Arrhythmias and Atrial Fibrillation: Heart and Vascular Care
Perhaps you feel that your heart is “racing” or you have unexplained chest pain or dizziness. You may have an arrhythmia, which is an abnormal heart rhythm.
What is an arrhythmia?
The term arrhythmia describes any change from the normal heart beat rhythm. Types of arrhythmias include tachycardia, a heartbeat that’s too fast; bradycardia, a heartbeat that’s too slow; and atrial fibrillation or AFib, an irregular heartbeat.
At Virginia Mason Franciscan Health, we provide the specialized care to manage all types of arrhythmias and atrial fibrillation (AFib). Our cardiologists and electrophysiologists (cardiologists specializing in heart rhythm disorders) will work with you to provide the individualized care you need to get back on your feet. Electrophysiologists are your heart’s “electrician.” They care for people with the most serious abnormal heart rhythms.
What is AFib?
AFib is a rapid heart rhythm caused by uncoordinated and weak contractions of your heart’s upper chambers, preventing your heart from pumping blood affectively. It can cause blood clots, stroke, heart failure and other serious heart conditions. It’s important that you seek treatment for AFib to prevent serious health conditions.
Treatments for arrhythmia and AFib
Some people can live with untreated arrhythmias for many years. If we determine that your arrhythmia puts you at risk for more serious complications, we’ll work with you to create a treatment plan to help restore your heart’s normal heart rhythm and treat underlying conditions that may be causing the condition. Treatment for arrhythmias can include:
Blood thinning medications
Your provider may prescribe antiplatelet or anticoagulant medication to treat related heart conditions or reduce the risk of blood clots and stroke. In some cases, the side effects of blood thinners may be deemed unsuitable. In this case, your physician may recommend left-atrial appendage (LAA) closure procedure.
Heart rhythm controlling medications
Abnormal heart rhythms can be treated with medications like sodium channel blockers which reduce the heart's ability to conduct electricity or potassium channel blockers which slow down the electrical signals that cause AFib.
In this procedure, a thin tube called a catheter is inserted into a vein and guided to your heart muscle. Through the catheter, the ablation process destroys a small area of heart tissue that’s causing the abnormal heartbeat.
Left atrial appendage (LAA) closure device
If you have nonvalvular AFib, and are not a suitable candidate for warfarin, a common blood thinner, your cardiologist may recommend a left atrial appendage (LAA) closure device. It blocks off an area of your heart (left atrial appendage) where blood clots are much more likely to form, effectively preventing clots from entering your bloodstream. The device is implanted via a catheter (thin tube), which is threaded into a blood vessel in your upper leg and guided to your heart.
Used to treat AFib, a doctor will create a pattern of scar tissue in the atria to block faulty electrical signals that can cause your arrhythmia. Scar tissue can be made using lasers, heat (radiofrequency energy), cold (cryoablation) or by making incisions with a scalpel.
Percutaneous left ventricular assist device (LVAD)
A mechanical pump that helps your heart pump more effectively. We monitor and care for patients who have these devices.
A small device is implanted in your chest to help regulate your heart rhythm by sending electrical signals when it beats too fast, too slow or irregularly.
Implantable cardioverter defibrillator (ICD)
Like a pacemaker, ICDs are implanted under the skin and use electric shocks to regulate your heart. The device monitors your heart rate, and when it senses dangerous rhythms, it sends a shock to correct the heart’s rhythm.
Coronary bypass surgery
If your arrhythmia is related to coronary artery disease (CAD), your cardiologist may recommend a coronary bypass surgery. When blood vessels become severely narrowed or clogged with plaque, less blood flows to the heart muscle. If your heart muscle isn’t receiving enough blood, it can’t pump effectively, and can cause an irregular heartbeat, an increased risk of heart attack or heart failure. Coronary bypass surgery can help restore blood flow to the heart and a healthy heart rhythm. A blood vessel is taken from a donor site in your body to bypass the blocked artery, rerouting blood flow around it.
AFib treatment to help prevent stroke
A left atrial appendage closure (LAAC) device now offers a non-drug alternative to daily blood thinners for some patients. The one-time, minimally invasive implant procedure helps keep clots from forming that can lead to stroke. The implant does not cure atrial fibrillation (AFib). It can improve quality of life by ending the need for long-term warfarin therapy (Coumadin®) and its constant medical monitoring.
How the LAAC device works
A small, fabric-capped device, shaped a bit like a jellyfish and about the size of a quarter, is placed at the opening of the thumb-sized appendage in the left atrium of the heart. The 10 tentacle-like fixation anchors secure the implant in place. The left atrial appendage (LAA) is where clots occur in over 90 percent of AFib-related strokes. The permanent implant device blocks the opening to prevent blood from pooling and forming clots in the appendage.
The left atrial appendage (LAA) is where clots occur in over 90 percent of AFib-related strokes
How LAAC implantation is performed
In the catheterization lab under general anesthesia, the implant is threaded through the groin to your heart in a narrow, flexible tube called a catheter, guided by real-time imaging. The cardiologist confirms placement and removes the catheter. The procedure takes about one hour. You recover overnight in the hospital and generally return home the next day.
After the LAAC procedure
Your cardiologist will prescribe warfarin, aspirin and an antibiotic to prevent infection. You should be able to resume regular activities after a few days, but it will take approximately 45 days for heart tissue to heal over the implant. At about 45 days, your provider will check the implant with imaging, and will adjust your medications accordingly. Most patients come off warfarin at that time. Your doctor will then prescribe a medicine called clopidogrel (also known as Plavix®) and aspirin for you to take for six months. After that, you will continue to take aspirin on an ongoing basis. A very small number of patients may need to keep taking blood thinners long term. It is very important that you do not change or stop your medications until your doctor instructs you to do so.
Who is a candidate for LAAC?
Not everyone is a candidate for LAAC. Blood thinners effectively lower the risk of stroke, but can also increase the risk of bleeding. Bleeding can be minor, or in some cases, life-threatening, such as when bleeding in the brain causes a stroke. If you have atrial fibrillation not caused by a heart valve problem (non-valvular) and you have a history of bleeding or a lifestyle, occupation or condition that puts you at risk for bleeding, your provider may consider LAA closure with an implant device.
There are risks and benefits to every procedure. Your cardiologist will weigh your risk of stroke against your risk of a serious bleeding problem. Before making a decision, your provider will review your health history, and perform a physical exam and TEE (transesophageal echocardiogram), to help determine whether LAAC is an option for you.
Left atrial appendage (LAA) closure device for atrial fibrillation (AFib)
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