Mark Link, M.D. Answers Questions On: Atrial Fibrillation (AFib)
What is atrial fibrillation (AFib)?
AFib is a type of heart arrhythmia, or irregular heartbeat. Patients with AFib often feel a “quivering” feeling in their chest instead of a typical, steady heartbeat. That happens when the upper chambers of the heart beat out of sync with its lower chambers. AFib can lead to stroke, heart failure, and other serious problems.
Do certain lifestyle behaviors and medical conditions raise the risk for AFib?
Yes. Some risk factors are not things you can change, such as family history, age, male gender, and the presence of underlying heart disease, such as valve disease and cardiomyopathies.
But there are also other, controllable risk factors associated with AFib, including obesity, a sedentary lifestyle, sleep apnea, diabetes, and hypertension. Fortunately, treatment of these risk factors is associated with improved outcomes for AFib patients.
How is AFib treated at UT Southwestern?
There are a multitude of treatment options for AFib patients: We provide comprehensive medical care, which includes anti-arrhythmia drugs for patients who haven’t been successful with other drugs. We have expertise in newer anticoagulants that have benefits relative to warfarin. We can also work with other disciplines to improve underlying risk factors, such as sleep apnea or diabetes. In some, catheter ablation is chosen, which involves going into the heart and knocking out the abnormal tissue.
A phrase we use increasingly in medicine is “shared decision-making,” which means that one treatment does not fit all. Many different factors come into the decision-making process, and we work with each patient to determine his or her best course of treatment.
In general, the more a patient is bothered by AFib, the harder you try to treat it with anti-arrhythmic drugs and ablations. Conversely, if patients are asymptomatic and not bothered by their AFib, they need to be anticoagulated to prevent stroke, but they may not require further treatment.
What will the future of AFib treatment look like?
AFib is the most common arrhythmia we deal with. It accounts for a significant portion of morbidity and mortality in our patient population and is a great contributor to poor quality of life and the risk of stroke. Because of this, AFib is on the forefront of both clinical practice and research.
We’re working to develop a comprehensive AFib center that incorporates complete care of the AFib patient, from diagnosis to treatment, including the latest technologies.
We have a superb program with excellent clinical care. We also have many leading-edge technologies at UT Southwestern, including advanced ablation labs, with 3-dimensional mapping, advanced catheter techniques including pressure-sensitive catheters, and cryoablation for AFib. We’re moving the field of ablation forward, and we will be involved in a number of AFib trials.
We are one of the few centers in North Texas implanting left atrial occlusion devices for AFib patients who have a high risk of bleeding and can’t be on anticoagulants. This is a new option for them. There are a number of specific risk factors, but in general, if people are frail, have had prior bleeds, or have liver disease, and they are at risk for stroke, this device may be an excellent option.
A comprehensive treatment program that addresses risk factors for AFib, including sleep apnea, diabetes, and hypertension improves the care of patients with AFib. This approach has been shown to reduce not only onset but recurrences of AFib after ablation.