An arrhythmia refers to an abnormal heart rhythm. You can sometimes feel this yourself, when it feels like your heart flutters, or there’s a brief pause in its rhythm. An arrhythmia can also make your heart beat too fast or too slow. Bradycardia is when the heart rate is too slow — less than 60 beats per minute, while tachycardia is when the heart beats too fast (100+ beats per minute).
If an arrhythmia is severe or lasts a long time, it can affect the heart’s functioning and keep it from pumping enough blood throughout the body. If this happens, you can feel tired, lightheaded, dizzy, or you may even suffer chest pain or pass out. At its extreme, it can also cause death.
While some arrhythmias are harmless and may need no further treatment, some arrhythmias are clinically significant and will require treatment.
Atrial fibrillation is a sustained arrhythmia due to the upper chambers of the heart (right and left atria) quivering instead of effectively beating. It is a common disorder that affects 2.7 million Americans.
Though the condition itself is not life threatening, it can have health-impacting consequences if untreated such as blood clots, stroke, and heart failure. Untreated atrial fibrillation doubles the risk of heart-related deaths and is associated with a 5-fold increase in the risk of stroke.
Many people who have this condition don’t experience symptoms. However, some common symptoms include:
If your doctor determines you need treatment, there are several courses of action. Atrial fibrillation treatment focuses on restoring your normal heart rate and rhythm to improve common symptoms such as fatigue, shortness of breath and a racing heart.
The first line treatment by a cardiologist for atrial fibrillation is medical therapy.
There are 2 key steps:
Management of atrial fibrillation also involves minimizing the risk of clot formation in the heart with blood thinning medications. Clots within the heart can lead to stroke.
In the case that medical therapy is not successful, ablation is a more invasive treatment available for treating atrial fibrillation.
Catheter ablation procedures involve inserting small plastic tubes called catheters into the body and using them to deliver energy to destroy cells responsible for atrial fibrillation. These procedures are performed in the cardiac catheterization lab by electrophysiologists.
Types of ablation for atrial fibrillation include:
The Maze procedure is an operation performed for atrial fibrillation where a number of small incisions and lesions are made on the left and right atria by a cardiac surgeon to form scar tissue. This scar tissue interrupts the abnormal electrical pathways that cause atrial fibrillation.
The Maze procedure can be done through an open chest or as a minimally invasive procedure. It can be performed as a stand-alone procedure or in combination with other open-heart surgeries (i.e. bypass surgery, valve surgery). The Maze procedure is useful in the multidisciplinary management of atrial fibrillation, but it is not necessary for all patients with the disease.
Hybrid surgical-catheter ablation offers a new treatment option for patients with hard-to-treat atrial fibrillation. This procedure combines catheter ablation with thoracoscopic surgery, a minimally invasive chest surgery. Both a cardiac surgeon and an electrophysiologist work together to perform the surgery.
By treating tissue both inside and outside the heart, hybrid ablation more effectively blocks the abnormal electrical signals causing the arrhythmia to provide a more permanent treatment for persistent atrial fibrillation. This innovative, collaborative approach provides better long-term outcomes.