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An individual’s heart will beat close to three billion times in an 80-year lifespan. Keeping that rhythm steady is important to overall health – but as many as 10.5 million Americans have atrial fibrillation, or Afib, a condition of disorganized rhythm in the upper chambers of the heart.
Afib can manifest clinically as palpitations, dizziness, or shortness of breath., but it can also be asymptomatic. Untreated Afib can lead to heart failure or stroke.
Doctors from the Minneapolis Heart Institute Foundation and the Joseph F. Novogratz Family Heart Rhythm Center presented some of the latest science on Afib at an October 2024 event. You can see a video of the event, which also featured patient Betty Brandt, who shared her story of navigating atrial fibrillation.
Dr. John Zakaib, a cardiac electrophysiologist, likens Afib to a bar fight in an old-west saloon, when one angry cowboy – or errant cardiac stimulus – can send the whole joint, or heart, into a tizzy (“complete electrical disarray”). Regular heart rhythm can be restored quickly through an intervention called cardioversion (or in Dr. Zakaib’s metaphor, “a single shot from the lawman”). This can be done using an electrical shock or anti-arrhythmic medications.
Technologic advances in Atrial Fibrillation management
“Imaging and treatment technology is developing quickly”, says Dr. Matt Olson, a bio-electrical engineer and electrophysiologist. He notes that new techniques can create a 3D computer model of the heart in real time, with no radiation needed as in the past.
This kind of imaging allows for highly precise radio frequency (RF) ablation: a technique that uses energy to destroy abnormal tissue that conducts electricity and causes Afib. RF ablation is delivered via a catheter during a minimally invasive procedure, although it may also take place during open heart surgery. Ablation for Afib may also use freezing (cryoablation).
The newest technology is pulsed field ablation, or PFA. According to the Cleveland Clinic, “Evidence indicates that this nonthermal ablation method treats [Afib] with good durability and faster procedure times than conventional ablation techniques — and, most importantly, with low risk to adjacent structures.” Dr. Olson says that while PFA isn’t quite “ready for prime time,” it is likely to become the number one choice for Afib ablation.
Atrial Fibrillation and Stroke
Dr. Jay Sengupta notes that a history of Afib can increase the risk of stroke risk by five fold. The irregular pumping of the heart can cause blood stagnation in the heart and formation of clots. These blood clots can break off, reaching the blood vessels in the brain, which cause a stroke. Ongoing management of Afib requires intense attention to stroke prevention. Other risk factors for stroke that should be addressed are hypertension, diabetes, heart failure or a family or personal history of stroke.
Even after cardioversion or ablation, patients sometimes need to take blood thinners. For those who can’t tolerate such medications, a surgical procedure can address the part of the heart where 90 percent of blood clots form: the left atrial appendage, or LAA.
For over a century, research has linked the LAA to the formation of blood clots inside the heart. Closing off the LAA via ligation reduces the likelihood clots will form.
LAA ligation is performed in one of two ways: through open-chest surgery, or a catheter inserted through a small incision in the groin or arm and guided into the LAA. A device such as a clip or suture is then used to close off the opening of the LAA.
As Americans become older on average, the incidence of Afib will continue to increase. The good news is that treatments for Afib are effective, tolerable, and brief.
Under the leadership of Dr. Jay Sengupta, the Joseph F. Novogratz Family Heart Rhythm Center works to advance the prevention and treatment of heart arrhythmias such as atrial fibrillation and sudden cardiac arrest. This center also drives innovation through research of medical devices like pacemakers and implantable cardiac defibrillators (ICDs) that are important in the management of common heart rhythm conditions.
