Is Ablation the Best Treatment for Heart Palpitation?

Did your heart skip a beat? Then another and another?

An irregular heartbeat is one of the many signs of atrial fibrillation. Commonly referred to by those in the know as AFib, this heart condition is one of the most common causes of palpitations. Generally AFib causes a rapid heart rate, though sometimes it may cause the heart to beat slowly or even pause. And surprisingly, the vast majority of people with AFib may have no symptoms at all.

So, what's the big deal?

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I recently had a 67-year-old female patient who for years suffered from palpitations, aka a rapid heart rate. And despite the recurrence, she brushed off the repeated episodes, claiming she had too much coffee or an issue that was causing her anxiety. One night, she woke up and complained to her husband that she had shortness of breath and chest tightness but was sure it was heartburn.

Her husband wasn't so sure and thankfully called 911, despite her protests. She was admitted to the hospital with heart failure. Her repeated episodes of palpitations had caused her heart to fail, and she slowly began to retain fluid. Only by slowing down her heart and giving her diuretics, which are medications which remove the fluid, did she improve.

She was lucky. She got better.

In addition to congestive heart failure and a heart attack, AFib has been known to cause stroke and even death.

Having a stroke is one of the most dreaded complications of Afib. When the atria, which are the upper chambers of the heart, fibrillate and don't pump the blood in a normal fashion, clots form. These tiny missiles of blood can "fly" and end up in any of your vital organs, particularly your brain, belly or kidneys. The risk of developing these clots or emboli increases with a number of factors, including your age, diabetes and sex. Treatments are often recommended based on your risk factor score.

Atrial fibrillation has been traditionally treated with medicines or with a medical procedure called ablation, which either burns or freezes the arrhythmia away. For those who fall within the higher risk range, anticoagulants, also known as blood thinners, are generally recommended to reduce the risk of clot formation. While each of these treatment strategies has its own benefits, there's been much debate as to which is the right approach.

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The most common risk with blood thinners, prescribed to either prevent or treat blood clots or a stroke, is bleeding. In addition, your physician may prescribe beta blockers to control your heart rate and calcium channel blockers to reduce your heart rate. Once your heart rate is regulated, your physician may prescribe antiarythmics to control your heart's rhythm.

Medications are generally a good form of treatment for most patients. The problem occurs when patients, without consulting their physician, stop taking their medications, either because of side effects or because they've decided they no longer need to be on them.

For those who prefer the one-and-done approach, catheter ablation may be a consideration, since once the procedure is performed, the need for medications may be reduced. Catheter ablation is a minimally invasive procedure, generally performed under local anesthesia as an outpatient. A catheter is inserted in a leg vein and then guided through vessels to the heart. Wires are then threaded through the catheter, positioned in the heart and then used to stimulate the heart tissue to help identify the source of the arrhythmia. It may sound complicated, but it's a relatively short and successful procedure.

A recent study published in the Journal of the American College of Cardiology compared the results of 2,000 patients. Interestingly, the trial found that those who underwent ablation had a lower risk of death and cardiovascular hospitalization. However, results of this trial and conclusions learned from the outcomes are clouded, as the trial design may have influenced the outcomes.

[See: 10 Ways to Lower Your Risk of Stroke.]

Studies such as this one make the topic of ablation an important one for consideration. Despite the short-term risks associated with the use of catheters and ablation, I view it as the treatment of choice for patients in their 40s and 50s, though there's never a one-size-fits-all model. So many medical decisions depend on age, risk tolerance, family support, tendency for compliance and your overall medical health.

Before making a decision, have a heart-to-heart conversation (pun intended) with your cardiologist. Together you can select a comprehensive and personalized health strategy to help you live better and longer, without skipping a beat.

Adam Splaver, MD, FACC, FACP, FASE, is a cardiologist in Hollywood, Florida. He's also an RPVI (Registered Physician in Vascular Interpretation) on Lyme disease.