The Medical Management of Atrial Fibrillation or A-Fib
According to the American Heart Association, an estimated 2.7 million Americans are living with A-Fib. Therapy is important for the purpose of preventing stroke and the development of heart failure. If A-Fib cannot be treated with medication or other non-surgical procedures, patients can be evaluated for a minimally invasive Maze procedure – also known as “mini maze”.
What is Atrial Fibrillation?
Atrial fibrillation is an abnormal heart rhythm with disorganized electrical activity in the atria (upper chambers of the heart) characterized by an irregular pulse that causes the symptoms of palpitations or fluttering. This disorganized atrial electrical activity causes the atria to quiver instead of contract regularly.
What are the symptoms?
Common symptoms include:
Some patients do not experience any symptoms during this rhythm. A-Fib can last from minutes to days and in many cases becomes permanent.
How is it diagnosed?
A thorough history and work-up should be obtained.
Tests used to help diagnose the disease can include:
Non-surgical treatment strategies
Control the heart rate but leave the heart in A-Fib. This is an easier goal to accomplish, using medications to slow down the AV node and the pulse rate. Types of drugs used for this include calcium channel blockers (verapamil, diltiazem), beta-blockers (atenolol, metoprolol, etc.), digitalis, and even amiodarone.
Restore and maintain sinus rhythm. This is usually less successful, but most people feel better in regular rhythm. The most common drug therapy for maintaining sinus rhythm are antiarrhythmic drugs such as flecainide, propafenone, sotalol, amiodarone and dofetilide. Unfortunately, these drugs do not work all the time and have side effects.
Surgical treatment strategies
If patients are not treatable by medical or percutaneous means, they can be referred for the Mini-Maze Procedure.
This procedure is performed through one small (two-inch) incision on each side of the chest. Using video-assisted technology, the maze lesions are made around the pulmonary veins on the left atrium without making an incision in the breastbone or using the heart-lung bypass machine. In addition, the left atrial appendage is removed, therefore getting rid of the primary cause of stroke from thrombus formation.
Some patients may not be candidates for a minimally invasive approach and can consider a formal Maze procedure, which is the most successful approach to curing atrial fibrillation. Most patients that are referred for the Mini-Maze procedure have had one or more catheter ablations and remain in A-Fib despite these procedures and medical therapy.
It can take up to six months for the maze lesions to completely mature after the ablation procedure. Nearly all patients are able to discontinue their anti-arrhythmic medications and their anti-coagulants such as warfarin. Patients will return to clinic for follow-up two weeks after surgery and then have a Holter monitor study at 3 months. After six months, evaluation for whether normal heart rhythm has been restored occurs and medications can generally be stopped at this time.
Atrial Arrhythmia Program at UW Health
UW Health’s Atrial Arrhythmia Program provides access to both the cardiac surgical team and the electrophysiology cardiology team, which specializes in the electrical function of the heart.
Dr. Shahab Akhter, Chief of Cardiothoracic Surgery, and his team focus on disease management and rely upon the multidisciplinary expertise of a wide range of health care professionals including electrophysiologists, cardiovascular surgeons, nurse practitioners, nurses, and pharmacists, to form the best treatment plan for each patient.
Share Your Insights
Do you have additional knowledge, experience, or questions on this topic? We’d love to hear from you — please click here to send us a message with your feedback!
For More Information
For more information about A-Fib and the Atrial Arrhythmia Program at UW Health, please click here.