HCA Houston Healthcare - September 27, 2021

Atrial fibrillation, or AFib, is one of the most common arrhythmias, affecting more than 2 million Americans according to the American Heart Association. The month of September is dedicated to sharing information and awareness about atrial fibrillation, warning signs and available treatment options.

“The incidence of AFib is rising annually with increasing awareness, better detection methods, and a population that is aging overall,” says Dr. David Burkland, a clinical cardiac electrophysiologist at HCA Houston Healthcare Medical Center.

In atrial fibrillation, the upper chambers of the heart (the atria) beat irregularly (quiver) instead of beating effectively to move blood into the ventricles. It usually progresses from short, rare episodes to longer and more frequent attacks. AFib can lead to heart-related complications such as blood clots, stroke and heart failure.

Dr. David Burkland portrait

“The slowing of blood flow through the quivering top chambers can lead to the formation of blood clots,” says Dr. Burkland. “A piece of the clot can then break off, enter the circulation, and clog a downstream vessel. If this happens in the brain, it can cause permanent brain damage in the form of a stroke. This is the most feared complication of atrial fibrillation and is the reason why most patients with AFib are on a blood thinner to reduce the risk of a stroke.”

There are some people living with AFib who do not experience any symptoms and don’t know that they have it. For these people, it may be discovered during a routine physical examination with their primary care provider (PCP). Those who do have symptoms of AFib may experience symptoms such as fatigue, lightheadedness, dizziness, fluttering or “thumping” in the chest, weakness or shortness of breath.

There are a number of factors that can increase your risk for AFib, including age, uncontrolled blood pressure, diabetes, obesity, sleep apnea and binge drinking. Dr. Burkland states that some patients may develop AFib without having any of these risk factors, but instead it is inherited from a close relative.

“Overall, you can reduce your chances of developing AFib by controlling your blood pressure, limiting alcohol to one to two drinks per day, losing weight, exercising regularly, and treating sleep apnea, if present,” Dr. Burkland says. “However, in many individuals, lifestyle modifications alone cannot prevent AFib.”

Arrhythmias are electrophysiologists’ focus

Electrophysiologists, as the name suggests, deal with electricity—specifically, with the electrical impulses in the heart that control its rhythm and trigger heartbeats. The electrophysiologist is trained to diagnose and treat arrhythmias.

Arrhythmias, such as atrial fibrillation, can originate along a variety of points in the heart’s electrical system, as well as from other parts of the heart. There are various types of arrhythmias including:

  • Atrial flutter
  • Bradycardia, or low heart rate
  • Sick sinus syndrome, which can lead to both atrial fibrillation/atrial flutter and bradycardia
  • Tachycardia, or fast heart rate, of which there are a number of types
  • Ventricular fibrillation (VF), a life-threatening “quivering” of the ventricles that can cause sudden cardiac death
  • Premature ventricular contraction, in which the ventricles suddenly contract when receiving an abnormal early signal
  • Heart block, in which electrical impulses originating from the upper chambers of the heart don’t reach the lower chambers as they should.
  • Long QT syndrome, which can cause VF
  • Brugada syndrome
  • Wolff-Parkinson-White syndrome
  • Arrhythmias relating to medication, pregnancy or abnormal metabolism

Arrhythmias can arise from long-standing heart conditions, including high blood pressure, as well as other issues, such as heart attack, injury, drug use or an electrolyte imbalance. Some heart rhythm disorders are linked to genetics or congenital heart defects.

Diagnosing and treating arrhythmias

Arrhythmia treatment depends on the type and severity of the arrhythmia. In order to properly treat your condition, an examination and tests must be done to accurately diagnose your condition. These tests may include blood tests, stress test, echocardiogram, electrocardiogram (EKG) or a holter monitor.

If a person has fainting spells or nearly faints due to their arrhythmia, the electrophysiologist may use a tilt-table test to determine why. In that test, patients lie on their back on a special table whose angle is changed, going from flat to upright. The doctor monitors heart rate and blood pressure to see how their heart adjusts to the tilt.

Your electrophysiologist may order an electrophysiology (EP) study to understand the nature of your abnormal heart rhythm. An EP study is a detailed look at your heart’s electrical system, which may catch an important arrhythmia in real time. This in turn can shed light on the origin of an arrhythmia, the effects of certain medications, your prognosis and whether you’d be a good candidate for a pacemaker or other intervention.

“The treatment of atrial fibrillation has progressed remarkably over the years,” says Dr. Burkland. “This has been accomplished through a better understanding of the triggers of AFib, alongside the development of truly amazing technology.”

Dr. Burkland’s treatment goals for atrial fibrillation include reducing the overall burden of AFib on the patient, controlling the heart rate when in AFib and reducing the risk of stroke.

Treatment options for arrhythmias include medications, lifestyle changes, invasive therapies, electrical devices or surgery. Cardiac ablation is one of the most effective strategies for treating AFib when performed early in the course of disease. Cardiac ablation involves using electrodes to destroy specific spots on the heart where abnormal electrical signals are originating.

Electrophysiologists also insert, replace and communicate with cardiac implantable electric devices (CIEDs), including pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices. They can also shock the heart to restore normal rhythm.

For patients who need an alternative to blood thinners, a minimally invasive procedure is available if their AFib is not caused by a heart valve problem. A device is permanently implanted in the left atrial appendage of the heart to prevent blood clots from forming and causing a stroke.

When to see a doctor

If you have a heart problem, do you need to see a PCP, general cardiologist or a subspecialist like an electrophysiologist?

A PCP is often a good first stop; depending on your problems, they may be all you need. PCPs typically can help you prevent and manage many problems that affect the heart, such as hypertension or diabetes. Your PCP can assess your heart and decide whether a cardiologist is better equipped to help.

In general, cardiologists help prevent and treat heart diseases, including heart attack, heart failure, valve problems and some arrhythmias. They commonly use EKGs, exercise tests and echocardiograms as diagnostic tools. They can also perform or recommend certain procedures, such as valve replacement, cardiac catheterization to diagnose and treat coronary artery disease, and heart surgery.

If your cardiologist determines you need specialized treatment, you will be referred to an electrophysiologist for treatment.

“Once present, atrial fibrillation tends to steadily progress in frequency and duration of recurrences,” says Dr. Burkland. “There is an old adage in cardiology, “AFib begets AFib.” The implication is that AFib itself causes changes in atrial structure or function that promotes atrial arrhythmias, which highlights the need for early recognition and intervention. For this reason, it is important to see an electrophysiologist early in the course of atrial fibrillation.”

If you have an irregular heartbeat, we invite you to learn more about our cardiology program or find a clinical cardiac electrophysiologist near you.