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Treating and Living with Atrial Fibrillation (A-Fib)

Dr. Jose Nazari February 09, 2011 10:00 AM This chat has ended. Thank you for participating.
Dr. Jose Nazari (NorthShore) - 10:05 AM:
Ready to chat

Lisa Landvogt (Homewood, IL) - 10:05 AM:
What are your thoughts on the MAZE procedure?

Dr. Jose Nazari (NorthShore):
It is a highly effective treatment for atrial fibrillation. The name is used losely nowadays. A full Cox Maze procedure is about 95% effective. The more commonly performed left atrial surgical pulmonary vein interruptions are much less effective. It is, of course, highly invasive.

Suzanne Schmitt (McHenry, IL) - 10:07 AM:
Is taking a beta-blocker a proper treatment for this? How is it properly diagnosed? Thanks for your help.

Dr. Jose Nazari (NorthShore):
B blockers are often used to slow the heart rate down, an important aspect of treatment, but not the only one.

Mike Collins (Elmwood Park, Illinois) - 10:08 AM:
Are there any medications that effectively control A-Fib? Is there a safe surgical procedure to effectively eliminate a-fib?

Dr. Jose Nazari (NorthShore):
There are many antiarrhythmics with variable levels of effectiveness (25 - 75%). Catheter ablation is about 75% effective in well selected cases. Full surgical maze procedures are about 95% effective. Nothing is 100% effective.

Lisa Cornwell (Northbrook,IL) - 10:09 AM:
I was diagnosed with a-fib on a Monday, after years of symptoms and no diagnosis, then cardioconverted(by drug) to knock my heartrate down from 150 to normal sinus, and had a clot-relatedstroke the following day(Tuesday). Is there any research that shows a link between cardioconversion and stroke? Could anything else have been done in the ER to prevent a stroke just 24 hrs later?

Dr. Jose Nazari (NorthShore):
There is always a risk of stroke with AF. It is highest immediately after cardioversion. The risk is least if you have been in AF for less than 24 hours. When we are reasonably certain AF has been there for less than 24 hours, cardioversion without other interventions is considered safe.

Peggy Rohan (Chicago, IL) - 10:11 AM:
I have had several cardioversions and two cardiac ablations without success. I also took Amiodorone which is a terrible drug. Why do you think I can not be converted, I go in and out all the time.

Dr. Jose Nazari (NorthShore):
Nothing completely eliminates atrial fibrillation. Surgical full maze procedures are most effective, and you could consider that. Amiodarone is both terrible and wonderful in that it is the most effective medical treatment we have, bar none.

Lisa (Evanston, IL) - 10:12 AM:
How is A-Fib diagnosed?

Dr. Jose Nazari (NorthShore):
Getting an electrocardiogram AT THE TIME IT IS OCCURRING.

Linda Flores (Addison, Il) - 10:13 AM:
My mom has had a-fib for two years. She had two cardio-versions and did not last for long. She is now being treated with cumadin and another medication. Her doctor is telling her she may be a candidate for a cardio ablation. Can you please explain this and the risks, etc.

Dr. Jose Nazari (NorthShore):
It is a procedure used to treat atrial fibrillation by burning off parts of the heart that are necessary to sustain it. You can find 2 videos that explains it at our web site. They will take about 20 minutes to watch.

Lisa (Evanston, IL) - 10:14 AM:
Can children get A-Fib?

Dr. Jose Nazari (NorthShore):
Uncommonly, but they certainly can.

David (Skokie, IL) - 10:14 AM:
What is the relationship between A-Fib and stroke?

Dr. Jose Nazari (NorthShore):
Atrial fibrillation is the most common cause of stroke. Because the blood is stagnant in the atria (upper chambers), it leads to clots that can travel to the brain (or other parts of the body) and cause damage.

David (Skokie, IL) - 10:16 AM:
Is it true that the venom of the tarantula spider is being used to develop a drug to treat this condition?

Dr. Jose Nazari (NorthShore):
Many venoms are blockers of sodium channel conduction (rarely potassium channel blockers) in nerves and heart. In appropriate doses, these can be highly effective antiarrhythmics and are therefore tested for this condition.

Craig (Northbrook, IL) - 10:17 AM:
How come some people may not have any symptoms at all until they have a stroke?

Dr. Jose Nazari (NorthShore):
We do not know why some people feel terribly with atrial fibrillation and why some are entirely unaware of it. It is a source of thought and research.

John (Chicago, IL) - 10:19 AM:
I was recently diagnosed with A-Fib. Is it okay to exercise daily, specifically running?

Dr. Jose Nazari (NorthShore):
It is best to consult with your doctor, as it depends on your underlying conditions, rate control, symptoms and multiple other factors that are hard to discuss in this setting.

Lisa (Evanston, IL) - 10:20 AM:
Can prescription medicines cause A-Fib?

Dr. Jose Nazari (NorthShore):
Occasionally. Medications such as pseudoephedrine and excessive thyroid supplementation have been associated with it, for example.

David (Skokie, IL) - 10:21 AM:
What is the most common form of drug therapy treatment

Dr. Jose Nazari (NorthShore):
The cornerstone of therapy is Coumadin, until recently the only available oral anticoagulant. Pradaxa is a new oral anticoagulant. For controlling rates, B blockers and calcium blockers. For trying to minimize atrial fibrillation, antiarrhythmics such as amiodarone, dronedarone, dofetilide, flecainide, and others.

David (Skokie, IL) - 10:23 AM:
Which form of treatment is most dangerous?

Dr. Jose Nazari (NorthShore):
All treatments have pros and cons, depending on how they are selected and used.

Bob (Grayslake, IL) - 10:24 AM:
Are there any long term negative effects of drugs such as Flecanide used in the treatment of AF? Could you explain what these drugs do to control AF?

Dr. Jose Nazari (NorthShore):
All currently used antiarrhythmics are either sodium or potassium CURRENT blockers (nothing to do with your blood levels of these chemicals). As with all medications, side effects can occur with flecainide, but by-and-large they are seen early on in treatment (first few weeks). Flecainide cannot be used in the presence of structural abnormalities of the heart, such as coronary artery disease or heart attacks.

John (Chicago, IL) - 10:26 AM:
Is an irregular heartbeat obvious to the patient?

Dr. Jose Nazari (NorthShore):
Some patients can tell readily, many cannot. If you are trained in checking your pulse, it might be obvious to you even if you don't feel it otherwise.

Will (Glenbrook, IL) - 10:27 AM:
Can stroke patients develop A-Fib later on?

Dr. Jose Nazari (NorthShore):
Many of the things that cause strokes, cause A fib (such as hypertension and heart attacks); accordingly strokes can occur first. Not uncommonly a stroke can be the first and only manifestation of A. Fib.

Lisa (Evanston, IL) - 10:28 AM:
Why are people with A-Fib placed on blood thinners?

Dr. Jose Nazari (NorthShore):
Because they prevent blood clots in the atria and thus prevent embolic complications such as strokes.

David (Skokie, IL) - 10:29 AM:
What is the most common form of drug therapy treatment?

Dr. Jose Nazari (NorthShore):
For strokes, Coumadin. For AF proper, it depends on too many factors to know. Until recently, it has been amiodarone.

Clair (Northbrook, IL) - 10:29 AM:
What can I do to prevent A-Fib? Is it hereditary?

Dr. Jose Nazari (NorthShore):
Prevent hypertension and treat it promptly if it occurs. Stay healthy, exercise regularly, eat healthily. It can be hereditary and we do not yet have treatment for genetic conditions, though I suspect we will one day.

Dr. Jose Nazari (NorthShore) - 10:42 AM:
Sorry about the temprorary breakdown of our web site. We are back up and ready to answer questions.

Dr. Jose Nazari (NorthShore) - 10:42 AM:
Sorry about the temprorary breakdown of our web site. We are back up and ready to answer questions.

Lisa (Evanston, IL) - 10:43 AM:
What age group has the greatest risk of A-Fib?

Dr. Jose Nazari (NorthShore):
The risk starts increasing at age 60 and increases each decade thereafter

John (Chicago, IL) - 10:43 AM:
What is the long-term effect of A-Fib?

Dr. Jose Nazari (NorthShore):
It can range from no symptoms or problems to absolute devastation with stroke and heart failure. It depends on a great number of factors.

Grant Gannon (Moderator) - 10:44 AM:
Minor technical glitch there folks, we're back online now with Dr. Nazari!

Will (Glenbrook, IL) - 10:44 AM:
Is there any group more at risk for A-Fib? Such as men or women, or a specific age group?

Dr. Jose Nazari (NorthShore):
The risk is highest in patients with hypertension and heart valve abnormalities. It increases as we age beyond 60.

Susan (Glenbrook, IL) - 10:45 AM:
What are the downsides of b-blockers?

Dr. Jose Nazari (NorthShore):
They can cause fatigue in some patients. They are otherwise quite safe -and old, therefore tested. They do not treat atrial fibrillation, just control the rate.

Jake (Glen Ellyn, IL) - 10:46 AM:
Are there certain medications that are known to cause A-Fib?

Dr. Jose Nazari (NorthShore):
excessive thyroid or adrenaline (for example pseudoephedrine)

Lisa (Evanston, IL) - 10:48 AM:
What are the symptoms of A-Fib?

Dr. Jose Nazari (NorthShore):
Most commonly, palpitations. some people can feel miserable and don't quite know why (fatigued, short of breath)

Will (Glenbrook, IL) - 10:49 AM:
How common is A-Fib?

Dr. Jose Nazari (NorthShore):
it is by far the most common arrhythmia. Up to 20% of people over 70 have it.

Craig (Northbrook, IL) - 10:50 AM:
What is the success rate of cardioversions? It seems many people have issues with it.

Dr. Jose Nazari (NorthShore):
It is virtually 100% successful; nevertheless, atrial fibrillation often recurs, be it in 5 minutes or 5 years. People rarely have issues with it.

David (Skokie, IL) - 10:52 AM:
What is the success rate for treatment of A-Fib?

Dr. Jose Nazari (NorthShore):
Medications control it to the tune of 25 to 75% of the time. But recurrences are expected. Catheter ablation has a 60 -85 % long term success, depending on the patient. Surgical full Cox Maze ablation is 95% effective.

Patrick (Moderator) - 10:54 AM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

Lisa (Evanston, IL) - 10:54 AM:
What is the long term risk of not being diagnosed with A-Fib?

Dr. Jose Nazari (NorthShore):
The main risk is stroke or unexplained cardiac symptoms.

Will (Glenbrook, IL) - 10:56 AM:
Does A-Fib leave the heart weakened, even after treatment?

Dr. Jose Nazari (NorthShore):
Untreated A Fib with fast rates can weaken the heart, sometimes permanently (most commonly until treated). The left atrium both grows, and is more prone to cause atrial fib, the longer it is in atrial fib.

Craig (Northbrook, IL) - 10:59 AM:
Can A-Fib shorten your life expectancy?

Dr. Jose Nazari (NorthShore):
It can, particularly if left entirely untreated.

Lisa (Evanston, IL) - 11:02 AM:
How does caffeine increase the risk for A-Fib?

Dr. Jose Nazari (NorthShore):
Controversial. I think it does not significantly increase it.

Patrick (Moderator) - 11:04 AM:
Thank you again for participating in our chat today. For more information please visit our Cardiovascular Care Center pages.

Also, a transcript of this chat will be available shortly.

Dr. Jose Nazari (NorthShore) - 11:09 AM:
Thanks for your questions. This completes today's chat on AF.

Dr. Jose Nazari (NorthShore) - 11:09 AM:
Thanks for your questions. This completes today's chat on AF.
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