The Medical Minute: Understanding AFib and how to treat it

Newswise — The heart rhythm disorder called atrial fibrillation (AFib) can affect people of any age, but is most common in older adults. It may start with a rapid heartbeat, a fluttering feeling in a person’s chest or a heightened awareness of their own heartbeat. Some people have no symptoms at all. Anyone diagnosed with it should take it seriously.

“While AFib itself isn’t life threatening, it can have consequences that are,” said Dr. Christopher Rogers, a cardiac electrophysiologist with Penn State Health Medical Group – Berks Cardiology. “The abnormal rhythm can lead to a blood clot forming in the heart. If that blood clot travels to the brain, it can cause a stroke.”

Anyone experiencing AFib symptoms should seek medical attention. They may undergo an electrocardiogram to show the heart rhythm. If that test doesn’t provide clear results, a provider may recommend the patient wear a heart monitor to track their heart rate for several days to weeks.

How medication can control AFib

Blood thinners help prevent blood clots from forming and traveling to the brain. Some patients with AFib may only need blood thinners short-term. But older adults and people with high blood pressure, diabetes or a history of prior strokes, mini-strokes or heart or vascular disease may need them long-term.

While blood thinners reduce the risk of stroke, “they won’t keep you out of AFib or make you feel better,” Rogers said. That’s why health care providers may also prescribe medications that control the heart’s rhythm.

Procedures to help treat AFib

AFib is a progressive disease, and as it advances, it’s harder to treat. “Your heart is more efficient in normal rhythm,” Rogers said.

Patients may find relief through nonsurgical and minimally invasive electrophysiology procedures. These include cardioversion, which delivers an electric current through paddles to “shock” the heart into a normal rhythm, and ablation — which is now considered part of first-line therapy in treating atrial fibrillation. During an ablation procedure, an electrophysiologist inserts a catheter through the groin and threads it up to the left atrium, the chamber of the heart where AFib typically originates.

At Penn State Health St. Joseph Medical Center, electrophysiologists use either a heat catheter or a freezing catheter (called a cryoballoon) to disable the heart tissue that causes AFib. In December 2023, the U.S. Food and Drug Administration approved pulsed field ablation technology — using electrical impulses rather than heat or cold — to perform ablations. Three Penn State Health hospitals — St. Joseph, Penn State Health Milton S. Hershey Medical Center and Penn State Health Holy Spirit Medical Center — began using pulsed field ablation technology in June.

It typically takes three months for physicians to see clear evidence of an ablation’s effectiveness. “Initial procedures carry a success rate of about 80%,” Rogers said, although some patients may need more than one ablation for successful treatment.

Even after successful ablation, patients may need to stay on blood thinners due a continued risk of stroke. Those at a heightened risk of bleeding or falling may benefit from a procedure to implant a WATCHMAN device instead. About the size of a quarter, it’s inserted into the left atrial appendage of the heart, the area where blood clots most often form. “Patients with a WATCHMAN can eventually discontinue blood thinners and still have the same level of protection from clotting and stroke,” Rogers said.

Lifestyle changes that can help prevent or treat Afib

Making sure other medical conditions such as sleep apnea, diabetes and high blood pressure are well managed plays an important role in the treatment of AFib. So, too, does limiting alcohol intake and maintaining a healthy weight. Losing just 10% of body weight has correlated with a sixfold decrease in atrial fibrillation, Rogers said.

Related content:

• The Medical Minute: AFib common and incurable, but controllable
• The Medical Minute: Reducing stroke risk from AFib without blood thinners

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.