Director, Heart Rhythm Center
Stony Brook University Heart Institute
Atrial fibrillation or AFib is a type of arrhythmia or irregular heartbeat – and it’s a common, serious but treatable cardiac condition. AFib affects more than 2.5 million people in the U.S. AFib makes it five to seven times more likely you’ll have a stroke than the general population. Clots caused by AFib can also travel to other parts of the body, and cause damage. Dr. Eric Rashba explains how AFib can be managed, as well as the latest treatment approaches.
What is atrial fibrillation or AFib?
AFib usually involves a rapid heart rate, where the upper heart chambers (atria) are stimulated to contract in a disorganized and abnormal manner. It is most often caused by abnormal electrical firing in the areas where the veins that drain blood from the lungs (pulmonary veins) connect to the left atrium. Atrial fibrillation can be related to high blood pressure, an overactive thyroid, congestive heart failure or diseased heart valves, or can occur in patients with structurally normal hearts who do not have an obvious predisposing condition. Persistent AFib can significantly weaken the heart and cause heart failure. It is important to be diagnosed and treated as early as possible.
What are the signs and symptoms?
Typical symptoms include a racing heart or palpitations, but some patients have more subtle symptoms such as shortness of breath or fatigue, without palpitations.
Can AFib be managed with medications?
Today there are more options for medical management, including three new blood thinners: Pradaxa®, Xarelto® and Eliquis®. However, not everyone can take these drugs because of their side effects, such as bleeding.
What new treatments are available?
At Stony Brook, three new approaches to treatment are now available.
1) LARIAT procedure. A valuable strategy for people who can’t take blood thinners long-term is the non-surgical LARIAT™ procedure. The LARIAT closes off a pouch-like structure called the left atrial appendage (LAA). Located in the muscle wall of the top left chamber of the heart, the LAA is where 95 percent of strokes due to blood clots originate. The LARIAT prevents blood from entering the pouch by closing off the opening of the LAA using a magnet-tipped guidewire with a noose.
Once possible only through open heart surgery, today the LAA can be tied off via a catheter. We go in through the groin and under the rib cage, both at the same time. Then we use a magnet-tipped guidewire to place a noose around the LAA and suture. It’s a permanent solution that may help decrease the risk of stroke without affecting the rest of the heart.
2) Hybrid nContact procedure. For patients who have failed a previous ablation (cauterization of the electrical pathways in the heart that trigger the arrhythmia) or whose AFib is longstanding and persistent, we now have an alternative: the hybrid nContact procedure. Before, these patients would have had to undergo multiple procedures to try to solve their AFib. Now, we’re bringing both a cardiothoracic surgeon and an electrophysiologist into the procedure, each using a different approach to ablation. The procedure is minimally invasive, does not require a chest incision and takes about four hours.
3) Cryoablation. Also new at Stony Brook is cryoablation for AFib. We use a freezing balloon in each pulmonary vein to electrically isolate the impulses that are causing the arrythmia. This is an alternative to radiofrequency ablation, where we use heat to accomplish the same thing.
What other cardiac arrhythmia services are offered at Stony Brook?
At Stony Brook, one of the more important clinical trials we’re involved in is the CABANA trial, which is looking at what should be the firstline treatment of AFib. Right now ablation, which involves cauterization of abnormal heart tissue, is usually reserved for those who’ve already tried medications, but there is some evidence that ablation should be a frontline therapy.
We’re also working to better understand the underlying causes behind AFib. Treatment now is directed toward the pulmonary veins, but it turns out there may be other drivers at work. Of course, the better we understand the underlying causes, the better we can target treatment.
Stony Brook University Heart Institute offers a full array of diagnostic and treatment options for patients with heart rhythm disorders.
For more information, call Dr. Rashba at (631) 444-3575. To learn more about the Heart Institute, call (631) 44-HEART (444-3278).