Experts describe innovative treatments for atrial fibrillation

Atrial fibrillation (AFib) is a type of irregular heartbeat that affects about 2.7 million people in the U.S. It occurs when there’s a malfunction in the heart’s electrical signals, causing it to beat rapidly and erratically.

AFib can be dangerous because it increases your risk of stroke by nearly fivefold and makes you more prone to develop heart failure and other heart-related complications. Luckily, recent years have seen major advancements in treating AFib.

During a free online health lecture, board-certified cardiac electrophysiologists Maria Anderson, MD, and Oussama Lawand, MD, FHRSD, along with interventional cardiologist  Srini Iyengar, MD — all from the AFib Clinic at Boulder Heart — described a range of innovative treatment options for bringing your heart back to a normal rhythm, including lifestyle changes and minimally invasive procedures such as catheter ablation, pacemaker implants and WATCHMAN.

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Watch "Innovative Treatments for Atrial Fibrillation"

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Take control with lifestyle measures

“You have the power to curb your AFib. There are many lifestyle measures that can improve your freedom from AFib,” said Dr. Anderson, who also received board certification in lifestyle medicine. “Lifestyle measures can prevent atrial fibrillation from progressing from episodic to persistent AFib. Lifestyle measures are so powerful that they make even the most effective procedure we have for AFib—catheter ablation—much more effective, as well as decrease your risk for stroke from AFib."

Here are lifestyle measures that can minimize your risk of getting AFib and actually improve it:

• Reaching a weight where your waist smaller is than your hips. Dr. Anderson stated recent studies have found that people who were able to lower their waist circumference or their body mass index had a greatly decreased percentage of time in AFib. Furthermore, losing 10% of weight, when needed, also greatly decreased AFib.
• Eating a diet high in whole plant foods and low in processed foods. “On one end of the spectrum, what we refer to as the standard western diet, is probably the diet most likely to cause AFib. Unfortunately, this is a diet very low in whole foods such as fruits vegetables, whole grains, beans, and legumes. Instead, it’s much higher in processed foods such as meats or canned foods that cause inflammation and damage blood vessels,” said Dr. Anderson.
• Smoking cessation. “Smoking is a strong risk factor for AFib. It makes AFib five times more likely,” Dr. Anderson announced. It also increases a person’s risk of stroke and causes damage to heart cells and blood vessels.
• Avoiding alcohol. Dr. Anderson warned that “even one drink per day can increase the risk of AFib. As daily alcohol increases so does the incidence of AFib." Cutting back on alcohol can help reduce your AFib burden.
• Exercising moderately - ideally five hours per week. “When people exercise very aggressively, for more than about five hours a week at a very aggressive pace, this is also associated with a risk of AFib. This sort of ‘baby bear’ zone, where not too little exercise and not too much exercise is where you want to be,” said Dr. Anderson.
• Reducing stress. Both physical and emotional stress can trigger AFib. Activities such as walking, hiking and various forms of meditation can all help decrease stress and consequently AFib.
• Improving sleep. Seven to eight hours of restful sleep is associated with the least amount of AFib. “Also, untreated sleep apnea can impact the success of ablation treatment. Success drops from about 70 or 75% with a single procedure down to 50%,” warned Dr. Anderson.

Heart rate control

AFib is a progressive disease, accumulating over time with more “wear-and-tear” on the heart. It tends to accelerate, especially if not treated properly. If there does come a time when you might need additional help managing your AFib, there are many treatment options.

The goals of treatment are to:

• Control your heart rate
• Reset the rhythm
• Prevent stroke

The most appropriate treatment will depend on how long you’ve had AFib, how troublesome your symptoms are, and the underlying cause of your AFib.

“You may be prescribed medications such as beta-blockers or calcium-channel blockers to restore your heart to a normal rate. But this really doesn’t treat the AFib itself or slow its progression down. This option is appropriate for people who have very early-stage AFib,” said Dr. Anderson.

Resetting your heart's rhythm

“Rhythm control options come in two different flavors. We have antiarrhythmic medications and ablation procedures. Both are really designed to suppress the triggers of AFib,” explained Dr. Anderson.

• Antiarrhythmic medications. Depending on your heart condition, you may receive medications through an IV or by mouth to help return your heart to normal rhythm. Your first doses are given in the hospital with an initial two-to-three-night stay for continuous monitoring of your heart rate. This helps your health care team know how much medication you need to take on a regular basis. However, Dr. Anderson warned, “There's always going to be some pros and cons when we're choosing antiarrhythmic medications. Unfortunately, the most effective drugs also have the most side effects in the long term. Taking these medications requires routine monitoring.”
• Electrical cardioversion. In this brief procedure, “we give you an electrical shock, delivered through paddles or patches placed on your chest, to stop your heart's electrical activity for a short moment and change your AFib back to normal rhythm,” said Dr. Anderson. Electrical cardioversion is more than 90% effective, although it does not prevent future recurrences of AFib.

Catheter Ablation to Restore Normal Heart Rhythm

If you wish to avoid medications or cardioversion — or if medications don’t work well enough — catheter ablation offers the best alternative for restoring a normal heart rhythm. This minimally invasive procedure selectively destroys the tissue creating problematic electric signals and interfering with the heart’s regular rhythm.

"It is performed using catheters, which are flexible narrow tools inserted through a vein in the groin in order to approach the beating heart," stated Dr. Anderson. “Ablation is by far the most effective management tool we have. When we couple it with lifestyle interventions, it significantly reduces the burden of the disease.”

Foothills Hospital hosts one of Colorado’s most sophisticated electrophysiology (EP) labs for catheter ablation procedures.

Atrial Fibrillation: The Role of Pacemakers for Permanent AFib

In his presentation, Dr. Lawand explained the role pacemakers have in treating AFib. “A pacemaker,” he said, “is a small device that keeps a heart beating regularly.” It is typically implanted under the skin and near the heart. Its job is to monitor and send electrical impulses to the heart and stimulate the heart to beat normally.

Dr. Lawand shared, “If the heart rate, while in AFib, continues to be too fast despite the use of prescribed medications, a pacemaker implantation coupled with an ablation may be a viable option.” He further explained, “This enables the pacemaker to take control of the overall heart rate and program the heart rate.”

Sick Sinus Syndrome

Those who have been diagnosed with sick sinus syndrome can experience heart rates that are slow, erratic, and difficult to control. “For these patients,” said Dr. Lawand “a pacemaker can be helpful in improving their energy levels.”

Transvenous (traditional) Pacemakers
A transvenous pacemaker is used when temporary pacing is necessary. This may occur when a permanent pacemaker is being replaced, repaired or changed, or when permanent pacing fails. Dr. Lawand explained, “This type of pacemaker requires minor surgery to be implanted.”

Micra Leadless Pacemaker
Dr. Lawand described the micra leadless pacemaker as, “being the size of a large pill.” He explained, “the leadless pacemaker is useful for patients with permanent atrial fibrillation and who require a pacemaker.” He added, “It is implanted directly into the heart using a minimally invasive procedure, has a lower risk of infection and no risk of lung puncture, when compared to a traditional pacemaker.” Dr. Lawand shared, “This is a great option for people who are not candidates for the surgery involved with implanting a traditional transvenous pacemaker, who have had an infection with a transvenous pacemaker or who need to have only the bottom chamber paced.”

Watchman for stroke prevention
Following Dr. Lawand's presentation, Dr. Iyengar spoke about the Watchman procedure.

According to Dr. Iyengar, blood-thinning medications such as warfarin (Coumadin®), are the most common treatment for protecting AFib patients from stroke. These clot-preventing medications can greatly reduce stroke risk if taken properly and no side effects are seen.

Yet, for certain individuals, there are barriers to taking a blood thinner, including dangerous interactions with other medications, dietary restrictions, high prescription costs, and concerns about bruising or excessive bleeding from an injury.

Dr. Iyengar stated because of these concerns, “The Watchman procedure could be an alternative to taking blood-thinning medications for some AFib patients. Watchman is a one-time procedure performed under general anesthesia in a catheterization laboratory setting. The procedure usually lasts about an hour and the patient is typically in the hospital for 24 hours following the procedure.”

Learn more about Watchman here.

AFib Clinic at Boulder Heart: A Multi-Disciplinary Approach to AFib Care

Boulder Heart offers one of Colorado’s most sophisticated facilities for diagnosing and treating heartbeat irregularities. The AFib Clinic at Boulder Heart's no. 1 priority is patient outcomes. When dealing with AFib patients, that means the best quality of life and the fewest number of symptom days possible. The clinic's highly experienced and multi-disciplinary team includes:

• Electrophysiologists
• Interventional cardiologists
• General cardiologists
• Cardiothoracic surgeons
• Specially trained nurse practitioners and nurses

Schedule an Appointment

Call 303-443-AFIB to schedule a consultation with the AFib Clinic at Boulder Heart.

Click here to view/download a PDF of slides shown during this lecture.

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