Atrial fibrillation cases on the rise

EAU CLAIRE, Wis. — After Debra Gregory passed out twice the same day at her home in 2008, a friend took her to Mayo Clinic Health System-Oakridge in Osseo.

Once there, medical professionals discovered the Osseo woman had an irregular heart rhythm.

Before fainting, the longtime elementary art teacher in the Osseo-Fairchild school district had been tired, but she hadn’t thought much about it. She had no history of heart problems.

Referred to the Cardiac Center at Mayo Clinic Health System in Eau Claire, Gregory saw Dr. John Rozich, a cardiologist, and nurse practitioner Mona Howard. Rozich implanted a loop recorder monitor under Gregory’s skin to capture information about her abnormal heart rhythm.

Gregory was diagnosed with atrial fibrillation, an irregular and often rapid heart rate that commonly causes poor blood flow to the body.

During atrial fibrillation, the heart’s two upper chambers — the atria — beat chaotically and irregularly, out of coordination with the two lower chambers — the ventricles — of the heart.

Left untreated, atrial fibrillation can lead to stroke or heart failure.

“It’s a debilitating disease that significantly can affect the quality of life,” said Dr. Arturo Valverde, an electrophysiologist at Mayo Clinic Health System in Eau Claire.

Electrophysiologists are cardiologists with additional training in the diagnosis and treatment of abnormal heart rhythms.

About 2.2 million Americans have atrial fibrillation, according to WebMD.com. Dr. Mahmoud Sharaf, an interventional cardiologist with the Eau Claire Heart Institute, expects to see the prevalence of the condition increase as the population ages.

Age is one risk factor for atrial fibrillation, physicians said. Others include heart disease, high blood pressure and family history.

Gregory, now 56, has a family history of heart disease and high blood pressure.

In addition, the loop recorder showed that she developed a very slow heart rate at times.

Several months after Gregory had the loop recorder implanted, Rozich replaced it with a pacemaker, which treats slow heart rhythm but does not treat atrial fibrillation. Her A-fib symptoms continued.

“Sometimes I would notice the fast racing heart — it was like it was running away, and at other times I wouldn’t,” Gregory said. “But the pacemaker check-ins would show (my heart) was doing that.”

Howard later referred Gregory to Valverde, and she underwent additional tests and discussed treatment options with him. They decided radiofrequency ablation was the best route for her, and she underwent the procedure Nov. 10, 2010.

Ablation typically uses catheters — long, flexible tubes inserted through a vein in the groin and threaded to the heart - to correct structural problems in the heart that cause an arrhythmia.

Cardiac ablation works by scarring or destroying tissue in the organ that triggers an abnormal rhythm.

“The procedure went extremely well,” Gregory said, “and I’ve had no problems since then.”

Valverde advises people who are experiencing symptoms of atrial fibrillation, such as weakness, shortness of breath, palpitations or decreased blood pressure, and who aren’t feeling well to seek medical attention soon.

When meeting with the doctor, tell him or her about initial symptoms — their duration, frequency, potential triggers and associated symptoms — as well as other medical conditions, such as diabetes or high blood pressure, and any bleeding problems, Valverde said.

He sees about 10 to 15 patients a week with atrial fibrillation.

Treatment goals for atrial fibrillation include regaining a normal heart rhythm, controlling the heart rate, preventing blood clots and reducing the risk of stroke, Valverde and Sharaf said.

Generally, initial treatment starts with medications. Medications can include rate and rhythm control drugs, along with anticoagulants to reduce the risk of blood clots and stroke, physicians said.

Lifestyle changes also can help, said Sharaf, who advises people to quit smoking and limit their intake of alcohol and use of caffeine. The latter can be a trigger for atrial fibrillation in some.

When medications don’t correct or control atrial fibrillation, or when patients can’t tolerate medications, a medical procedure, such as an ablation, may be necessary to treat an abnormal heart rhythm, Valverde said.

At Mayo Clinic Health System in Eau Claire, Drs. Thomas Carmody and Robert Wiechmann use a variation of something known as the surgical maze procedure. The cardiovascular surgeons access the heart through a small incision between the ribs rather than dividing the sternum.

Then they use heat to create a pattern of scar tissue on the outside of the heart. Because scar tissue doesn’t carry electricity, it interferes with stray electrical impulses that cause atrial fibrillation.

Before leaving the operating room, the physicians test the heart by stimulating the organ with a probe to try to make the patient go into atrial fibrillation, Carmody said.

The traditional maze procedure involves cutting - rather than burning — the heart to create scar tissue, he explained. Sometimes more burns are necessary before closing up the patient.

“There is not one magic bullet for treating A-fib,” Carmody said, adding the maze procedure is not the answer for all patients.

Carmody, Wiechmann and Valverde also have combined their skills to offer a hybrid approach in which patients receive surgical and electrophysiology treatment. It combines surgical maze on the outside of the heart, done by the surgeon, and catheter ablation on the inside of the organ, performed by the electrophysiologist.

“The combination of the two probably results in our best success rate with the ideal patient,” Carmody said.