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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
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Atrial Fibrillation
& Flutter
Tests
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. |
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A patient
wears a Holter monitor, a device that makes a continuous recording of
the heart's electrical activity.
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| 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. |
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Echocardiograms
create moving pictures of the heart with sound waves.
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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. |
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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.
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Atrial
Fibrillation & Flutter
Treatment
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There are several approaches
to treating atrial fibrillation and atrial flutter. These may include:
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Medications
to prevent stroke and control the heart rate
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Short-term
and long-term treatments to control or stop abnormal electrical signals
in the atria |
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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. 
- 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:
- 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. |
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Pacemakers
and other devices are implanted to regulate the heartbeat. |
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