SINUS (NORMAL)

Even steady beat

ATRIAL FIBRILLATION

Uneven skips beats

ATRIAL FLUTTER

Extremely Rapid uneven beats

Whether it's caused by nerves, exercise or too much caffeine, most people experience a racing heart from time to time. Most cases are harmless. But AF is an actual medical condition and it may often be long lasting. Some people with AF experience no symptoms at all. But for others, AF may cause:

Exercise intolerance
Fatigue
Severe shortness of breath
Chest pain
Palpitations
Light-headiness

BACK TO THE TOP

Your heart is divided into four chambers: the two upper chambers called atria, and two lower chambers called ventricles. In order for blood to be pumped through your body, a group of cells sends electrical impulses to the atria that tells your heart to contract. Contractions of the heart send approximately five quarts of blood through your body every minute. In people with AF, however, the impulses are sent chaotically. The atria quiver instead of beat; the blood isn't completely pumped out and may pool and potentially clot.

Are you at risk?

The older you are the greater is your chance of developing AF. AF occurs more commonly in women than in men. According to the Framingham Heart Study (http://circ.ahajournals.org/cgi/content/full/110/9/1042) AF is associated with a higher risk of death for women than for men. You are also at greater risk if you suffer from an overactive thyroid, high blood pressure, a prior heart attack, congestive heart failure, valve disease or congenital disorders.

BACK TO THE TOP

AF can sometimes be diagnosed with a stethoscope during an exam by a doctor or other health care provider and is confirmed or diagnosed with an electrocardiogram (EKG). There are several types of EKG’s. They are:

1. Resting EKG – Electrical activity in the heart is monitored when a person is at rest.

2. Exercise EKG – Activity is monitored when a person jogs on a treadmill or exercises on a stationary bike.

3. 24-hour EKG (Holter Monitor) – A person wears a small, portable monitor that detects activity over the course of a day.

4. Transtelephonic event monitoring – A person wears a monitor for a period of a few days to several weeks. When AF is felt, the person telephones a monitoring station or activates the monitor's memory function. This type of EKG is particularly useful in detecting AF that occurs only once every few days or weeks. Unfortunately this type of monitor does not record heart events while you are sleeping.

The CardioNet Monitor

Your doctor may have you used a CardioNet monitor. This monitor stores 48 hours of continuous data. When it detects an arrhythmia or irregular heartbeat it automatically transmits the EKG to a CardioNet Monitoring Center, where certified cardiac technicians continuously analyze the incoming EKG’s 24 hours a day, 7 days a week. The centers prepare and send reports to the doctor.

BACK TO THE TOP

Your medication options

There are three primary goals in the treatment of AF:
1. slow the heart rate
2. prevent clots and strokes, and
3. if possible, restore the heart to its regular rhythm.

Blood-thinning medications, including aspirin and warfarin, may help reduce stroke risk. In fact, long-term use of warfarin has been proven to prevent up to 80% of strokes in people suffering from AF. Aspirin is an option when the risk of stroke is not high. To reduce heart rate, many people can be treated with medications such as digoxin, alone or in combination with beta-blockers and calcium channel blockers, as well as other medications. Your treatment will depend on your age, physical condition and history of heart disease.

BACK TO THE TOP

To help the heart maintain a normal rhythm, a procedure called cardioversion may be effective. Cardioversion delivers brief electrical shocks that stun the heart and temporarily stop all electric activity. This may allow the normal rhythm to reemerge. However, medication may be required to maintain the normal rhythm and it is not always effective. Cardioversion is used in situations and also may be done electively. Catheter ablation is a method to relieve the rapid, irregular heartbeat that accompanies AF. This procedure involves disconnecting the atria from the ventricles electrically. Without the signals from the atria, the ventricles would beat extremely slowly, requiring a permanent pacemaker in anyone who chooses this procedure.

For some hard-to-treat AF, a surgical procedure that is occasionally performed is the "maze" procedure in which a surgeon divides the atria into small, isolated sections. The chaotic electrical activity of the heart is halted because the electrical impulses cannot cross the scars that separate the sections of the atria. It should only be used for people with severe AF that can't be controlled with medication, or for people undergoing heart surgery for other reasons.

BACK TO THE TOP

The “Wolf MiniMaze”

The latest interventional procedure to treat AF is a minimally invasive operation called the "Mini-Maze." The "Mini-Maze" was developed by Dr. Randall K. Wolf, Professor of Cardiothoracic Surgery and Director of the Center for Surgical Innovation at the University of Cincinnati., using instruments that he helped design. Dr. Wolf's procedure combines an “ablation” method and the "maze" procedure, WITHOUT performing "Open heart surgery." Dr. Wolf developed this new minimally invasive procedure to cure AF without making a 7 inch incision in the sternum or breastbone and without having to use the heart-lung machine. The mini-maze procedure is a much less invasive procedure, in which he enters the heart through small incisions between the patient’s ribs.

Dr. Wolf performs in fact two surgical procedures at one time. He uses a special "bi-polar" RF clamp to ablate and electrically isolate the pulmonary veins, where the triggers are located that activate AF. This ablation procedure is performed through two small “non-rib-spreading” mini-incisions, one on each side of the chest. The word "ablation" simply means to destroy tissue by burning it. This is done in a specific pattern. The chaotic electrical activity of the heart is halted because the electrical impulses cannot cross the burn scars that separate the areas of the atria. The "bi-polar" RF clamp is so efficient that he can perform an ablation in 8 seconds. An ablation would normally take up 3 minutes with a conventional unipolar RF head.

The second part of the procedure is the endoscopic exclusion of the left atrial appendage, a useless “thumb-like” structure of the heart that can host clot formation that can lead to a stroke. Strokes due to AF are particularly devastating.

The devices are navigated by a micro-miniature television camera, so that Dr. Wolf can actually see the heart without opening the chest. The procedures performed at the University of Cincinnati were specifically focused on treating AF as a stand-alone condition. The new less invasive procedure allows patients who have suffered from long-standing intermittent AF to undergo a less invasive surgery to treat their AF and recover faster than traditional surgery for AF. Patients who undergo this procedure are expected to have hospital stays of only 2-3 days, compared to 7 days or more with conventional surgery.