(Please hit “like” if you want more videos like this!) Atrial fibrillation treatment options are explained without the “doctor language,” focusing on symptoms. For other patient videos, click my picture, then the “Playlists” tab, and visit the Patient Education section! For an a.fib office consultation, click or call us at 215-707-7526 to make an appointment.
This is dr. joshua cooper and the purpose of this video is to teach you a little bit about the treatment options for atrial fibrillation specifically focusing on relieving symptoms you’ll get the most out of this video if you first watch my previous video entitled what is atrial fibrillation you can find that other video on my youtube channel listed here and if
You click on playlists i have one for patient education so go watch that one come back here and i hope you find this talk useful in order to best understand the treatment options for afib i’m going to quickly review a few of the main points i made in the last video we discussed how a fib patients have multiple little trigger spots that electrically start firing
Quickly and erratically taking over control of the top chambers from the sinus node natural pacemaker spot that normally controls the heartbeat we also discussed that the only way electrical signals can travel from top down to the bottom pumping chambers of the heart is over a special electrical bridge called the av node some people have a very fast av node bridge
And therefore a fast pulse rate during afib and their symptoms tend to be more severe while other patients have a slower av node and fewer signals get from top to bottom during afib they have a slower pulse rate and usually fewer symptoms but before we start talking about controlling the symptoms of afib it’s important to talk about the risk of stroke the main reason
Patients with afib are at higher risk for stroke is related to a little pouch that sits in the top left part of the heart and it’s known as the left atrial appendage when the top chambers of the heart are fibrillating and shivering rather than squeezing in their normal pattern blood sits around longer than normal especially in this little pouch if a blood clot were
To form in this pouch and travel out of the heart and get pumped up to an artery in the brain it can block that artery and cause a stroke this is the reason that most patients with atrial fibrillation are treated with a blood thinner medicine to reduce the risk that a blood clot can form in the heart travel out and cause a stroke there are other treatments other
Than blood thinners that are sometimes used but that’s beyond this particular talk and i can cover that in a different video there are two main strategies that we use to deal with the symptoms of atrial fibrillation and in many patients we address both strategies because many of the symptoms related to atrial fibrillation have to do with the speed of the bottom
Half of the heart that directly relates to the bridge that connects top to bottom and so we first think about how fast the pulse rate how fast the heart is going in the bottom half and we can target the bridge itself to slow down how many signals are getting from top to bottom during atrial fibrillation by attacking the bridge and slowing the pulse symptoms can be
Reduced and in some patients they can be fully eliminated and there are two ways that we can attack the bridge one is using medications and the other is a specific type of procedure in both cases we refer to this strategy of dealing with the bridge as rate control because we’re dealing with the heart rate the other strategy is to tackle the top part of the heart
Directly we think about the atrial fibrillation trigger spots and also some of the scar tissue i mentioned in the previous talk and in this case we can attack the triggers also in two different ways we can either use medications or a procedure approach to try to quiet down or eliminate these trigger spots from causing atrial fibrillation in the first place when we
Use this type of strategy we call this rhythm control because we’re trying to correct the original problem the arrhythmia in the top half of the heart and as i said we often start with the first part of treatment controlling the pulse rate in people who have periods of fast heartbeat but in some patients that’s not enough to control symptoms and then we move to
Step two which is using medications or procedures to try to eliminate the atrial fibrillation altogether let’s first talk about that bridge strategy targeting the av node so there are certain medications that can be used they’re known as av node blockers because they slow down the av node they slow down the bridge and there are three main categories of medicines
That can do this the first is called beta blockers and there are many medicines in this category that can slow down the bridge the next category is called calcium channel blockers and there are two that are most commonly used diltiazem and verapamil they have other names as well that are sometimes used and the third medicine is called digoxin or digitalis and all
Of these medicines can slow down the bridge and by doing so even while the top half of the heart remains in fast fibrillation the bottom ventricles can go slower and that can make people feel better the other strategy is a procedure strategy where instead of using pills to slow down the bridge we can actually do something called an ablation and that means to burn
And permanently damaged heart muscle and if we’re targeting the bridge the av node this is called an av node ablation we use a long thin tool that is inserted usually in a vein in the top of the leg sometimes people go from the neck or the shoulder and that tool is called an ablation catheter it’s a long skinny wire that we can thread up inside the beating heart
Itself and we can actually burn the bridge with this procedure and if we burn the bridge we can permanently destroy it so that no signals ever again can get from the top to the bottom half of the heart and that’s virtually guaranteed to control the pulse rate so that the bottom chambers will never again be able to go fast from atrial fibrillation in the top half
When we burn that bridge however it leaves us with another issue to address because if we burn the bridge and we leave the top half in atrial fibrillation but no signals at all are ever able to get to the bottom half then they’re not going to beat there’s nothing telling them when to pump so we never do an av node ablation alone but instead we always do the av node
Ablation procedure where we permanently burn the bridge with a part two a second part of the procedure which is to put in a permanent electrical pacemaker there are different types of pacemakers but what they have in common is that they all can deliver little electrical signals at a regular pace directly to the bottom half of the heart so that they’re told when and
How fast to beat the pacemaker acts essentially as a new substitute spark plug and we can program it and tailor it to the individual patient so that the pacemaker can meet all of their daily needs at rest and with exercise notice in this strategy that the top half of the heart continues to be an atrial fibrillation but the pulse now becomes regular because it’s
Under the direction of the electrical pacemaker the second strategy that i mentioned earlier is a little bit more complicated and it deals with trying to directly go to the source of the problem and suppress or eliminate these trigger spots that throw the top half of the heart into fibrillation the reason that one might choose a rhythm control strategy is either
Because the person still has symptoms related to afib even after their pulse rate is welcome or in many people we think that there may be long-term heart health benefits for being in normal rhythm instead of being in atrial fibrillation or maybe some of each but the ways that we can target these trigger spots are in two categories either we can use medications to
Try to quiet them down and these medicines are different from the av node bridge blockers that i mentioned earlier these medicines are called anti-arrhythmics and there are a number of them with different names and here are some of them that you may have heard but all of them in common are trying to quiet down those trigger spots they’re not perfect and sometimes
They reduce the number or the length of afib episodes or sometimes they work for a while and then stop working as well but in many patients they actually can work quite well for a period of time the other way that we can target these trigger spots instead of using medicines to suppress them is a procedure approach that procedure is known as an afib ablation procedure
It’s done under anesthesia sometimes under full anesthesia and sometimes under partial sedation sometimes called twilight sedation where patients are made very comfortable and don’t know what’s going on but are not a hundred percent asleep the strategy of this type of procedure is to use special tools that we thread up inside the heart and if we can find individual
Trigger spots in certain places then we can use our equipment to try to permanently zap them if we find a trigger spot and zap it then we hope that that spot never comes back and medicines would not be needed to address it in the future but because there are often many different spots that can trigger afib episodes and they frequently will come in clusters where
There’s a lot in a small area instead of trying to zap each one individually we can use our same tools and instead we can create a circle of little birds around this cluster of trigger spots and trap them and if we trap them inside a circle and they can no longer electrically communicate with the rest of the heart they won’t be able to tell the heart what to do
Anymore by using one or two or more circles of burns around clusters of trigger spots we hope to eliminate all of the potential spots that are responsible for triggering a fib episodes so whether we zap triggers directly when we find one at a time or whether we trap them within a circle the goal is to permanently eliminate these trigger spots from causing future
A-fib it’s not uncommon to require a second procedure because sometimes in the first procedure there are spots that we just didn’t see the first time around or there are spots where we targeted and did our little burns but we were a little too gentle and we have to go back in and reinforce those spots and do a little more work at certain places there are different
Tools that different people use to do this ablation and sometimes we use tools that heat up the heart muscle or burn it in very precise spots or sometimes we use tools that cool or freeze the heart muscle in very precise spots but either way we’re permanently damaging heart muscle with the goal of eliminating or trapping these trigger spots to keep the heart in
Its normal rhythm i hope that this video was helpful to teach you that there are two main strategies we use to manage the symptoms of afib the first is to target the bridge and slow down the pulse in the bottom half of the heart that’s called rate control and in some people whether we use medicines or a procedure approach that may be all that’s needed to eliminate
Or greatly reduce the symptoms from a but in other people we need to go one step further and target the root of the problem which is the trigger spots that start these episodes of afib in the first place in the top half of the heart and then we either use medicines or an afib ablation procedure to try to suppress or permanently eliminate these trigger spots from
Causing afib episodes thank you again for watching and if you want to see more videos you can go to my youtube channel as listed on the screen click on playlists for more patient education videos
Transcribed from video
Atrial Fibrillation: How do we treat it? – Plain English, no Doctor language! By Dr. Joshua Cooper – Arrhythmia Education
