Atrial Fibrillation: Understanding the Electrical Disorder of the Heart
9/19/2023
Dr. John Johnkoski, cardiothoracic surgeon at Aspirus Heart & Lung Surgery
Every year, the month
of September is dedicated to raising awareness about atrial fibrillation, or
AFib, a common but often misunderstood heart rhythm disorder. To shed light on
this condition, John
Johnkoski, MD, cardiothoracic surgeon at Aspirus Heart & Lung Surgery,
provided valuable insights into the complexities of AFib and its management.
The Dance of the Heart
According to the
American Heart Association (AHA), AFib is a quivering or irregular heartbeat,
or arrhythmia. Unlike normal sinus rhythm, where the heart's rhythm is
orchestrated with precision, AFib disrupts this harmony. Dr. Johnkoski
explains, “normal sinus rhythm is named that way because there's a conductor in
your heart called the 'sinus node.' This conductor signals the upper chambers
of your heart (the atria) to start beating, and then, like clockwork, the lower
chambers (the ventricles) follow suit. It's like a well-choreographed dance
where everyone moves together smoothly."
AFib's Fearsome Companions
While AFib itself is a
significant concern, it often brings two more daunting companions: stroke and
congestive heart failure.
In AFib, the left
atrial appendage, a small pouch-like structure in the heart, fails to contract
effectively. Dr. Johnkoski likens it to a windsock that can trap blood, forming
clots. These clots can then travel to the brain, causing a stroke. “The risk of
stroke increases about five-fold in individuals with AFib compared to those in
normal sinus rhythm,” says Dr. Johnkoski.
He also relates the
risk of heart failure to an overexerted car engine. “When your heart goes above
its normal rhythm it’s kind of like just putting the gas all the way down in
your car and just running it for hours. Your car might last a few hours, but it’s
going to be hard on the engine. Our heart isn’t nearly as durable.” Dr.
Johnkoski elaborates, "When your heart goes above its normal rhythm for
even a few weeks, your heart function can go from normal to very seriously
impaired."
Patients have nearly
three times higher risk of hospitalization and are twice as likely to die of
sudden cardiac death, according to AHA and National Institutes of Health (NIH).
This is why prompt diagnosis and management are crucial.
Diagnosis: Catching AFib in Action
Diagnosing AFib can be
challenging, especially when symptoms are intermittent. Dr. Johnkoski
recommends immediate medical attention for anyone experiencing heart
palpitations, lack of energy, feeling over-tired, racing irregular heartbeat,
shortness of breath, dizziness or fainting, or “butterflies” in the chest. An
electrocardiogram (EKG) is the primary diagnostic tool, but for intermittent
symptoms, a halter monitor may be used for a more extended period to capture
the irregular rhythm.
It’s also possible to
not experience any symptoms at all. “For some, AFib may be discovered on a
pre-operative EKG for some kind of elective surgery, where then their surgery
gets canceled and treatment for AFib is addressed,” explains Dr. Johnkoski.
Treatment Strategies for AFib
The management of AFib
is multi-faceted, with several approaches available, depending on the patient’s
condition. Dr. Johnkoski emphasizes the importance of medications for heart
rate control and rhythm maintenance. Anticoagulation therapy, or the use of
blood thinners, is another critical aspect, especially for stroke prevention.
Fortunately, newer blood thinners have simplified this aspect of treatment.
When medications are
insufficient or poorly tolerated, minimally invasive surgery is considered.
These procedures involve accessing the heart through small punctures on each
side of the chest to create lines of scar on the outside of the heart.
For
those who are having open heart surgery and also have AFib, a maze procedure is
likely. “A maze procedure is where we create lines of scar on the inside and
the outside of the heart at the time of the surgery designed to get and keep
your heart in rhythm,” explains Dr. Johnkoski. He continues,“AFib is
really an electrical disorder of the heart and really has nothing to do with
pumping. If we create a line of scar, it will not conduct an electrical
impulse. A line of scar is kind of like the insulation on your pair of pliers
at home – it won’t conduct electricity.”
Preventing the Unthinkable
Dr. Johnkoski
encourages anyone who thinks they're having AFib to go to either to the walk-in
or to the emergency room right away.He highlights the 48-hour window after
first experiencing symptoms as a critical period to initiate treatment and
prevent clot formation.
Hope on the Horizon
Dr. Johnkoski is
optimistic about the future of AFib management, especially for those being
treated at Aspirus Health. He notes, "we have been addressing AFib in a
very aggressive way for the better part of 20 years. We have a lot of
experience here, and a surgical program that most places don't have in terms of
treatment options – particularly minimally invasive options." He also
anticipates the integration of robotic surgery in the treatment of AFib,
further enhancing patient outcomes.
The Atrial
Fibrillation Clinic at Aspirus Heart Care offers care for patients with
atrial arrhythmias. The clinic offers the ability to see an electrophysiologist
(EP) and cardiothoracic surgeon in the same setting to learn about treatment
options. For information regarding referrals, scheduling or to answer general
questions, please call 866.783.6266.
For more information
on all things AFib, including available treatments and patient testimonials,
visit TreatAfib.org.
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