Posts Tagged ‘Atrial Fibrillation’

Lone Atrial Fibrillation (A-Fib) – Takeaways from our Heart to Heart

Lone Atrial FibrillationThank you for those who were able to participate in the Emory Heart & Vascular Center Live Chat on Arrhythmias last week! You all had great questions and highly engaged. If you could not join me, you can view the Arrhythmia chat transcript here. We covered a lot of different topics. Please feel free to use the comments below to let us know if you have other heart and vascular topics you would like to cover in future live chats, and we will see if we can organize!

During the chat, there were questions I did not have time to answer. Specifically, I told attendees that I’d be posting a follow up blog on Lone Atrial Fibrillation, a less discussed type of arrhythmia that I got some good questions around.

What is Lone Atrial Fibrillation (A-Fib)?

Lone Atrial Fibrillation (A-Fib) is atrial fibrillation seen in patients younger than 60 years with no underlying structural heart disease.  It may be caused by a specific trigger or could occur without any trigger.

What are the possible triggers for Lone Atrial Fibrillation?

Lone A-Fib can be triggered by:

  • Emotional or work related stress
  • Physical Overexertion
  • Alcohol use or overuse
  • Caffeine consumption
  • Infection
  • Dehydration
  • Electrolyte imbalances
  • Drugs (cocaine, amphetamines, etc)
  • Hypoglycemia

Unfortunately, in the majority of cases of Lone Atrial Fibrillation occur without any triggers. It is probably difficult to avoid all the potential triggers for Lone A-Fib.  But when a trigger exists, it is  typically specific to each individual.  There is no consistent way to safely and effectively manage Lone A-Fib episodes, so I recommend you consult your cardiologist to ensure you are taking the most appropriate steps for your particular case.

You can visit our website to learn more about Emory’s Arrhythmia Program.

Dr. Mikhael El-ChamiAbout Mikhael El-Chami, MD
Dr. El-Chami completed his residency at Emory in 2003 and he was nominated for a chief residency year at Emory in 2004. His training in cardiology and electrophysiology also was completed at Emory. His areas of clinical interest include: cardiac arrhythmia ablation, cardiac resynchronization therapy and prevention of sudden cardiac death. Dr. El-Chami holds organizational leadership memberships with the American College of Cardiology and the Heart Rhythm Society. He speaks Arabic and French fluently.

Has Your Heart Ever Skipped a Beat?

Arrhythmia Web Chat with Dr. El-ChamiHave you ever experienced a skipped heart beat or a change in the regular beat of your heart? If so, you may have a rhythm disorder called an Arrhythmia. Arrhythmias are common in middle-aged adults. Some arrhythmias are relatively harmless, but others can be fatal if not treated. Nearly 1,000,000 people are hospitalized for an arrhythmia each year, and some arrhythmias, such as Atrial Fibrillation, are extremely common and affect over 2,500,000 million Americans.

Join me on Wednesday, August 24, at 12:30 p.m. for an interactive web chat on the topic of Diagnosing, Managing and Living with Arrhythmias. I will be available to answer questions and discuss various topics about arrhythmias, including symptoms, diagnosis, prevention and treatment, as well as innovative new cardiovascular research on the horizon.

You can register online for the live chat! UPDATE CHAT TRANSCRIPT

Dr. El-Chami

About Mikhael El-Chami, MD

Dr. El-Chami completed his residency at Emory in 2003, and he was nominated for a chief residency year at Emory in 2004. His training in cardiology and electrophysiology also was completed at Emory. His areas of clinical interest include: cardiac arrhythmia ablation, cardiac resynchronization therapy and prevention of sudden cardiac death. Dr. El-Chami holds organizational leadership memberships with the American College of Cardiology and the Heart Rhythm Society. He speaks Arabic and French fluently.

Learn About Atrial Fibrillation (A–Fib) in new Physician “Ask the Expert” Video Series

Atrial Fibrillation Ask the ExpertsAs we have discussed in previous blogs on the topic of arrhythmias, atrial fibrillation, also referred to as A – Fib, is the most common irregular heart rhythm in the United States.  It is so prevalent that over 2 million Americans suffer from it. Even though it is not directly life threatening, it can lead to other heart problems such as congestive heart failure and stroke, as well as shortness of breath, dizziness, chest discomfort and palpitations.

The physicians in Emory’s Arrhythmia Program talk about various arrhythmia topics and how to best manage your condition in our new “Ask the Expert” video series.

You can also view past blogs about arrhythmia including:

If you have further questions or think you may have A- Fib after viewing our atrial fibrillation videos, please call Emory HealthConnection℠ 404-778-7777 to speak with a nurse.

Do you have questions about this procedure or about A-Fib in general? If so, please let me know in the comments section.

About Angel Leon, MD:

Dr. Leon is a Professor of Medicine and the Chief of Cardiology at Emory University Midtown. His specialties include electrophysiology, cardiology, and internal medicine, and his areas of clinical interest include arrhythmia ablation, electrophysiology lab, and pacemaker. Dr. Leon holds organizational leadership memberships with the American College of Cardiology and the American Heart Association. He has been practicing with Emory since 1991.

Case Study: A Catheter Ablation Approach to Atrial Fibrillation

In recent posts, we’ve presented various case studies and examples of patients suffering from atrial fibrillation (A-fib). We’ve seen how debilitating this condition can be, and how severely it can affect a patient’s quality of life.

In this post, we’ll take a glimpse into the life of a Georgia 55-year-old school administrator who developed A-fib over a two-year period, causing him to suffer from fatigue, shortness of breath, and a decreased ability to exercise.

His local physicians made every effort to restore the rhythm of his heart through the use of anti-arrhythmic drugs—unfortunately; the medication generated side effects that necessitated the placement of a pacemaker implant.

When the patients’ A-fib continued to reoccur, the physicians realized that the drug therapy was failing and decided to pursue a course of rate control and anticoagulation therapy. This attempt failed to alleviate the symptoms as well, which prompted his local cardiologist to refer him to Emory University Hospital Midtown to be evaluated for catheter ablation.

Catheter ablation is a minimally invasive procedure that doesn’t involve open-heart surgery, making it a viable option for patients suffering from A-fib. In our patient’s case, it was the ideal solution for his condition—which is why in February of 2010 he underwent the procedure for treatment of his arrhythmia.

Catheter ablation involves threading catheters through the blood vessels towards the heart, which destroys (or ablates) the abnormal heart tissue that causes the condition. We performed the ablation on our patient using conscious sedation, and achieved femoral vein access with catheterization into the patient’s left atrium. Electro-anatomic mapping guided the irrigated-catheter ablation system.

The procedure was completed in less than three hours, and our patient was discharged the following morning. He was able to return to normal activity two days later. After the ablation, we continued to keep him on anti-arrhythmic medication for a month.

At his 3-month and 6-month follow-up visits, he showed no signs of A-fib, and we were able to discontinue the use of the anti-arrhythmic drugs. Today, our patient says that he feels “great”, and he continues to be completely free of atrial arrhythmia and its symptoms.

When anti-arrhythmic drugs fail to alleviate the symptoms of A-fib, catheter ablation is an advantageous alternative. While the procedure works best for patients with recurring A-fib, it can also make sense for A-fib cases without the presence of significant heart disease. Further, recent pilot studies have revealed that catheter ablation is superior to medication as the primary form of therapy for A-fib.

Do you have questions about this procedure, or about A-fib in general? If so, please let me know in the comments section.

About Angel Leon, MD:

Dr. Leon is a Professor of Medicine and the Chief of Cardiology at Emory University Midtown. His specialties include electrophysiology, cardiology, and internal medicine, and his areas of clinical interest include arrhythmia ablation, electrophysiology lab, and pacemaker. Dr. Leon holds organizational leadership memberships with the American College of Cardiology and the American Heart Association, and he’s been practicing with Emory since 1991.

Overcoming A-Fib at Emory

My name is Bill Hughes. I’m 73 years of age, and I’ve lived in West Point, Georgia for 25 years. For 35 years, I was employed by Neptune Technology Group, a company that manufactures and distributes water meters and automatic meter reading systems. When I retired in 2000, I was the national sales manager for water distribution. Now, I work as a consultant. I’m married, and I have two children and two grandchildren.

I first came to Emory Heart and Vascular in January of this year. Prior to this, I’d been seeing a cardiologist for about two and a half years for what they call “a-fib”, or atrial fibrillation. My heart was beating out of rhythm, and the situation was worsening. Despite all of my heart regulation medications, my heart just couldn’t stay in rhythm.

At one point, I was hospitalized for about three days while the doctors administered a very strong heart-regulating drug. Unfortunately, my body just wouldn’t accept it, and I had several unpleasant side effects from it. And still, the medication wasn’t keeping me in rhythm.

When you suffer from A-fib, you basically feel horrible the majority of the time. You lose all of your energy and strength, and feel as though you can hardly do anything—it’s as though you just exist. Sufficed to say, it was incredibly depressing for me. After dealing with A-fib for two and a half years, I had forgotten what it felt like to feel normal.

At that point, my cardiologist recommended Dr. DeLurgio at Emory, and suggested that he examine my case in order to pinpoint what type of procedure would improve my condition. I was concerned that it would be difficult to schedule an appointment with a heart doctor, but the folks at Emory were able to see me right away.

After he performed a thorough examination, Dr. DeLurgio informed me that my A-fib condition was a fairly severe case, and decided that I needed to have radiofrequency ablation. I had three procedures between January and March. During the first procedure I had some bleeding, so we had to stop the surgery. A few weeks later, they performed the second ablation, this time with much better results. Although I was feeling better than I had in a long time, I went back into the hospital a third time because I was experiencing what they call a “flutter”. The doctors determined that they needed to go back in one more time and fix whatever circuitry wasn’t working properly. This was completed in March, and was a total success.

I really appreciated how Dr. DeLurgio explained the ablation procedure beforehand and set the right expectations with me. In the beginning, he let me know that I may require more than one ablation procedure due to the severity and complexity of my case. From the start, I never doubted him or had any concerns.

Everyone at Emory treated me as though my case was very special. The nurses and physician’s assistants did a wonderful job of preparing me for the surgery. At the hospital, from the time I checked in to the time I left, everything went incredibly smoothly. I feel very fortunate to have been at Emory and to have had Dr. DeLurgio as my doctor.

Now, I’m feeling better every day, and I no longer have to take nearly as much medication, which is a huge advantage. I’m 73 years young and back in the gym, back on the golf course, and life is good again.

From Dr. DeLurgio:

Mr. Hughes represents a case of a patient with “permanent” atrial fibrillation. This is a more severe and far-progressed variety. Typically, treatment options are limited. Using advanced techniques, however, we were able to achieve excellent results while avoiding major surgical intervention. It is very gratifying to see how much improvement in his quality life Mr. Hughes has gained.

About David DeLurgio, MD:

Dr. DeLurgio has been practicing medicine at Emory since 1996. His specialties include Internal Medicine, Cardiology, Electrophysiology, and Cardiac Electrophysiology. Additionally, his areas of clinical interest include arrhythmias, atrial fibrillation and ablation therapy, prevention of sudden cardiac death, and treatment of heart failure with medical devices. Dr. DeLurgio holds organizational leadership memberships with the American College of Cardiology, the American College of Physicians, the Heart Failure Society, and the Heart Rhythm Society.

An Innovative Emory Cardiothoracic Surgical Treatment

Imagine experiencing atrial fibrillation (A-Fib), or a quivering of the heart, half of each day, every day. Now imagine a solution—and it doesn’t involve open-heart surgery. The only after effects: a few half-inch marks beneath your armpit accompanied by a new approach to life.

In one anonymous case study, a 46-year-old female executive had suffered from seven years of disabling A-fib, and described how the symptoms of her condition resulted in “zero quality of life.” She was unable to participate in numerous medication trials due to a variety of negative reactions to anti-arrhythmic medications, and she underwent two unsuccessful percutaneous catheter ablation procedures out-of-state.

After thoroughly researching multiple surgery options across the region, she agreed to be Emory’s first patient for a trial of a “Totally Thorascopic Mini-Maze”, involving a fully endoscopic approach to bilateral pulmonary vein isolation, a procedure utilizing bipolar radiofrequency energy and “stapled occlusion” of the left atrial appendage procedures.

On February 14, the patient received three tiny incisions in her chest on each side of her armpit. We made no other incisions, and a thorascopic camera provided our only visualization. At the beginning of the procedure, we carefully measured the exit and entry areas across the pulmonary veins on each side. Electrophysiology measurements confirmed a conduction block across the pulmonary vein on each side.

We stapled the patient’s left atrial appendage shut with an endoscopic, or “no-knife” stapling device, a tool that safely closes the base of the left atrial appendage with three rows of staples and no incisions, thus reducing risk of hemorrhage. Consequently, the patient experienced very little blood loss, and the cosmetic results were ideal, as her three incision sites were hidden beneath her armpit.

The procedure allowed the patient to be discharged a mere three days after surgery, and she only experienced one single brief episode of irregular rhythm upon her return home. At both her 1-month and 3-month follow-up appointments, she showed no signs of A-fib. As part of our comprehensive follow-up, on the anniversary of her 3-month visit, we provided her with a small, portable cardiac rhythm monitor that she used for two weeks to record her heart beat 24 hours a day. The monitor also documented a complete absence of A-fib.

We’re thrilled with the success of this procedure—this pioneering patient, once disabled by severe A-fib symptoms, is enjoying life once again. For carefully selected patients, this procedure could very well be an ideal solution.

If you have questions about this procedure, or about A-fib in general, I’m happy to address them in the comments section below.

About John D. Puskas, MD:

Dr. Puskas specializes in adult cardiac surgery. He began performing coronary bypass operations on beating hearts without using a heart-lung machine in 1996. In 1997, he performed the world’s first triple off-pump bypass surgery using minimally invasive coronary artery bypass graft (mini-CABG) instrumentation. Dr. Puskas is PI of a grant from the National Institute of Health’s National Heart Lung and Blood Institute that makes Emory one of eight U.S. centers charged with rigorous scientific evaluation of newer methods of fighting cardiovascular disease.

A Look at Causes & Diagnosis of Atrial Fibrillation (A-fib)

In our last post, Dr. Langberg defined Atrial Fibrillation, or A-fib, as the quivering of the two upper chambers of the heart resulting from disorganized electrical activity, and the most common heart rhythm conditions requiring treatment. Together, Emory University Hospital and Emory University Hospital Midtown perform more than 3,600 electrophysiology procedures per year, including diagnosis and treatment procedures for A-fib. In this post, I’ll examine causes of A-fib and discuss how we diagnose it.

It’s crucial that we identify potential causes of A-fib in order to determine the best approach to treatment. Although we can’t always find the specific trigger, certain pre-existing heart and lung conditions are the most common causes. These conditions include:

–      Thyroid conditions

–      Obesity

–      Obstructive sleep apnea

–      Hypertension (high blood pressure)

–      Coronary artery disease

–      Heart valve disease

–      Heart surgery

–      Chronic lung disease

–      Heart failure

–      Cardiomyopathy (disease in which the heart muscle is weakened)

–      Congenital heart disease

–      Pulmonary embolism (blood clot to the lungs)

Less common causes of A-Fib include hyperthyroidism, pericarditis and viral infections.

In at least 10% of cases, we’re unable to find underlying heart disease or lung conditions. In these instances, A-fib may be related to alcohol, excessive caffeine use, stress, certain drugs, electrolyte or metabolic imbalances, or severe infections. It’s important to note that the risk of A-fib increases with age, particularly after age 60.

Next—how do we diagnose Atrial Fibrillation? There are a variety of methods, but our initial diagnosis begins with a conversation. We ask you about your medical history, including your health habits and symptoms, which may include fatigue, palpitations, chest discomfort, shortness of breath, or dizziness. We also ask about your family history, and then perform physical exams and conduct appropriate tests and procedures. One of the most useful tests is an electrocardiogram (EKG), a painless procedure that records the heart’s electrical activity. With an EKG, we can determine how fast your heart is beating, whether its rhythm is steady or irregular, how strong the electrical signals are when they pass through your heart, as well as how long it takes these signals to reach each section of your heart.

In our next Heart & Vascular post, we’ll explore treatment options for A-Fib at Emory, including innovative therapies and clinical trials.

For more information about the Emory Atrial Fibrillation Program, or to schedule an appointment, please call Emory HealthConnectionSM at 404-778-7777 or 1-800-75-EMORY.

Are you concerned that you may have A-fib? If you have questions or comments about A-fib diagnosis, please let me know in the comments section below.

About Michael Lloyd, MD:

Dr. Lloyd began practicing medicine at Emory in 2007—he specializes in Internal Medicine, Cardiology, and Cardiac Electrophysiology. His areas of clinical interest and research include arrhythmias, electrophysiology lab, and pacemaker. Dr. Lloyd’s organizational leadership memberships include the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society.

Defining Atrial Fibrillation

Atrial fibrillation, or A-fib, is the most common irregular heart rhythm, or cardiac arrhythmia in the United States. In fact, according to the American Heart Association, approximately two million Americans suffer from A-fib, which results when multiple circuits of disorganized electrical activity in the two upper chambers of the heart (the atria) take over the organized electrical activity normally generated by the heart’s sinus node. This produces a fibrillating, or quivering of the atria, as opposed to a regular heartbeat.

Although A-fib isn’t directly life threatening, it’s often debilitating, as it produces a fast, irregular pulse that can cause fatigue and contribute to additional heart problems over time, such as congestive heart failure. Other symptoms include palpitations, chest discomfort, shortness of breath, or dizziness. In many cases, A-fib greatly increases the risk of stroke; consequently, patients are often placed on blood thinners.

Just a few years ago, patients suffering from this condition were informed that they’d have to learn to live with it. However, increasing numbers of people suffering from A-fib can now be treated or even cured, thanks to innovative therapies and procedures available through The Emory Heart & Vascular Center.

Now that we’re able to successfully treat atrial fibrillation, we’re greatly improving the quality of life for our patients, reducing the number of medications they have to take, and limiting the amount of hospital trips they have to make.

Our next Heart & Vascular post will touch on the diagnosis of A-fib and arrhythmias in general.

Do you have any questions or thoughts about atrial fibrillation? If so, be sure to let me know in the comments.

About Jonathan Langberg, MD:

Dr. Langberg is the Director of Cardiac Electrophysiology at Emory University Hospital, as well as a professor of Internal Medicine. He is board certified in Internal Medicine, Cardiology, and Cardiac Electrophysiology. Dr. Langberg is a pioneer in the field of catheter ablation of arrhythmias and has published over 150 articles related to his field.