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Winthrop University Hospital

Atrial Fibrillation Treatment Center

What is Atrial Fibrillation?

Atrial fibrillation is the most common irregular heart rhythm in the United States. Atrial fibrillation is an abnormal heart rhythm originating in the atria. Instead of the impulse traveling in an orderly fashion through the heart, many impulses begin and spread through the atria and compete for a chance to travel through the AV node. This causes a rapid and disorganized heartbeat. The rate of impulses through the atria can range from 300 to 600 beats per minute.

The AV node limits the number of impulses it allows to travel to the ventricles. The resulting heart beat is irregular, ranging from about 50 to 150 beats per minute.

What Causes Atrial Fibrillation

Most common causes
  • Hypertension (high blood pressure)
  • Coronary artery disease
  • Heart valve disease
  • Heart surgery
  • Chronic lung disease
  • Heart failure
  • Cardiomyopathy
  • Congenital heart disease
  • Pulmonary embolism
Less common causes
  • Hyperthyroidism
  • Pericarditis
  • Viral infection
Illustration of atrial fibrillation In at least ten percent of the cases, no underlying heart disease is found. In these cases, AF may be related to alcohol or excessive caffeine use, stress, certain drugs, electrolyte or metabolic imbalances, or severe infections. In some cases, no cause can be found.

The risk of AF increases with age, particularly after age 60.

Treatment of Atrial Fibrillation

At Winthrop's Atrial Fibrillation Treatment center treatment of Atrial Fibrillation is individualized to patients' needs. Lifestyle, age, and co-existing medical conditions are all taken into consideration.

Anticoagulation

Anticoagulation is one of the of the fundamental and important treatment modalities for Atrial Fibrillation. There is a strong association between stroke and Atrial fibrillation. Numerous studies have shown the benefit of anticoagulation with warfarin in patients with Atrial Fibrillation. One of the drawbacks to taking warfarin is that the patient is required to have monitoring bloods tests (INR) on a regular basis to adjust the dosage and the blood thinning effect of medication. The goal of therapy is to maintain the patients INR between 2 and 3. If it is too high the patient may have a bleeding problem. If it is too low the patient is not protected against a possible stroke. For patients with an absolute contraindication to warfarin, aspirin therapy is an option; however, the benefit is only about half that of warfarin.

Rate Control

One of the medical therapies used in the treatment of Atrial Fibrillation is rate control. The choice of agent should be based on the individual patient but in general beta-blocker therapy, calcium channel blockers or Digoxin can be used to achieve this goal.

Rhythm Control

Antiarrhythmic Medications

While part of the medical therapy for Atrial Fibrillation is targeted to control the rate of the heart, other medication may assist in getting the heart to covert or maintain a normal regular sinus rhythm. These drugs may include quinidine, procainamide, disopyramide, flecainide, propafenone amiodarone, sotalol, and dofetilide. The efficacy of these antiarrhythmic drug ranges between 50% and 80%. The selection of which drug(s) are used is based on the individual patient's medical and cardiac assessment.

Electrical Cardioversion

If medications are not able to control atrial fibrillation, cardioversion may be required. Cardioversion frequently restores a normal rhythm, although its effect may not be permanent. After a short-acting anesthetic is given, a small electrical shock is delivered to the patient's chest wall to "short circuit" the heart and have the heart's normal pacemaker take over. This can restore a normal rhythm.

Radiofrequency

Ablation

Studies have shown that almost all atrial fibrillation signals come from the four pulmonary veins. During the Radiofrequency Ablation procedure special catheters are inserted into the heart. Two catheters are inserted into the right atrium and two into the left atrium. One catheter in the left atrium is used to map or locate the abnormal impulses coming from the pulmonary veins. The other catheter is used to deliver the radiofrequency energy to ablate, or create lesions outside the pulmonary veins. The procedure is repeated for all four pulmonary veins.

The lesions heal and within 4 to 8 weeks, form a circular scar around the pulmonary veins. The scar blocks any impulses firing from within the pulmonary veins, thereby "disconnecting" the pathway of the abnormal rhythm and curing atrial fibrillation.
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259 First Street | Mineola NY 11501 | 516-663-0333


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