What is Atrial Fibrillation?

Atrial fibrillation (AF) is an abnormal heart rhythm, which involves the two upper chambers of the heart. In a normal sinus rhythm, the impulse generated by the SA node spreads through the heart and causes coordinated contraction of the heart muscle. In AF, the regular electrical impulses of the SA node are replaced by disorganized, rapid electrical impulses, which result in irregular heartbeats.

Atrial fibrillation is often asymptomatic, but can result in significant symptoms.  During Atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart. The result is an irregular and often rapid heartbeat that causes poor blood flow to the body and symptoms of heart palpitations, shortness of breath and weakness. It is also a leading cause of stroke as the erratic motion of the atria leads to blood stagnation, which increases the risk of blood clots that may travel from the heart to the brain and other areas.

Symptoms of Atrial Fibrillation

What is the risk of having a stroke or dying in the next 5 years if you suddenly develop Atrial Fibrillation?

Investigators from the Framingham Heart study have created a website to help answer this commonly asked question. You can go to their website and insert your own risk factors: In this example, we considered the risk to a 70 year old diabetic woman with relatively modest risk factors.  We gave her moderate hypertension with a systolic blood pressure of 150 mm Hg and a smoking history. Remarkably, she has a 25% risk of a stroke, and a 51 % risk of stroke or death in the next 5 years! 

http://www.nhlbi.nih.gov/about/framingham/stroke.htm

Now that you know this disease is something very serious, how can we treat it?

Atrial fibrillation may be treated with medications, which either slow the heart rate or revert the heart rhythm back to normal. Synchronized electrical cardioversion may also be used to convert AF to a normal heart rhythm. People with AF are often given anticoagulants (blood thinners) such as Coumadin to help protect them from strokes.  This was basically all that we could do to treat Atrial Fibrillation on the islands until now…

Minimally Invasive Endoscopic Ablation is now available at HMC!

The American College Of Cardiology in 2007 released clinical treatment guidelines regarding the role of this exciting new treatment option in the treatment of Atrial Fibrillation.

http://www.hrsonline.org/News/Media/press-releases/upload/HR-and-Euro-Copy-for-Print.pdf

Who should consider Minimally Invasive Endoscopic Ablation?

The American College Of Cardiology treatment guidelines indicate that patients should be considered for Ablation if they are significantly symptomatic from Atrial Fibrillation (shortness of breath, heart palpitations, fatigue) and have failed at least one trial of antiarrhythmic drug therapy.  You also may qualify, if you already have had a complication from Atrial Fibrillation (for example, a stroke or a temporary stroke).  You should ask your doctor if you should be considered for this life changing procedure.

What is Minimally Invasive Endoscopic Ablation?

The physicians at HMC have pioneered Minimally Invasive Endoscopic Atrial Ablation on the islands.  In this surgical procedure, 3 tiny, less than 1 inch, incisions are created on the right chest.  Using advanced endoscopic techniques, a flexible microwave-emitting catheter is then wrapped around the heart and ablation is then performed on the beating heart.  No sternotomy and no cardiopulmonary bypass pump are used.  This procedure can take as little as 2 hours and usually the patients can be discharged home the next morning in Normal Sinus Rhythm!

Band-Aid incisions	A final healed result!

What is the success rate of Minimally Invasive Endoscopic Ablation?

The chances of success are patient specific but in general can be expected to approximate 75 – 80 %, measured at 3 – 6 months after the procedure.  How long the patient has had Atrial Fibrillation and how diseased and enlarged the heart has become, are important determinants of success. When a patient spontaneously alternates between AF and a normal rhythm, the condition is known as paroxysmal atrial fibrillation. When a patient continues with AF as the dominant cardiac rhythm without reversion to a normal rhythm, the condition is known as chronic atrial fibrillation.  The chances of success are greater for those patients who have been in Atrial Fibrillation for a shorter period of time or who are in paroxysmal atrial fibrillation.

For more information, please call 678-7600.