Published: Mar. 23, 2011
Updated: Mar. 23, 2011
Three Duke experts explain the signs and dangers of atrial fibrillation
By Carol Harbers
What keeps your heart beating, every second of every day, throughout your life?
Your pacemaker. (Yes, you have one.)
The sinus node, a group of cells near the upper right chamber in your heart, is your natural pacemaker. It creates the electrical impulses that start every beat of your heart . . . with . . . nice . . . even . . . spaces . . . between . . . each.
In some people, sometimes, that nice, even rhythm can go chaotic. Atrial fibrillation (AFib) occurs when the upper chambers of the heart (the atria) beat fast and irregularly.
Duke AFib specialists Tristram Bahnson, MD, Patrick Hranitzky, MD, and Tim Donahue, MD, have heard many colorful descriptions from patients of what AFib feels like: a mouse running or a fish flopping in the chest, a fluttering or racing heart, a fullness in the throat.
Most people with AFib -- but not all -- will also have fatigue, chest pain, or dizziness.
“AFib is the most common of the abnormal heart rhythms,” says Bahnson, who is also director of the Duke Center for Atrial Fibrillation. “Up to one in 10 people will have it.”
Anyone, at any age, can get AFib, says Hranitzky, but there is a strong correlation between getting older and getting the disorder. “AFib in a young person is typically due to a genetic predisposition,” he says.
“In the older population, over 65 years old, AFib is most likely caused by environmental factors. That is, the fibers in the atria stiffen with age, leading to chaotic electrical activity.”
In addition to growing old, other culprits commonly associated with AFib include high blood pressure, heart valve disease, thyroid problems, and sleep apnea. “As many as half of people with sleep apnea will get atrial fibrillation,” says Bahnson.
Some people with AFib will have extreme fatigue or exercise intolerance, and some will not.
Some will have frequent symptoms, and some will have only occasional flutters.
For this reason, some people may not realize they have the disorder. But even the occasional racing heart should be reported to your doctor, says Hranitzky.
“Frequent symptoms may warrant an EKG [electrocardiogram],” he says. “If the symptoms are infrequent, monitoring may not be necessary, but a consultation with your family doctor is needed.”
The most pressing danger of not getting AFib treated is stroke -- people who have AFib are at a much higher risk of stroke than people who don’t.
But once the AFib is diagnosed, the stroke risk can be lessened with anticoagulants (blood thinners).
And there’s a second risk, says Donahue, who treats patients at Duke Regional Hospital. “When the heart races for long periods of time, that can lead to heart failure, and this can happen in a matter of weeks.”
Heart failure occurs when the heart is damaged enough that it can’t adequately do its job of pumping blood through the body.
The first line of defense against AFib is usually medication.
“Normally we’ll prescribe benign medication like beta–blockers -- medications that slow the heart rate -- in addition to aspirin or some form of blood thinner, such as warfarin [Coumadin] to reduce stroke risk,” says Hranitzky.
For many people, these medications will be enough to get rid of most, if not all, symptoms and restore quality of life. For those who do not get relief, there are more options, including pacemakers and, more recently, a minimally invasive surgical procedure called catheter ablation.
“Ablation is a game-changer,” says Donahue. “It allows us to cure AFib completely in some patients.”
In the procedure, long and flexible tubes (catheters) are inserted in the veins, usually in the groin, and are threaded up to the heart through the blood vessels.
Instruments on the catheters are used to cauterize (burn) regions of the heart that are responsible for disrupting the heart rhythm. The cauterizing creates scar tissue, which disrupts the electrical activity that causes the abnormal rhythm.
Because the procedure is minimally invasive, complications from catheter ablation for AFib are rarely serious. But it’s still an evolving procedure that is now offered at only a limited number of centers in North Carolina.
Duke physicians have documented some of the lowest complication rates for patients who undergo catheter ablation compared with other centers in North Carolina and around the world.
The consensus among Duke experts is that virtually all AFib patients can be successfully treated.
“But it’s very important to get treated early,” says Bahnson. “Successful therapy is improved by early intervention. Plus, it is very important to have your stroke risk assessed early.”
The Duke Center for AFib offers an unusual breadth of experience for patients.
In addition to a wide array of treatment options, the center recognizes the other conditions common among AFib patients such as sleep apnea or heart failure, and collaborates with other Duke experts to treat them.
“Duke is unique in that our treatment strategies are varied, we have a large spectrum of treatment options, and we recognize that it is important to individualize care,” says Bahnson.
Duke AFib experts treat patients at:
For more information, call 888-ASK-DUKE (888-275-3853).