surprise you, it is not surprising to us. Many of our patients who end up requiring treatment for Afib only find out about their condition from an ER visit. The visit may have resulted from significant chest pain or palpitations that they thought were representative of a heart attack. Or, they may have been in the ER for a completely different reason, but heart irregularities were detected. Regardless, you should look at this diagnosis as an opportunity to avoid what can cause a follow-on life-threatening condition such as stroke or heart attack.
Being diagnosed with Afib at the ER does not make the condition any more dangerous than a diagnosis at the office or incidentally at a check-up with your primary care physician. Sometimes, this incidental diagnosis at the ER catches Afib at an earlier stage when it is more treatable and before it has progressed to something more persistent, which can be far more difficult to handle.
Because of the complexity of cardiac catheter ablation and the technology needed, ablations are performed in a specialized operating room at the hospital, known as an electrophysiology or EP lab. For many, despite the procedure being performed in the hospital, there is the opportunity to be discharged at the end of the day. However, several factors may require an overnight stay or longer for some patients.
When you think about atrial fibrillation or Afib, your mind probably conjures up pounding feelings in the chest, a sense of fluttering, uneasiness, and panic, wondering if you may have a severe heart concern or even a heart attack—however, not all cases of Afib present with these classic symptoms. When Afib is asymptomatic, it is known as silent Afib. It may seem odd to think that a fast or irregular heartbeat would not cause any symptoms at all, but it’s certainly possible and happens more often than you think.
The electrophysiology or EP lab is an incredibly advanced operating room at our hospitals. It allows for advanced diagnostics and treatment tools that we didn’t have just a couple of decades ago. This is especially beneficial for patients suffering from paroxysmal or occasional atrial fibrillation or Afib that has been difficult or impossible to diagnose through standard testing.
As you probably already know, Afib is a progressive disease. Typically, episodes begin sporadically with no pattern or timeframe for their onset. Many patients do not bring it up with their doctor or seek treatment. While it is estimated that upwards of 5 million Americans may be suffering from Afib, only a tiny fraction gets treated appropriately. As the condition is left untreated or undertreated, and the patient does not change their lifestyle, these episodes often become stronger and more frequent. Eventually, Afib can become persistent, making it exceptionally difficult to treat.