Ned Hallick, a lighting specialist used to hauling heavy equipment, was 63 when he first noticed occasional bouts of dizziness. Until one day, Hallick, who lives in New York, said to me, “I was so exhausted that taking the subway stairs was like climbing a mountain.”
His GP, suspecting a heart problem, ordered several tests, including an electrocardiogram, and, based on the results, referred him to a cardiologist. Diagnosis: atrial fibrillation, the most common heart rhythm abnormality.
The disease occurs when the atria, the heart’s two upper chambers, beat rapidly and chaotically, out of sync with the ventricles, the heart’s lower pumping chambers, which are responsible for circulating blood throughout the body. The ventricles may be unable to pump enough blood to meet the body’s needs, resulting in sluggish circulation, fatigue, and shortness of breath.
Atrial fibrillation affects about three million adults in the United States, a number that is expected to quadruple over the next decade as the population ages and risk factors such as obesity, diabetes and high blood pressure become even more common. The lifetime risk of developing the disease is over 20 percent, but many people don’t even know they have the disease.
Proper diagnosis and prompt treatment, however, can save lives. In a report published in “The New England Journal of Medicine” in January 2021, Dr. William G. Stevenson and Dr. Gregory F. Michaud, cardiologists at the Vanderbilt University Medical Center in Tennessee, wrote that untreated atrial fibrillation can increase the risk of stroke by four times in men and about six times in women, and can increase the risk of heart failure three and 11 times, respectively.
It is also associated with dementia, likely the result of strokes and disturbances in circulation to the brain caused by irregular heart rhythm. The condition is directly or indirectly responsible for more than 158,000 deaths a year.
How do I know if I have atrial fibrillation?
Those affected by the condition may feel their heart racing or throbbing periodically for several minutes at a time, or they may notice occasional episodes of shortness of breath, dizziness, or excessive fatigue from exertion.
Symptoms can be triggered by excessive consumption of alcohol or caffeine. In some people with the condition, the abnormal rhythms come and go, while in others they persist, and the heart is unable to restore a normal rhythm without treatment.
Unfortunately, many people with atrial fibrillation, including Hallick, don’t see these symptoms as abnormal, especially when they go away on their own.
To confirm the diagnosis, your doctor may order an electrocardiogram or an exercise stress test, or you may wear a portable monitor for several weeks to check for an abnormal heart rhythm. These tests help differentiate atrial fibrillation from less serious conditions that cause palpitations, such as anxiety and stress.
How is atrial fibrillation treated?
If atrial fibrillation is confirmed, your doctor may try to get the heart to return to its normal rhythm using a procedure called electrical cardioversion, in which an electrical current is applied to the chest using the defibrillator. You will be sedated for the brief procedure and will not feel the shocks.
In the long term, most patients with the condition can be treated effectively and safely with medications, usually beta-blockers and calcium blockers that help the heart keep its normal rhythm. Patients are also given an anticoagulant to prevent blood clots from forming.
Several currently popular blood thinners, including rivaroxaban, the same one Hallick takes, have long-lasting anticoagulant effects even if the patient misses a dose or two, which can help prevent a stroke.
These anticoagulants also do not require constant and repeated monitoring of their effects on clotting, unlike their predecessor warfarin, which was for many years the main anticoagulant in the treatment of atrial fibrillation.
Warfarin has an important advantage over newer drugs: an almost immediate reversal of its anticoagulant effect, when the patient must stop taking it to prevent excessive bleeding, for example, before surgery or after an injury.
Can atrial fibrillation medications stop working?
Yes, that’s what happened to Hallick. He did well on the drug for seven years until May, when a routine checkup revealed that, unbeknownst to him, his atrial fibrillation had reappeared and his heart had a rate of 165 beats per minute, about twice the rate. normal.
“I was getting a little out of breath and having trouble walking uphill, but I disregarded that. I thought I was now 70 and maybe really out of shape because of the pandemic.”
A change in medication and two shocks to try to restore normal heart rhythm only helped for a short time, and Hallick has just undergone a procedure that promises a longer-lasting benefit: the destruction of cells along the posterior wall of his left atrium. heart that are transmitting unstable signals to the ventricles.
The procedure, called ablation, involves inserting a catheter into a vein into the atrium and typically burns or freezes the erratic cells.
How effective is ablation in treating atrial fibrillation?
Controlled trials have shown that, over time, ablation is significantly more effective at correcting disease than drug therapy.
In a recent study of 203 patients, ablation successfully prevented disease one year later in about 75% of patients in one group, whereas drug therapy helped only 45% of patients in another group. In healthy people like Hallick, the ablation can often be done on an outpatient basis, followed by a few days of limited activity while the heart heals from the resulting inflammation.
According to Vanderbilt’s Stevenson, some patients with persistent atrial fibrillation prefer to undergo ablation rather than taking long-term drugs, which can cause bleeding problems or other side effects.
The benefit of ablation, however, is sometimes delayed. He said that in the first few months after the procedure, about half of patients have an abnormal heart rhythm and may need shock or drug therapy until the heart recovers from the procedure.
Are there new treatments on the horizon?
Hallick is participating in an ongoing clinical trial of a new and presumably safer procedure called pulsed-field ablation, which destroys errant cells by puncturing them with electric shocks. The procedure is considered faster than other ablation techniques such as cauterization or freezing, and is less likely to damage the esophagus, which is close to the atrium.
The new technique, known commercially as Farapulse, was approved for use in Europe in January but is not yet licensed in the United States. It is being tested in a controlled clinical trial involving at least 350 patients at more than 30 US medical centers, including the Mount Sinai Health System in New York.
“If we’re going to change, we need to prove that pulsed field ablation is clearly better and safer than what we do now,” commented Stevenson.
Chad-98Weaver, a distinguished author at NewsBulletin247, excels in the craft of article writing. With a keen eye for detail and a penchant for storytelling, Chad delivers informative and engaging content that resonates with readers across various subjects. His contributions are a testament to his dedication and expertise in the field of journalism.
