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Skipping a Beat: Managing Atrial Fibrillation

February 27, 2013 12:00 PM with Dr. Jay Alexander

Having an irregular heart beat can be a serious matter. Atrial Fibrillation (A-fib), a common heart condition, is often hard to diagnose because patients either don’t have symptoms or aren’t able to identify them as a problem. If left untreated, it can lead to other health complications. Join Jay Alexander, MD, Cardiologist at NorthShore, as he answers your questions about A-fib symptoms, diagnosis and treatment options. He’ll also answer your questions about heart health and heart disease prevention. Submit your early questions today.

Angela (Moderator) - 11:50 AM:
Welcome! Today’s chat: Skipping a Beat: Managing Atrial Fibrillation will begin shortly. Please start submitting your questions and Jay Alexander, MD, cardiologist will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit our Cardiovascular pages on our website. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

  Debra H. (Chicago Heights, IL) - 12:00 PM:
Good day, I was diagnosed with AFib, AFlutter, HCM a murmur and other problems. I've had mapping with many ablations. Was told had to stop burning because as soon as one was burnt another 'break' popped up. I have almost chronic attacks w/syncopal episodes. I asked if I should tell my Reg DR about my diagnosis. Was told no. Nothing to worry about. I know it's no big deal, but surprised he said no. Should I treat my issues like they're not there as he suggested? Not even mentioning it in a history?
Dr. Jay Alexander (NorthShore)
Debra, I would suggest that you do discuss this with your regular physician and he/she should then discuss this with your cardiologist and electrophysiologist.

  stewart (aviemore) - 12:04 PM:
hi, i got propanolol from my gp yesterday, i have been finding out about it online and it says people with irregular heart beats should not take them. i think i have an irregular heart beat and was wondering if what i have read is true and i should go ahead and take them. thanks
Dr. Jay Alexander (NorthShore)
Stewart, Beta-blockers (which propranolol is one of) is commonly used for various types of arrhythmias and symptoms of irregular heart beats and palpitations. Propranolol by itself does not worsen or cause irregular heart rhythms, so I would feel comfortable in suggesting that you follow your doctor's advise and try the propranolol and see if you notice an improvement.

  Elena G. (Evanston) - 12:09 PM:
Any possible increase of AFib frequency in patients diagnosed with PVCs?
Dr. Jay Alexander (NorthShore)
Elena, There is no relationship between premature ventricular beats and the frequency of atrial fibrillation. They are two separate issues and both can occur in the same patient. They do not influence each other as to frequency or severity of the arrhythmia.

  Horn - 12:12 PM:
Hi My heart went into AFib last October. While at the hospital it was discovered my thyroid was hyper active. It has since returned to normal (my heart went back to normal after about 12 hours) but my cardiologist wants to leave me on beta blockers for another 2 months (total of 6). Is this normal and is there any reason to believe I won't be able to come off the beta blockers eventually? I'm 44. Thank you!
Dr. Jay Alexander (NorthShore)
Horn, Atrial fibrillation is very common in both low thyroid and high thyroid states. The common treatment for atrial fibrilation related to high thyroid is beta-blockers. I agree with your doctor that withdrawing the beta-blocker too soon could result in a recurrent episode of AFib. Keeping you another two months is prudent and if your thyroid is kept in the normal range, I feel confident that you will be able to stop the beta-blocker.

  Elena G. (Evanston) - 12:18 PM:
Thanks, Dr. Alexander! Any recommendation regarding life style/dietary/physical activity changes one can make to lessen the frequency and duration of AFib episodes?
Dr. Jay Alexander (NorthShore)
Unfortunately AFib episodes are random. they may more frequent with alcohol, caffeine, and various over the counter medications especially for colds. I would avoid those, and it's always a good idea for a heart healthy life to get into exercise, eat prudently and get a good night's sleep.

  Christopher (Crete, IL) - 12:21 PM:
When should you seek medical care when you have a lasting AFib attack?
Dr. Jay Alexander (NorthShore)
Christopher, If it is your first episode the answer is immediately. If you have had them before, I would develop a strategy with your doctor as to how he would like you to proceed when you have an episode. Most commonly, it is suggested that if your pulse rate is consistently over 100 to 120, that you seek attention sooner than later. Certainly, within the first 24 hours.

  Joan (Skokie) - 12:25 PM:
Can you be too young to be considered for an ablation? My husband is 46 and it was recommended that he gets one. Flecanide, Tikosen and Sotalol have not worked for him, and it seems that his episodes are getting worse. Is there another drug he could try or should we start more seriously considering an ablation?
Dr. Jay Alexander (NorthShore)
Joan, The current belief is that if he has failed more than two medications that it is likely that he will fail more medications if tried. therefore the best overall solution would be to attempt ablation. There is no clear age cut off for ablation and he is certainly in an age group where ablation is commonly considered as an alternative to daily medications which potentially have side effects and commonly also are not successful in maintaining normal rhythm.

  Samantha C. (Homewood) - 12:28 PM:
Good day Dr. Alexander and thank you. Has there been any further advances in corrective measures for AFib since the ablation or is that still the only surgical cure? It's a wonderous advacement. Is there still research going on for AFib?
Dr. Jay Alexander (NorthShore)
Samantha, Good question. There is a lot going on in treatment for AFib. Advances in ablation include cold ablating and there are now minimally invasive surgical procedures as well as hybrid procedures that include ablation and minimally invasive maze type procedures.

  Elena G. (Evanston) - 12:30 PM:
What are your thoughts on AFib and genetics (both in terms of "hereditary" AFib and "individualized" treatments, especially in light of the new medications available)?
Dr. Jay Alexander (NorthShore)
Though commonly you can find several members of a family with AFib, there is no clear genetic trait for AFib. AFib is so common that heredity probably plays little role. As far as treatment, therapy tends to be individualized. Not everyone needs to have a strategy for rhythm control (maintaining normal rhythm) and some are just rate controlled keeping heart rate below 100 at rest. The other aspect of treatment for AFib includes reducing the risk of embolic stroke using anticoagulation which is added in patients at such risk.

  Charles (Deerfield) - 12:35 PM:
I’ve known of my atrial fibrillation for the last three years, even though I am certain I’ve had it much longer. My cardiologist recently told me that’d be a good candidate for a cardio ablation. What are the risks? Is this an effective way to treat it?
Dr. Jay Alexander (NorthShore)
Charles, Ablation is a well accepted treatment to prevent atrial fibrillation (AFib) It entails placing a catheter into the left atrium and performing radiofrequency "burns" in a specified pattern commonly known as pulmonary vein isolation. The data suggests that ablation works approximately 70% of the time as a single procedure and can be as effective as 80% if a second or third procedure is required. Any invasive procedure carries risk and this needs to be discussed prior to embarking on a strategy of ablation. Though the risks are rare they can include perforation, esophageal fistula, pulmonary vein stenosis, to name a few. I suggest you discuss this fully with your electrophysiologist before committing to such therapy.

  Debbie (Columbia, KY) - 12:40 PM:
Hi Dr. Alexander. Can you tell me the difference between AFib and AFlutter? Do they usually go hand in hand? Can you have both? Does it change the treatment options? Will an ablation cure both or just AFib? Thank you for taking your time to help us understand this problem!
Dr. Jay Alexander (NorthShore)
Debbie, AFib and atrial flutter are similar but different. Flutter is a more electrically organized rhythm and frequently starts in the right atrium, while AFib is electrically disorganized and from the left atrium. Yes, they can occur together or separately. Both can be treated with ablation and flutter ablation is frequently more successful and slightly less risky. I commonly suggest to patients with flutter that ablation (I believe) is the most definitive treatment while AFib ablation (being less successful in my view) should require failure of medical therapy.

  jess (highland park) - 12:44 PM:
My dad will be getting some dental work done in the next week that will require anesthesia. He’s had episodes before from previous visits to the dentist, and my mom and I were wondering what other options may exist for him. Is it common for anesthesia to cause AFib?
Dr. Jay Alexander (NorthShore)
Jess, Local or general anesthesia in themselves do not cause AFib, however, commonly dentists use lidocaine with a small amount of epinephrine added to reduce bleeding and to make the anesthesia last longer. the epinephrine may cause arrhythmia. therefore, I tell patients to ask their dentists to use a local anesthetic without epinephrine.

  Elena G. (Evanston) - 12:49 PM:
Do you envision a possibility of an effective genetic or other testing prior to prescribing, when needed, a respective medication in a more targeted way?
Dr. Jay Alexander (NorthShore)
There is a lot of work going on with targeting medical therapy in a genetic fashion. To my knowledge there is little of that in regard to AFib. I suspect many of the medical therapies that we use in cardiology as well as other fields of medicine will be modified by genetic targeting in the future. We are not yet there in regard to arrhythmias.

Angela (Moderator) - 12:49 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

  Marsha (St. John, IN) - 12:51 PM:
What causes AFib? Is it something you're born with or can something cause it? If it's from birth, why does it take so long to find?
Dr. Jay Alexander (NorthShore)
Marsha, AFib is an irregular rhythm which starts in the left atrium. There are many thoughts as to why it occurs. It is commonly seen with various forms of heart disease, thyroid disease, associated with high blood pressure, and advancing age. There is likely not one clear cause but treatment is the same for most people with AFib and is based on a strategy of either rate control or rhythm control. It can be seen with a structurally normal heart and we call that "lone" atrial fibrillation. It may be hard to diagnose because at its earliest form it may be intermittent lasting minutes to hours, and may result in little symptoms.

  peter (chicago) - 12:56 PM:
i have to drive a lot for my job and am worried that it’s not something i should be doing with my AFib. i try to not take medication before driving and make sure that i pull over if i get too dizzy. Is there anything i can do to control my episodes better?
Dr. Jay Alexander (NorthShore)
Peter, Symptoms from AFib are commonly due to fast heart rates and controlling the rate during episodes frequently controls the symptoms, such as dizziness. I agree with you Peter, that you should not drive if you are dizzy. You need to find a medical regimen with the help of your doctor that better controls both the frequency of your AFib and the heart rate when you go into AFib. I suggest you discuss this with your physician soon.

Angela (Moderator) - 12:59 PM:
Thank you for participating in our online chat today. An online transcript will be available shortly. To learn more about NorthShore’s Cardiovascular services, visit our website.

This chat has ended.

Thank you very much for your participation.