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What Can Be Done About An Irregular Heart Rhythm?

The Tampa Tribune

Published: September 13, 2008

By ANNE CURTIS, MD
Tribune correspondent
Do you know anyone with the heart rhythm disorder known as atrial fibrillation? If so, he or she has lots of company.
Atrial fibrillation is the most common sustained irregular heart rhythm in older adults. President George Herbert Walker Bush was diagnosed with atrial fibrillation while still in office, and the former NBA -star-turned-Sen. Bill Bradley has a history of it, too.
Atrial fibrillation is a very disorganized, rapid electrical rhythm in the top chambers of the heart, the atria. Rather than contracting in a coordinated fashion with each heartbeat, atrial fibrillation causes the atria to quiver. These chaotic contractions cause blood to pool in certain areas of the atria, promoting the formation of blood clots. If these clots break off, they may travel to the brain and cause a stroke. The fast, irregular rhythm can also trigger symptoms such as palpitations, shortness of breath, fatigue and exercise intolerance.

Most patients with atrial fibrillation are treated with medications, at least initially. Three types of medications are prescribed to control this arrhythmia: anticoagulants, rate control drugs and rhythm control drugs. Anticoagulants, or blood thinners, are used to prevent strokes. Not all patients need to be on blood thinners. Physicians make that determination by evaluating risk factors such as age (older than 75); a history of hypertension, diabetes or heart failure; and previous stroke or near-stroke.

Rate control drugs include digoxin, beta blockers and calcium channel blockers. They are used to slow down the heart rate when patients are in atrial fibrillation. In untreated atrial fibrillation, the heart may beat about 150 times a minute. Rate control drugs bring the heart rate down to a more normal level at rest, 60 to 80 beats a minute.
Rhythm control drugs help maintain a normal heart rhythm and prevent recurrences of atrial fibrillation. Many patients are treated with both rate control and rhythm control drugs - to prevent atrial fibrillation, but also to slow it down if the condition does recur. Recent clinical studies have shown that outcomes with either a rate control strategy or a rhythm control strategy are equal in terms of the patient's survival and quality of life. Health professionals decide on the best treatment course based on the severity of an individual's symptoms and the patient's overall health, including other potentially complicating medical conditions.

Catheter ablation is a relatively recent treatment option that may offer a cure for patients who still experience symptoms from atrial fibrillation after medical therapy. This invasive procedure, performed in a cardiac catheterization laboratory, delivers radiofrequency energy through a catheter, primarily to the left side of the heart. The goal is to block electrical impulses originating in the pulmonary (lung) veins from entering the atria and causing atrial fibrillation.

Success rates are good, particularly for patients with intermittent atrial fibrillation, but some patients require repeat procedures and some still need to take medications afterward. Patients with persistent atrial fibrillation have lower success rates. Some serious complications can occur with this procedure, so the risks and potential benefits must be carefully weighed.

Patients who experience rare episodes of atrial fibrillation and minimal symptoms when the rhythm disturbance occurs may need no treatment. Whether or not you require treatment, which medical treatment is right for you and whether you might benefit from catheter ablation is best discussed with your doctor.

Dr. Curtis is professor and director of Cardiology at USF Health.

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