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Atrial Fibrillation Center

North Mississippi Medical Center's Atrial Fibrillation Center provides state-of-the-art treatment options for patients with atrial fibrillation. This program is a unique collaboration between electrophysiologists (cardiologists who specialize in heart rhythm conditions) and cardiothoracic surgeons to evaluate patients for the most appropriate treatment. Then, working with the patient's primary care physician, a treatment plan is developed. Once treated, the patient will return to the primary care physician for follow-up care that can be coordinated, if necessary, with the physician who performed the procedure.

What is atrial fibrillation?

Atrial fibrillation is the most common arrhythmia, an irregularity of the heart's rhythm. In the United States more than 2 million people have atrial fibrillation. This condition originates in the atria (top chambers of the heart). Instead of the electrical impulse traveling in an orderly fashion through the heart, many impulses begin and spread through the atria causing the atria to quiver or fibrillate. Some of the electrical impulses travel through the heart and make the ventricles (bottom chambers of the heart) squeeze or contract.

Symptoms

Atrial fibrillation episodes may last minutes, hours or days. You may have atrial fibrillation without having any symptoms. However, if symptoms do occur, they may include:

  • Heart palpitations (skipping or racing sensation in your chest)
  • Shortness of breath (difficulty breathing during normal activities, climbing stairs or walking long distances)
  • Dizziness (lightheadedness or feeling faint)
  • Weakness (lack of energy)
  • Discomfort, pain or pressure in chest

Causes

The most common causes of atrial fibrillation include:

  • Hypertension (high blood pressure)
  • Heart failure
  • Cardiomyopathy (heart enlargement)
  • Coronary artery disease
  • Heart valve disease
  • Previous heart surgery
  • Congenital heart disease
  • Chronic lung disease
  • Pulmonary embolism
  • Thyroid problems

In approximately 10 percent of cases, no underlying heart disease is found. In these cases, atrial fibrillation may be related to use of excessive caffeine or alcohol, stress, certain medications, or electrolyte or metabolic imbalances. In some cases, no cause can be found. The risk of atrial fibrillation increases with age, especially after age 60.

Diagnosis

The most common diagnostic tools for atrial fibrillation include:

  • Electrocardiogram (ECG or EKG): a tracing of your heartbeat.
  • Echocardiogram: a test in which sound waves are used to produce a video image of your heart.
  • Holter monitor: a monitor worn over a short period of time, usually one to three days.
  • Event monitor or a loop recorder: a monitor worn for approximately a month for patients who have less frequent irregular heartbeat episodes and/or symptoms.
  • Implantable loop recorder: a recorder implanted in the chest that can monitor for up to 18-24 months.
  • These monitoring devices can capture the episode of irregular heartbeats and help the doctor learn more information. For instance, they help the doctor identify the type of irregular rhythm, how long the irregular rhythm lasts and possible causes.

An electrophysiologic study may be needed. This procedure allows doctors to determine exactly what your rhythm problem is and choose appropriate treatment.

Consequences

Atrial fibrillation is not a life-threatening arrhythmia, but it can be extremely bothersome and sometime dangerous. People with atrial fibrillation are seven times more likely to have a stroke. Blood clots can travel to other parts of the body (heart, lungs, kidneys, intestines), causing damage. If your heart rate is fast over a long period of time, it can cause heart failure. Chronic atrial fibrillation can cause an increased risk of death.

Treatment

Treatment for atrial fibrillation includes restoring and maintaining a normal heart rhythm, controlling the heart rate and preventing blood clots, thereby reducing the risk of a stroke. Medications, lifestyle changes, procedures and surgery are used to treat atrial fibrillation.

Medications

  • Rhythm control medications help restore or maintain a normal heart rhythm (sinus rhythm). Commonly used medications include amiodarone (Cordarone, Pacerone); propafenone (Rhythmol); procainamide (Pronestyl); quinidine (Quinidex); metoprolol (Toprol, Lopressor); sotalol (Betapace); dofetilide (Tikosyn); and flecainide acetate (Tambocor). You may need to stay in the hospital when you first start taking these medications so that your heart rhythm and response to the medication can be monitored carefully. These medications may be needed indefinitely. Unfortunately, they may lose their effectiveness over time.
  • Rate control medications slow the heart rate and do not control the heart rhythm. Types of rate control medications include digoxin (Lanoxin); beta-blockers (such as metoprolol or sotalol); and calcium channel blockers (such as diltiazem or verapamil).
  • Medications to prevent blood clots reduce the risk of stroke. However, these medications do not eliminate the risk of stroke. Anticoagulant or antiplatelet therapy medications, such as warfarin (Coumadin) are commonly used. Depending on your medical history, aspirin may be used instead of warfarin.

Lifestyle changes

  • Limit or avoid caffeine and other stimulants (such as coffee, tea, and some over-the-counter medications).
  • Limit your intake of alcohol.
  • Stop smoking.

Procedures

  • Electrical cardioversion. After a short-acting anesthesia or sedative is given, an electrical shock is delivered to your heart through patches or paddles placed on your chest. This procedure frequently restores a normal rhythm but its effect may not be permanent.
  • Catheter ablation. Ablation therapy is used for people who cannot tolerate medications or when medications cannot maintain a normal heart rhythm. These procedures are performed by a highly trained cardiac electrophysiologist. Various energy sources are used to destroy (ablate) abnormal heart tissue that causes or sustains the abnormal heart rhythm. The two types of ablation that can be performed include pulmonary vein isolation or ablation of the AV node.
    • Pulmonary vein isolation. Research has proven that most atrial fibrillation signals come from the four pulmonary veins. During this procedure, special catheters are inserted into the blood vessels of the atrium. A catheter is used to locate the abnormal impulses coming from the pulmonary veins. Another catheter is used to deliver the radiofrequency energy to create scars that block any electrical impulse from firing within the pulmonary veins. This technique is repeated for all four pulmonary veins.
    • AV node ablation. Catheters are inserted through the veins (usually in the groin) and guided to the heart. Radiofrequency energy is delivered through the catheter to disconnect the electrical pathway in the AV node. The AV node is a pathway which separates the top and lower chambers of the heart. This technique will cause a permanent, very slow heart rate. A permanent pacemaker will be implanted to maintain an adequate heart rate.
    • Permanent pacemaker. A pacemaker is a device that sends small electrical impulses to pace the heart when its own rhythm is too slow or irregular.
  • Maze procedure. This procedure is performed by a highly trained cardiothoracic surgeon. Small, precise incisions are made in the right and left atria (top chambers of the heart) to isolate and prevent abnormal electrical impulses from forming. Radiofrequency (ablation) or cryotherapy (freezing) can be applied to the outside surface of the heart. The procedure may require open heart surgery. However, a less invasive technique may be used in which a small chest incision is made.

Physician Referral

To refer a patient to NMMC's Atrial Fibrillation Center, physicians may call the Heart Institute at 1-888-HEART14 or (662) 377-AFIB (2342).

To Learn More

If you are a patient with atrial fibrillation and would like more information about treatment options, you may also call 1-888-HEART14 or (662) 377-AFIB (2342). Our atrial fibrillation specialists will assist you in accessing the physicians of the Atrial Fibrillation Center.