is an abnormal heart rhythm caused by an irregular, disorganized heartbeat originating in the upper chambers of the heart, known as the right and left atria. Medical, catheter-based, and surgical treatments exist today to restore a normal heart rhythm, relieve symptoms and improve the quality of life of patients with atrial fibrillation. The choice of treatment depends on the severity of a person’s symptoms, the successfulness of prior treatments, and other related medical conditions.
The Washington University and Barnes-Jewish Heart & Vascular Center team of cardiologists, cardiac electrophysiologists, surgeons and clinical nurse specialists are world leaders in treating this condition. Working together, the goal is to restore normal rhythm or to slow down the heart rate and reduce symptoms. In addition, our clinical team actively leads research to develop and refine new treatments.
The abnormal heart rhythm that underlies atrial fibrillation occurs in the top chambers of the heart, which is known as the atria. During atrial fibrillation, the steady rhythm of the normal heart beat is replaced by an irregular, and often rapid, rhythm. This electrical "storm" within the atria causes these chambers stop beating rhythmically and continuously quiver (fibrillate). Some of this irregular activity in the atria is transmitted to the lower chambers of the heart, known as the ventricles, causing the pulse to be irregular and often too fast.
Some people may not have any symptoms. Others may experience a sensation of an irregular or fast heartbeat, fatigue, lightheadedness, shortness of breath, inability to exercise, and chest discomfort or anxiety.
Although atrial fibrillation is often considered a harmless arrhythmia, it is associated with serious illness and death because of its effects:
- palpitations, resulting in patient discomfort and anxiety
- inefficient blood circulation, which may lead to cardiomyopathy (enlargement of the heart) and heart failure
- lack of blood flow in the left atrium, which increases the risk of blood clot formation that can trigger a stroke
The goal of treating atrial fibrillation is to reduce symptoms as well as try and prevent stroke, pulmonary embolism, heart attack and heart failure
Treating Atrial Fibrillation
Medical treatment is the “front line” of therapy. Commonly prescribed medications either control heart rate, attempt to restore and maintain a normal rhythm, or both. To prevent the risk of developing a blood clot within the left atrium due to atrial fibrillation, physicians commonly use aspirin or the more potent drug, warfarin, to block blood clot formation. Together, these treatments are often sufficient to adequately control the condition.
Other treatment options include electrical cardioversion, catheter ablation
, or cardiac surgery
. Cardiac electrophysiologists at the Heart & Vascular Center use advanced ablation techniques to create ablation lines (scar tissue) within the atria that work as barriers to surround and disrupt the abnormal heart rhythms.
When surgical treatment is needed, surgeons look to a procedure that was pioneered right here at Barnes-Jewish Hospital and Washington University School of Medicine. James Cox, MD, developed the Maze procedure
to create “barriers” in the heart that block abnormal electrical signals. Recent technological advances have led to the minimally invasive Cox-Maze procedure
, a less invasive treatment.
Minimizing Stroke Risk for Atrial Fibrillation
According to the National Stroke Association, patients being treated for atrial fibrillation are five times more likely to suffer a stroke. During an abnormal heart rhythm, the left atrial appendage (LAA), a small pocket attached to the left upper chamber, fills with blood, potentially resulting in a blood clot.
A newly FDA approved procedure using the LARIAT® Suture Delivery Device, manufactured by SentreHeart Inc., focuses on using sutures to tie off the left atrial appendage through a small incision in the groin, decreasing the risk of stroke and the need for patients to be on blood thinning medications. The procedure combines an internal and external approach to the heart. The internal approach is through a vein in the leg, and a magnet-tipped wire is placed into the appendage. The external approach is from underneath the rib cage, and another magnet-tipped wire is brought near the first. These two wires meet and connect, which provides a rail to guide the lasso-shaped suture. The procedure is expected to last about an hour or less and requires general anesthesia. Once recovered, most patients can go home the next day or two, unless there are other areas of concern.
While the new procedure may not be a treatment for AFIB itself, the benefits of the Lariat procedure include:
- May decrease the risk of stroke
- The minimally invasive procedure poses a smaller risk than traditional open heart surgery
- Provides an alternative for patients not able to be prescribed blood thinning medication
- Reduces the risk of bleeding complications attributed to blood thinners
To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call