Health Report: Alternatives to drugs offer new ways to treat Atrial Fibrillation

According to the National Institute of Health, most adults have an average heart rate of 60 to 100 beats per minute. Most of the time, you don’t think about how fast your heart is beating unless you’re exercising, feeling stressed — or have cardiac arrhythmia.

Cardiac arrhythmia is a condition in which the heart may suddenly start to beat too quickly, too slowly or with an erratic rhythm.  In serious cases, arrhythmias may increase the risk of cardiac arrest, stroke and heart failure. The most common type of arrhythmia is atrial fibrillation.

“Normally, the two upper chambers of the heart (the atria) contract, followed by the two lower chambers (the ventricles), in a steady rhythm,” said Douglas Gibson, M.D., a Scripps Clinic electrophysiologist. “With atrial fibrillation (AFib), the electrical impulses that control this rhythm become irregular, disrupting the atria’s ability to effectively pump blood from the heart.”

As a result, the heart may beat very quickly, sometimes exceeding 200 beats per minute. In addition to a rapid heartbeat, some people with AFib experience symptoms including shortness of breath, fatigue, dizziness or chest discomfort.

About 30 percent of all strokes in the United States are related to atrial fibrillation. Since AFib prevents the heart from pumping blood effectively, blood can pool in the atria and form clots. In people with AFib, clots are most likely to occur in an area of the left atrium called the left atrial appendage. If these blood clots travel to the brain, they can cause a stroke. People with AFib have a stroke risk that is about six times higher than normal, and strokes related to AFib tend to be more disabling than other strokes. 

Medications such as Warfarin, Eliquis, Xarelto and Pradaxa can help people with AFib reduce their risk of having a stroke, by causing the blood to become thinner, thereby reducing the likelihood of clot formation.

While these medications can be very effective, some people find them difficult to use or experience unwanted side effects.  Warfarin, for example, requires certain dietary restrictions as well as frequent blood tests to see how thin the blood is and whether the dosage needs to be adjusted. Blood thinning medications can cause some people to bruise more easily, as well as raise the risk of life-threatening bleeding. 

Two relatively new, minimally invasive surgical treatments, known as left atrial appendage occlusion procedures, may be options for people who cannot or prefer not to take blood-thinning medications. Both occlude (or close up) the left atrial appendage, which is where most clots form. Closing the left atrial appendage has no effect on normal heart function in adults.

“Having these non-medication alternatives is important for patients who have previously only had blood thinners as an option, in many cases for years,” Dr. Gibson said.

One procedure implants a tiny, parachute-like device called the Watchman into the heart. 

During this relatively short procedure performed under general anesthesia, the surgeon inserts a long tube called a catheter through a small incision in the groin and threads it through a vein up to the heart. The device is then placed in the heart through the catheter.

Most patients spend one night in the hospital and can usually stop taking their blood-thinning medications 45 days after the procedure.

Scripps Health doctors and patients participated in the research trials that led to Food and Drug Administration approval for the Watchman. Scripps doctors are currently studying a second procedure that uses a device called the LARIAT, which ligates or “ties off” the left atrial appendage. It also is minimally invasive and performed under general anesthesia. Early results of the research are promising.

Dr. Gibson will be leading free seminars about recent advances in the treatment of Afib in San Diego on Thursday, Sept. 24, from 6 to 7 p.m. at the Rancho Bernardo Inn at 17550 Bernardo Oaks Drive, and on Friday. To register for one of the limited spaces, call 825-240-5075.

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