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Afib Management or Treatment
PROCEDURES:
1. Ablation
2. Maze surgery
3. HIFU
4. Cardioversion (Chemical
or electrical
Goal: Elimination of afib
and permanent conversion
to sinus rhythm.
MEDICATION:
1. Rate Control-control
of
pulse rate to reduce
symptoms
Common Rate Control Drugs:
Atenolol
Metoprolol
Verapamil
Digoxin
2. Rhythm Control-conversion to
and maintenance of sinus
Common Rhythm Control Drugs:
Class Ia: Quinidine,
Procainamide
Disopyramide
Class Ib: Lidocaine
Class Ic: Flecainide, Propafenone
(Rhythmol)
Class III:
Sotalol, Dofetilide,
Amiodarone, Ibutilide
3. Anticoagulation drugs: thinning
the blood to prevent stroke
from clotting of pooled blood
due to decreased pumping
activity of the heart in afib.
Coumadin
Warfarin
Aspirin
Plavix
Common Afib Triggers
ALMOST UNIVERSAL:
Alcohol
Caffeine
Nicotine (smoking)
C0MMON:
MSG and food additives
Stress/anxiety
Novocaine (Epinephrine)
Illegal drugs (cocaine,marijuana, etc.)
Thyroid hormone (excessive
or inadequate)
Cold drinks and foods
Cold remedies
Acidic foods or drinks
Certain postures (lying
left side, bending,
slouching while eating)
Hypertension
Large meals
Late meals
Fast meals
Low blood sugar
Low electrolyte levels
Electrolyte imbalance
Dehydration
Sleep loss
Sleep apnea
Dairy products
Chocolate
Viruses and infections
Excessive activity
Clothing - Too tight or
restrictive
Structural heart
problems
Stomach problems
(excessive gas)
Some Common Afib Symptoms
Many persons having afib may
usually experience some but rarely all
of these symptoms:
Pounding heartbeat
Irregular, erratic pulse
Throbbing of the jugular vein
(which can sometimes be seen)
Feeling of movement in the
chest (often described by afib
patients as the feeling of a
"squirrel fight" in the chest
Sweating
Fatigue
Weakness or pain in the
extremities
Pain in the chest
Flushing of the face
Tingling or numbness in
the extremities
Dizziness
Feeling of imminent fainting
accompanied by visual
disturbance as in "everything
turning gray"
Actual fainting
Shortness of breath
Some people who have
asymptomatic afib may
experience no symptoms.
This is not necessarily good
if it prevents them from knowing
that they have afib. Not knowing
about the presence of afib can
lead to stroke because of
failure to evaluate the necessity
for anticoagulation to prevent
the clots possibly formed in the
presence of the inefficient pumping
due to afib.
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Two Major Afib Types
Vagal Afib is caused by vasovagal
stimulation, meaning stimulation
of the vagus nerve, a large nerve
which controls both digestion and
heart beat. Because of the connection
between the vagus nerve and the
stomach, vagal afib can often follow
stomach symptoms such as gas or
stomach pains. Also, vagal afib
often develops in the presence of
a low, resting pulse rate. For this
reason, athletes and other very fit
individuals with low pulse rates are
often susceptible to afib.
Adrenergic Afb is caused mainly by
stress, both physical and mental.
Stress that may trigger afib includes
anxiety, fear, grief, or sudden upset.
Physical stress of excessive exercise
may cause afib in some susceptible
individuals.
Some individuals may be vulnerable to
both types of afib, but many
experience one exclusively or one
type more frequently than the other.
GLOSSARY OF AFIB TERMS
Ablation - a procedure in which a doctor destroys (ablates) very small
portions of the heart which are causing fast heart rate
Antiarrhythmic drugs - drugs used to control all abnormal
heart rhythms except very slow ones
Anticoagulants - drugs that inhibit blood clotting
Arrhythmia - an abnormal heart beat, either too fast or too slow
Atria - the upper chambers of the heart from which blood flows to the ventricles: oxygen poor blood from right atrium
to right ventricle and to lungs; oxygen rich blood from left atrium to left ventricle and out to the body
Atrial fibrillation - an irregular, usually fast heartbeat in which the heart pumps blood with about 33 percent less
efficiency
Atrial flutter - an extremely fast, irregular beat
Bradycardia - a too slow heart beat
Cardioversion - converting one electrical pattern to another
by drugs or electrical stimulation
Conduction system - the system by which electrical signals travel from
the atria to the ventricles to pace the heartbeat
C Reactive Protein Test -- a test that measures blood levels of C Reactive protein, a substance produced by the liver,
in response to inflammation -- High CRP levels can mean a part of the body is inflamed -- may play a role in afib according
to theory
Electrocardiogram - (EKG or ECG) a machine-generated electronic tracing of the heart's electrical rhythm with a computer
generated diagnosis of rhythm
Electrophysiology study - a procedure in which a thin tube (catheter)
is inserted into a vein or artery and guided to the heart to perform
highly specific measurements of electrical activities and pathways
Event Monitor -- a device which records heart rhythm while the patient is moving freely with information possibly being
sent through the phone lines to the doctor
Hemorrhagic stroke - bleeding into or around the brain
HIFU - a procedure for eliminating afib using Highly Intense Focused Ultrasound
Holter monitor - a portable electronic monitoring device which is worn for 24 hours or more to determine the electrical
activity of the heart
Hypertension - higher than normal blood pressure which can contribute to afib
INR -- the number resulting from a Protime test which measures the time it takes for a patient's blood
to clot -- and International Normalized Ratio
Ischemic stroke - blood supply to the brain is interrupted
Lone - afib with no apparent systemic cause
Maze surgery - procedure involving open heart surgery to stop afib's errant electrical impulses by creating lesions and
scar tissue in heart tissue to block aberrant impulses
Mini-Maze - a catheter type procedure, not open heart, using different types of energy sources to create the lesions
to block aberrant electrical impulses that cause afib
Pacemaker - a battery-powered device that monitors and if necessary
corrects abnormal rhythm
Paroxysmal - recurring intermittently
Protime test - a prothrombin time test necessary to monitor the blood coagulation status of those taking Coumadin
or Warfarin for anticoagulation
PVA - Pulmonary Vein Ablation - a procedure to stop afib
PVC's - (Premature ventricular contractions) an abnormal heartbeat that
occurs when the heart's lower chambers (ventricles) are told to pump
too soon by a signal that came from an area other than the sinus node,
the heart's natural pacemaker - happens once or several times in a row
PVI - Pulmonary Vein Isolation - procedure to stop afib
Sinus rhythm - a normal, regular heartbeat usually within the range of 60 - 100 beats per minute
Sleep apnea - a condition in which a person's breathing stops and starts many times during sleep, possibly triggering
afib
Stroke - a potentially fatal event in which oxygen to the brain is restricted, often because of a blood clot
Supraventricular Tachycardia -- condition in which electrical impulses traveling through the heart are abnormal because
of a cardiac problem above the ventricles e.g. afib, atrial flutter, or AV node reentry
Tachycardia - an abnormally fast heartbeat, usually more than 100 beats per minute
Vasovagal stimulation - stimulation of the vagus nerve which controls digestion, heart beat, and other functions
Valsalva maneuvers - a series of physical exercises or natural techniques for stopping or avoiding afib, with the most
common being bearing down with the diaphragm muscle
Vagally mediated afib - afib induced by vasovagal stimulation of the vagus nerve
Ventricles - the heart's main pumping chambers
Ventricular Fib - a life threatening arrhythmia in which heart
no longer beats but quivers (much more serious than afib)
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Days filled with excessive, stressful activity can affect afib.
Sleep loss can be a potent afib trigger.
Drugs can control either heart rhythm or rate and thereby prevent or control afib symptoms, making life in afib
very tolerable for many afibbers.
Hypertension and other health problems can trigger afib.
Caffeine is an almost universal afib trigger, which causes afib for most, although not all, afibbers.
Research and understanding of afib can lead to living with afib more comfortably.
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