Sunday June 29th 2014

- Patients stories

Donald F. Seemann

ICD for Ventricular Fibrillation

    Syndicated Columnist Judy Foreman

    On undergoing Catheter Ablation.

    Former Vice-President Richard Cheney

Why former Vice President Richard Cheney has an ICD.

    Author Deborah Daw Heffernan

    Living with an ICD.

    Roger Blanchette

    Sudden Cardiac Death, a survivor's story.

    Lawrence Beckmen

After frightening episodes of fainting, Lawrence Beckmen's healthy and happy lifestyle was restored.

    Sebastian Hitzig

    Millions of patients have been helped by pacemakers and ICDs. No story is as remarkable as that of Sebastian Hitzig.


Health Articles on Heart

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Arrhymia diet

Heart safe supplements vs unhealthy supplements

Can Anti aging medicine keep heart young?

The role of heart in erectile health?

Heart rate and Body metabolism





The Normal Heart
signs and symptoms
Heart Diseases &Disorders
Substances Causing Arrhythmia

Risk Factors and Preventionon


Ejection Fraction

Atrial Fibrilliation

Atrial Fibrillation causes

Non cardiovascular syncope

Patients quiz


Heart structure

Cardiac arrest

Tests for heart failure

Tilt table

Too fast heart beat

Long QT syndrome

Heart failure prevention

Heart failure risks

What to ask your doctor?

When to see a specialist?

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NASPE-Heart Rhythm Society is located at Six Strathmore Road, Natick, MA 01760 Phone: 508-647-0100 Fax: 508-647-0124
Copyright NASPE-Heart Rhythm Society

Atrial Fibrillation & Flutter

The simplest way for your doctor to diagnose A Fib or AFL is a combination of feeling your pulse and recording the electrical activity of your heart with an ECG. If your pulse is faster than 100 beats per minute and irregular, AF is suspected. A rapid pulse that is not irregular is more likely to be atrial flutter or some other rhythm disorder. The diagnosis can be confirmed with an ECG - a simple, painless test that records the electrical activity of the heart through electrodes that are pasted temporarily to the skin of the chest, arms and legs. An ECG often is performed in your doctor's office, using a machine that prints out a graph showing the electrical activity of different parts of the heart.

Sometimes, the patient may be asked to wear a small portable device with electronic memory to record ECGs over time. These devices include Holter monitors and event recorders. A Holter monitor runs continuously, and usually is worn for 24 to 48 hours. An event recorder is switched on by the patient to record an ECG whenever he or she senses an irregular heartbeat.

A patient wears a Holter monitor, a device that makes a continuous recording of the heart's electrical activity.

Echocardiogram. In this painless noninvasive test, a device called a transducer is placed on the chest and sound waves are bounced off the heart. This provides a moving picture of the heart.

Echocardiograms create moving pictures of the heart with sound waves.

An electrophysiology study (EPS) is a test that can determine which areas of muscle in the atria give rise to atrial fibrillation or flutter. The test is performed in a safe and controlled electrophysiology laboratory at a hospital or clinic and the patient is in no danger. In an EP study, local anesthetics are used to numb areas in the groin or near the neck, and small catheters are passed into the heart to record its electrical signals. During the study, the physician studies the speed and flow of electrical signals through the heart, identifies rhythm problems and pinpoints areas in the heart's muscle that give rise to abnormal electrical signals.

In an EP study, one or more thin tubes (catheters) are introduced into a blood vessel (usually from the groin) and directed into the heart under x-ray guidance. The heart is 'paced' or tested- that is, tested with electrical signals to see which areas of heart muscle give rise to abnormal rhythms.

Atrial Fibrillation & Flutter

There are several approaches to treating atrial fibrillation and atrial flutter. These may include:

Medications to prevent stroke and control the heart rate

Short-term and long-term treatments to control or stop abnormal electrical signals in the atria


Preventing Stroke

Drugs may be prescribed to stop formation of blood clots that can lead to stroke. These medications, called anticoagulants, must be carefully regulated so that the body maintains its ability to form clots to stop bleeding in the event of injury. The decision to prescribe these medications - and which to prescribe - is based on patient age, the severity of the condition and various risk factors. asprin bottle, color photo

  • Warfarin (Coumadin) usually is prescribed for patients who are over age 65, have had a prior stroke or have other health problems such as heart failure, coronary artery disease, diabetes, hypertension, or heart valve disease.

  • Aspirin (or no medication) is the standard treatment for people under age 65 who do not have any other risk factors that increase their chances for developing blood clots associated with A Fib or AFL.

Short-Term Treatments

  • Medications that slow the rapid heart rate associated with A Fib or AFL. Drugs such as beta blockers (metoprolol, atenolol, propranolol), calcium antagonists (verapamil, diltiazam.) and digoxin slow the transmission of electrical signals from the atria to the ventricles. These can be administered by mouth to slow the ventricular rate to 60 to 90 beats per minute, even though the atria continue to fibrillate.

  • Electrical Cardioversion. For most individuals with persistent A Fib or AFL, or those whose symptoms are not improved with medications, the heart's normal rhythm can be restored by delivering a controlled electric shock to the heart. The shock breaks the pattern of abnormal electrical signals. This procedure is performed under careful medical supervision and short-acting sedatives are used so that patients do not feel any pain or discomfort. In many cases, however, cardioversion is not a permanent cure, and the abnormal heart rhythm returns. Medications called antiarrhythmic drugs may be prescribed to reduce the likelihood of recurrent Afib od AFL

  • Drug Cardioversion. Drugs (such as ibutilide) sometimes can restore the heart's normal rhythm. These drugs are given under medical supervision, and are delivered through an IV tube into a vein, usually in the patient's arm.

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Long-term treatments

Sometimes the goal of long-term treatment is to maintain the heart's normal sinus rhythm and prevent future episodes of rapid or irregular heartbeats in the atria. In some cases, A Fib is allowed to persist and treatment is given to control the heart rate. These treatments may include:

  • Oral medications called "antiarrhythmics" that may help control heart rhythm disorders. Oral medications include: medications in hand, color photo

    • Amiodarone

    • Disopyramide

    • Dofetilide

    • Flecainide

    • Procainamide

    • Propafenone

    • Quinidine

    • Sotalol


    Unfortunately, medications are not always effective in controlling A Fib or AFL, or cannot be used in some patients because of undesirable side effects.

  • Radiofrequency ablation, or RFA. When medications do not work or are not an option because of side effects, RF ablation may be effective for some patients. In this procedure, one or more flexible, thin tubes (catheters) are introduced under x-ray guidance into the blood vessels and directed to the heart muscle. A burst of radiofrequency energy destroys very small areas of tissue that give rise to abnormal electrical signals, or to block abnormal electrical pathways. This treatment is especially effective for atrial flutter and for:

    • Atrial fibrillation that is triggered by extra heart beats that arise within one or more of the pulmonary veins - the four blood vessels that carry blood from the lungs to the left atrium of the heart.

    • For some individuals, a technique called atrioventricular junction ablation is used to disrupt AV node. This is the group of cells in the middle of the heart that conducts impulses from the atria to the ventricles so that they work together to pump blood efficiently. Because this procedure interrupts the conduction of electrical signals through the AV node, a pacemaker must be permanently implanted to regulate activation of the ventricles. This is especially useful for patients who continue to have a rapid heart in atrial fibrillation despite maximally tolerated doses of medicines.

      • AFL ablation procedures are particularly effective for patients with atrial flutter that uses a circuit in the right atrium and travels through the tricuspid isthmus. (the area of the atrium between the tricuspid valve and inferior vena cava)

  • Surgery. Although surgery is rarely performed to control A Fib, new operations have been tested successfully in a small number of patients. In one, called the Maze procedure, open-heart or minimally invasive surgery is performed and several incisions are made in the atria to disrupt the electrical pathways that generate AF.

  • Atrial Pacemakers. These devices are permanently implanted under the skin to regulate the rhythm of the heart to reduce the frequency of A Fib in some patients.

    Low-energy internal atrial defibrillators (atrial ICDs). Like pacemakers, these devices are permanently implanted under the skin. They automatically or on command deliver a controlled electric shock to restore the heart's normal rhythm when they detect a too-rapid heartbeat in the atria.
    implanted ICD, x-ray

    Pacemakers and other devices are implanted to regulate the heartbeat.

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