Treating Atrial Fibrillation: Holistic Care For This Common Cardiac Condition

Atrial fibrillation (AFib) is a common heart rhythm disorder that affects 20 million to 25 million Americans - but did you know that it’s a major brain threat?

AFib increases odds for an ischemic stroke, the type caused by a blood clot, by 500 percent, according to Daniel Alexander, DO, a cardiologist and electrophysiologist with Winchester Cardiology and Vascular Medicine | Valley Health.

“Ninety percent of clots that lead to a stroke in AFib form in a small pocket near the top of the heart called the left atrial appendage,” Dr. Alexander explains. “If you’re at risk for a stroke due to AFib, preventing clots from forming and leaving the heart is a top priority.”

At Valley Health, experts who specialize in heart rhythm disorders offer a holistic, individually tailored approach to AFib care. Here’s what to know about this condition and how it’s treated and managed at Valley Health.

Inside a Quivering Heart

In AFib, electrical signals that control heartbeats become fast and chaotic. The two upper chambers of the heart quiver instead of squeezing in a regular, coordinated way to pump blood into the lower chambers of the heart. As a result, blood can pool and clot—especially in the left atrial appendage, or LAA, which is a tiny, thumb-shaped pouch in the upper heart. If a clot from the LAA travels to the brain, it can block a blood vessel and cause a stroke.

“Risks for AFib include increasing age, hypertension, diabetes, coronary artery disease, peripheral artery disease, heart failure, and obstructive sleep apnea,” Dr. Alexander says. “Researchers are also finding that alcohol use is another factor. Having more than two drinks per day can increase AFib risk by 7 percent per year.” These factors can damage the heart or cause abnormalities.

Symptoms of AFib include a racing heart rate or irregular pulse, says Valley Health cardiologist Jeffrey Skiles, MD, also of Winchester Cardiology and Vascular Medicine, whose specialties include noninvasive cardiac imaging. “Others may feel breathlessness, chest discomfort, or even energy loss and fatigue. But some patients with atrial fibrillation have no symptoms at all.”

A Steadier Beat and Lower Stroke Risk

Your primary care doctor or cardiologist may refer you to a heart rhythm specialist due to symptoms, findings when your doctor checks your heart or because of a test that uncovers signs of AFib.

At Valley Health, “the first thing we do is evaluate risk for stroke with AFib,” says Zachary Hollis, MD, a cardiologist and electrophysiologist with Winchester Cardiology and Vascular Medicine. “Then we evaluate how to best improve quality of life by reducing the symptoms and burden of this condition.”

Physicians work with each patient on a personalized treatment plan that may include medications or a procedure called cardiac ablation to control heart rhythms. Other key considerations to promote heart health and discourage AFib episodes include a healthy lifestyle and attention to risks like high blood pressure and sleep apnea.

Meanwhile, blood-thinning medications can significantly reduce risk for an AFib-related stroke. These include warfarin as well as newer drugs that need less monitoring and dose adjustments such as apixaban (Eliquis), rivaroxaban (Xarelto) and dabigatran (Pradaxa). If you’re among the many people with AFib who cannot take a blood thinner due to kidney disease, interactions with other medications, or a high risk of bleeding due to your age or a profession, a device called the Watchman FLX, inserted in the heart via a minimally invasive endovascular procedure, is an alternative that also protects against AFib-related stroke.

“The Watchman looks like a little umbrella without a handle,” explains Valley Health cardiologist Saif Al-Najafi, MD, also with Winchester Cardiology and Vascular Medicine, whose expertise in advanced cardiac imaging is used before and during the minimally invasive procedure that attaches the device to the LAA. “All the tools to perform the procedure and the Watchman FLX device are inserted through a small incision in the femoral vein of the leg and threaded up to the heart,” Dr. Al-Najafi says.

After the procedure and an overnight hospital stay, patients can return home; during the following weeks and months, heart tissue grows around the device, securing it in place and blocking the opening of the LAA so clots cannot escape into circulation. If the Watchman is not an option, heart surgeons can close off the LAA with a hairpin-like device called the AtriClip.

Individualized treatment for AFib patients results in better quality of life, improved overall heart health and freedom from worry about AFib-caused stroke, though “you still have to control other stroke risks, like high blood pressure and being overweight,” Dr. Alexander notes.

The result? “People often discover they had been ‘living down’ to AFib, experiencing symptoms like fatigue, shortness of breath and weakness that make everyday activities difficult,” Dr. Hollis adds. “I’ve had patients tell me ‘I didn’t realize how much AFib impacted how badly I felt.’ With our holistic approach, significant improvement is possible.”

Visit the Valley Health Heart & Vascular website for more information on Valley Health’s comprehensive heart and vascular care services.