August 14, 2020 - Friday


ATRIAL FIBRILLATIONATRIAL FIBRILLATIONAtrial Fibrillation (also known as “a-fib”) is the most common cardiac arrhythmia affecting up to 2.6 million Americans annually. Beyond the critical medical importance of atrial fibrillation to be underscored below, the burden of atrial fibrillation on our health care system is estimated 7 billion dollars annually. Atrial fibrillation is one of the most common causes for new visits to a cardiologist’s office, as well as visits to Emergency rooms and subsequent hospital admissions. A-fib may cause issues for patients for a variety of reasons including palpitations (feeling rapid heart beats), chest pains, breathing problems, or most importantly, atrial fibrillation may be involved in 15-20% of stroke patients. In fact, atrial fibrillation may increase a patient’s risk of stroke by 5x
compared to similar age-matched patients.
The atria (consists of both the left and right atrium) are the upper pumping chambers of the heart. The atria have thinner walls than the lower pumping chambers, the ventricles. The atria function to receive returning blood to the heart from both the lungs (to the left atrium) and from the rest of the body (to the right atrium), then deliver the blood to their respective ventricles.
Furthermore, the walls of the atria help to carry the electrical impulses to the ventricles which help determine how fast the heart is actually beating (i.e. our pulse rates). Fibrillation is a condition of disorganized & chaotic electrical activity, an electrical storm
so to speak. Fibrillation can occur in the atria as well as the ventricles. During fibrillation, the chambers affected may beat as fast as 300-600 times per minute. In fact, these rates are too fast for any meaningful mechanical contractions of the affected chambers. In the ventricles, this is therefore a cause for people to pass out, and in fact cause sudden death if not promptly treated. However, fibrillation of the atrium is usually very well tolerated and a normal blood pressure is usually maintained despite what can be a very fast pulse at times. When the atria are fibrillating, there is no contractile squeezing of the chambers, and therefore there is stasis blood in the chambers. Whenever there is stagnant blood in the ventricles, there is a risk of a blood clot forming. If a blood clot forms in the left atrium, and is subsequently dislodged, it can embolize into the circulation and travel to the brain and cause a stroke, or to other parts of the body like the leg and cause major harm with impaired blood flow the affected limb.
When we see someone with atrial fibrillation, we try to assess their cardiac structure and function to determine if there is an actual primary cardiac cause of the arrhythmia. Alternatively there can be significant non medical problems that can trigger atrial fibrillation such as thyroid gland dysfunction or infections in the body. A full medical and cardiac evaluation should be
done for someone with a new onset of atrial fibrillation. Often a t rue cause can never be found, and we are left just telling patients that “A-fib happens … ”
There are 2 main targets of therapy for atrial fibrillation. One is controlling the pulse to reduce any symptoms someone may be having such as palpitations or shortness of breath. There are various approaches highlighted by medical therapy to reduce the pulse rate of someone with atrial fibrillation. If simply controlling the pulse is not effective, then we have means to control the rhythm for people with atrial fibrillation. There are drugs or procedures (called cardioversion) to convert the heart from fibrillation to a normal rhythm.
The second major path of therapy is that of stroke prevention. Atrial fibrillation can happen in elderly people with significant cardiac and other medical problems, in addition it can occur in otherwise healthy young patients (even in their 20-30s). The stroke risk associated with atrial fibrillation is different based upon a patients’ unique features. There are carefully created tools available to physicians to assess a patients risk of stroke associated with atrial fibrillation. Factors weighed include age, presence of structural heart problems, vascular problems, prior stroke, prior blood clot, diabetes, and hypertension. Based upon these predictors,
a physician will make a recommendation for blood thinners to prevent clot and maximally reduce the risk of stroke associated with atrial fibrillation. This may include aspirin, Coumadin/warfarin, or newer agents like Xarelto, Eliquis, or Pradaxa.
”…one’s Individual story needs to be carefully considered and treated.,,
There are unique circumstances where patients may be recommended to receive a pacemaker to help treat their atrial fibrillation, or specialized ablation procedures to literally ablate (burn or freeze) the structural areas of the atria that are responsible for the chaotic electrical activity.
If you have atrial fibrillation, or even suffer with palpitations, rapid heart beats, shortness of breath, dizziness etc, you should be seen
and evaluated by a cardiac specialist. Every patient is different, and therefore should not be subjected to a ‘cookie cutter’ approach to
medicine where every patient receives the same tests and the same treatments for the same problems. Rather one’s individual story needs to be carefully considered and treated. Come see us at South Palm Cardiovascular Associates for further discussions.
Michael L. Metzger, M.D., F.A.C.C.
Board Certified in Cardiovascular Disease
and Interventional Cardiology

To Schedule a consultation call (561) 420-0409

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