Residents learn about dangers of atrial fibrillation and treatments available

·4 min read

Jan. 28—February is often associated with hearts, thanks to Valentine's Day. But the real beating heart and the problems that often plague it are also linked to February, and it has little to do with cards and candy.

February is a time when Americans are encouraged to focus attention on their cardiovascular health.

Which is why Freeman Health System cardiologist Dr. Ryan Longnecker was speaking earlier this month to a gathering of 70 residents during a regular Freeman Advantage Healthwise gathering. He spoke about the causes and treatments for atrial fibrillation, an irregular and often rapid heart rate resulting from poor blood flow.

A-fib, as it's often called, occurs when the heart's upper chamber, the atria, beats out of coordination with the lower chambers, the ventricles. When this occurs, symptoms include palpitations, shortness of breath and fatigue. Those palpitations can be irregular (A-fib) or very rapid (arrhythmia). They can feel like a soft flutter of fingers on the chest, the heart suddenly doing flip-flops, or a slight skip beat followed immediately by an attention-grabbing "thud."

Doctors nationwide are seeing more and more A-fib cases each year, he said.

"A-fib is growing in prevalence in the United States, and by the year 2030 they are estimating around 12 million people will have it," Longnecker told the group. "It's one of the most common arrhythmias that we deal with, which is why we've kind of had to modify our plans over the years on how to treat it."

Increased risk of strokes

While A-fib rarely leads to heart attacks, the irregularities can increase the risk of stroke, which is when clots block oxygen and nutrients from the heart to the brain.

"With A-fib, that quivering on the top chamber of the heart, it gets rid of the (normal) mechanical pumping of that chamber, and when that mechanical pumping goes awry, the blood, as opposed of going forward, it pools. And once it pools, clots form."

If a clot breaks off and enters the bloodstream, it can lodge inside an artery leading to a brain, resulting in a stroke. Between 15 to 20% of people who have strokes have this heart arrhythmia.

He said the longer a person is in A-fib, the greater the risk for strokes. Other factors, including age, diabetes and heart disease history, are also important factors — the more problems, the greater chance of a stroke, he said. They can take these risks, put a number to it, and put together a chart showing the stroke risk an individual patient faces.

"A-fib is definitely a challenging disease at best," Longnecker said. "You can do everything right and the patient will still have atrial fibrillation." Other times, "the moon can align with Jupiter on a Tuesday and everything goes back to normal, and we don't exactly know what makes it go in and out like it does.

Technology helping save lives

But technology is helping shed new light on A-fib, he said — primarily pacemakers and implantable loop recorders, helping patients receive treatment faster and rewriting the book on how to approach and treat the problem.

Longnecker mentioned the Watchman device as an option for preventing strokes caused by blood clots. The procedure is available at Freeman and it's a minimally invasive surgery where a tiny pouch located on the left atrial appendage is intentionally closed off. It's an area of the heart that results in 90% of strokes from atrial fibrillation. After the device is inserted — roughly the size of an acorn — skin will grow over the device in three to six month's time, neatly closing the heart pouch off and preventing blood from pooling inside it, leading to the formation of clots.

"So by excluding (that pouch), data would suggest there's no difference being on a baby-dose aspirin with the Watchman device versus being on full-dose anticoagulant (medicines). So I think that's a great thing."

Treating A-fib

Medications to treat A-fib include beta blockers, which slow down the heart; calcium channel blockers, which control the heart rate; digoxin; anti-arrhythmic medications; and blood thinners to reduce the risk of stroke.

"We have to look at the big picture of what we put into our bodies to see what affects us, and I think that's something that a lot of times gets lost in the medication and the other therapies that we can offer," he said.

Lifestyle changes include eating heart healthy food, exercising regularly, quitting smoking, maintain a healthy weight, keeping blood pressure and cholesterol levels down and limiting alcohol and caffeine. These are very important to implement if possible, he said.

"I'm certainly a believer in (making life changes) — if we can avoid something and not have a problem happen, that's better than taking two or three pills to try to treat" a problem.

Kevin McClintock is features editor for The Joplin Globe.