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A Fluttering Heart: Diagnosis and Treatment

August 6, 2008 6:59 PM with Dr. Westby G. Fisher

Westby G. Fisher MD, Director of Atrial Fibrillation Program within the Cardiovascular Institute, discusses the signs, symptoms and treatment options for Atrial fibrillation.

Kristin Philbin (Moderator) - 6:45 PM:
Thank you everyone for attending. The chat will begin shortly. Feel free to begin submitting questions.

Dr. Westby G. Fisher (NorthShore) - 7:00 PM:
Hello and welcome to our online chat discussing atrial fibrillation and its management. My name is Dr. Wes Fisher and I will be with you for the next hour. I serve as the director of the Division of Cardiac Electrophysiology at Evanston Northwestern Healthcare (ENH) and am an Associate Professor of Medicine at the Feinberg School of Medicine, Northwestern University. I look forward to fielding your questions. Realize that I will be selecting as many questions as possible to answer in the short hour we have together, but there is a chance I cannot answer them all. Before we begin, a short disclaimer is in order. Although I am a doctor, I am likely not YOUR doctor, and as such, the responses here follow generally accepted practices and may not be appropriate for every patient. As always, it is advisable to discuss issues regarding the management and therapies for atrial fibrillation with your personal physician to make sure it’s right for you. Okay, let's get going!

  Irene Schuman (Melrose Park, PA) - 7:00 PM:
How well does Sotalol control Atrial fibrillation? What are chances of recurrence as this is my second attack in 20 years?
Dr. Westby G. Fisher (NorthShore)
Most of our antiarrhythmics for atrial fibrillation are (at best) 50 to 60 percent effective at maintaining normal sinus rhythm in patients treated with these medications. Given the very low recurrence rate you've enjoyed, it sounds like you've had better-than-average efficacy with this medication.

  Irene Jakobsen (Oak Park, IL) - 7:04 PM:
I’ve read up on the symptoms of Atrial fibrillation and some sound very similar to a heart attack (shortness of breath and chest pains for example). How do I differentiate between the two?
Dr. Westby G. Fisher (NorthShore)
Heart attacks are often difficult to identify from symptoms alone, because nearly have of those who have a heart attach never feel the symptoms. In general, atrial fibrillation is characterized by an irregular pulse and loss of mechanical contraction of the upper chambers of the heart, which diminishes the heart's pumping ability slightly. This can lead to symptoms of shortness of breath, lightheadedness, palpitations (an uncomfortable heart beat), and sometimes chest or neck discomfort described as tightness or (less often) pain. If concerned, it is wise to seek medical attention if you have any of these symptoms.

  Susan (Chicago) - 7:09 PM:
How do you know if you're at risk for AFib?
Dr. Westby G. Fisher (NorthShore)
Risk factors for atrial fibrillation include underlying structural heart disease (especially valvular heart disease), hypertension, a history of diabetes, prior stroke or transient ischemic attack (brief, stroke-like symptoms), and advanced age. (Atrial fibrillation incidence increases dramatically in people over age 75).

  Karl (Old Town, Chicago) - 7:12 PM:
How will Atrial fibrillation affect my work out? I’m mostly concerned about cardiovascular exercise. Should I stay away from treadmills, etc.?
Dr. Westby G. Fisher (NorthShore)
Karl, your doctor is the best person to ask this question. However, the primary treatment for atrial fibrillation is to treat its symptoms. If your heart rate is controlled when you exercise (this can be tested with a simple treadmill test), then your exercise regime may not have to be curtailed. Medications can help control the heartrate during exercise. Realize, however, that the normal mechanical pumping contribution of the atria is compromised in atrial fibrillation, so you may find your performance is limited somewhat by fatigue and shortness of breath.

  Connie Ream (Boca Raton, Fl) - 7:17 PM:
I have a one ICD Lead and my Doctor told me to upgrade it to three leads. What Are the advantages and disadvantages?
Dr. Westby G. Fisher (NorthShore)
Although this particular question does not pertain to atrial fibrillation per se, another individual asked a similar question, so I'll try to hit 2 birds with one stone. We have found that adding an extra pacing lead to the far left side of the main pumping chamber (the left ventricle) in addition to the usual right ventricular pacing lead (so-called biventricular pacing), particularly in individuals with a history of heart failure, can markedly improve in their heart muscle function, phyical ability, and reduce hospitalizations for heart failure. If an extra wire is also placed in the uppe chamber of the haert, then the computer in an inplantable defibrillator can better differentiate when the heart is in normal sinus rhythm or atrial fibrillation. For these reasons, some doctors recommend "upgrading" defibrillators from single-lead systems to three-lead (or biventricular) pacing systems.

  T. Hay (Boca Raton, Fl) - 7:24 PM:
I have been diagnosed with cardiac heart failure. I also have AFib. They are suggesting a 3 lead pacemaker will improve my heart function. Can you suggest who makes units that will not have the ICD go off if I go into AFib?
Dr. Westby G. Fisher (NorthShore)
T.- Hopefully I've answered this question above.

  Maggie Michaels (Chicago) - 7:26 PM:
Are there alternative therapies that combined with medication may help decrease your risk for another episode?
Dr. Westby G. Fisher (NorthShore)
Maggie, Before embarking on therapies to manage atrial fibrillation, it is important to make sure there are no correctable problems that might predispose one to developing atrial fibrillation. Evaluating for structural abnormalities of the heart, ruling out occult thyroid disease, diabetes, hypertension, etc. is important. Following this and assuming no other cause is found, avoiding excessive alcohol intake might help limit AFib's recurrence. Coffee, interestingly, does not seem to have a significant effect on AFib frequency, provided it is consumed in limited quantities. Some medications to decrease adrenaline levels (like beta blockers) can help limit episodes on patients whose AFib occurs more commonly in high-adrenaline states, like vigorous exercise.

  Irene Schuman (Melrose Park, PA) - 7:33 PM:
For several years I've had chronic palpitations, especially after eating. Doctors have sent me for stress tests, echocardiograms, Holters, carotid artery sonograms, etc. all with negative results (no heart disfunction). Now that I've had a bout of atrial fibrillation and have been put on Sotalol these chronic symptoms have all but disappeared. An echocardiogram at the time of the AFib showed some leakage in the mitral valve and "stickiness" in the aortic valve. Is there a connection between
Dr. Westby G. Fisher (NorthShore)
Unfortunately, the last sentence was truncated, but I think I can guess where it's going. In some patients I have seen, there is a clear relationship with eating certain foods (cold things stick out (like ice cream) for instance). It is possible that some of your symptoms may have been related to this. More recently, we commonly utilize "event recorders" (rather than 24-hour Holters that record every heartbeat over 24 hours), because they can record symptoms over 30 days and help us correlate your symptoms to your heart rhythm. I'm not sure if you had this done. You AFib now may be related to either to your prior symptoms or is now related to your heart valve abnormalities - teasing out which one would be very difficult to determine at this point.

  Patrick Krohn (Northfield,IL) - 7:39 PM:
My sessions of AFib have increased from one (one min) a day to three (one minute ) a day Shall I adjust medication???? Thank You.
Dr. Westby G. Fisher (NorthShore)
Patrick, It would depend on how much these episodes bother you. It might be possible that your more frequent episodes could be diminished by increasing your dose, but this should only be done after consulting with your physician.

  T.Hay (Boca, Fl) - 7:42 PM:
Thank you for your answer. But, can you suggest which devices I should check out that have algorithms to deal with Afib and not fire the ICD. I have contacted several manufactures and some say the doctor has to set thresholds while others say they have programs for the problem. I realize that anything you suggest must be discussed with my doctor.
Dr. Westby G. Fisher (NorthShore)
T- All manufacturers have ways to program their devices in the event AFib occurs. Most use a rate threshold of sensed beats in the atrium to tell the computer inside the defibrillator that the atrial fibrillation is occurring. These devices also have built-in "logic" to compare the relationship between the sensed upper chamber (atrial)signals to the lower chamber (ventricular) signals. The doctor can program this additional feature "on" or "off." With the feature "on", the ICD is less likely to fire when AFib occurs, but may (in very rare circumstances) also be slighty les likely to detect life-threatening rapid lower chamber rhythms. Therefore, devices have to be programmed depending on an individual's response to AFib. Usually, the extra feature is programmed "off" initially to assure life-threatening rhtyhms are always treated, then the additional feature programmed "ON" if an inappropriate shock occurs (from AFib) to "fine-tune" the programming.

  Larry Hollert (Naperville, IL) - 7:50 PM:
What is the Maze procedure? I have advanced AFib and this was recommended. Surgery seems aggressive - what should I consider before taking this step?
Dr. Westby G. Fisher (NorthShore)
Larry- Good question. The MAZE procedure is a surgical procedure performed either through an incision in the side of the chest or through the breastbone, to burn (cauterize) the atrium just beside the pulmonary veins of the left atrium (where AFib is thought to arise) from the outside of the heart (rather than the inside, like a catheter-based approach is used). The burns are created with electrical or ultrasound energy. The lines are often full-thickness and have had a good track record at relieving atrial fibrillation. There has been a fairly high incidence of the need for a permanent pacemaker after the procedure (5% or so) in patients with chronic atrial fibrillation due to the underlying abnormality of the normal pacemaker portion of the atrium (called the sinus node) once the AFib is corrected. It's success rates with a single procedure are fairly good (80-85%).

Kristin Philbin (Moderator) - 7:52 PM:
Thank you everyone for participating. The chat will end in 10 minutes. Please submit any remaining questions you may have.

  T.Hay (Boca, Fl.) - 7:56 PM:
Thank you for your time. You have been very helpful. It is hard these days to find a doctor who will take time to discuss issues.

Kristin Philbin (Moderator) - 7:57 PM:
The doctor has time for one last question. Thank you everyone for submitting questions today.

  Marcus Williams (Racine, WI) - 7:57 PM:
I’ve felt palpitations come and go maybe twice in the past four weeks. I feel a bit light headed, but not for long and can easily resume regular activity. When should I seek medical attention?
Dr. Westby G. Fisher (NorthShore)
Marcus- Heck, I'd seek it now. Your doctor could issue you an event (or "loop") recorder for 30-days to capture the rhythm, evaluate it and recommend the best therapy for you. If you're lightheaded when it occurs, it certainly warrants evaluation.

Kristin Philbin (Moderator) - 8:01 PM:
Thank you everyone for participating. To learn more about Atrial Fibrillation, please visit us here: Cardiology.

Dr. Westby G. Fisher (NorthShore) - 8:01 PM:
Thanks to all who participated!

This chat has ended.

Thank you very much for your participation.