Atrial Fibrillation (AFib), characterized by an irregular heartbeat, affects over 2.7 million people a year and some estimates project that it will affect 12 million people in the U.S. by 2050. There are various types of arrhythmias or irregular heartbeats. The heart can beat too slowly, too fast or erratically. An arrhythmia can affect how well the heart works and make it unable to pump enough blood to meet the body's needs.
Tests
Genetic Testing
Genetic tests may help determine the genetic causes of many inherited cardiac diseases. Your doctor may recommend echocardiography on a regular basis for family members with an identified variant. Our genetic heart disease program has experts who can interpret the complex tests required to identify inherited heart rhythm disorders such as the long QT and Brugada syndromes.
Transthoracic Echocardiogram
In this test, a device (transducer) is pressed firmly against your skin and aims an ultrasound beam through your chest to your heart, producing moving images of the working of the heart.
Electrocardiogram (ECG)
Wires (electrodes) attached to adhesive pads on your skin measure electrical impulses from your heart. An ECG can detect enlarged chambers of your heart and abnormal heart rhythms.
Treadmill Stress Test
Your heart rhythm, blood pressure and breathing are monitored while you walk on a treadmill so your doctor may evaluate symptoms, determine your exercise capacity, and determine if exercise provokes abnormal heart rhythms. Treadmill stress tests are sometimes performed with ECG.
Tilt Table Test
If you’ve had fainting or near fainting spells, your doctor may recommend this test that monitors your heart rate and blood pressure as you lie flat on a table and then how heart rate and blood pressure respond when the table is tilted to standing position.
Electrophysiological Testing (EP) and Mapping
In this test, doctors thread thin, flexible tubes (catheters) tipped with electrodes through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart.
Cardiac Magnetic Resonance Imaging (MRI) Exam
A cardiac MRI uses magnetic fields and radio waves to create images of your heart, and is often used in addition to ECG to create a more precise diagnosis.
Ambulatory Monitoring
- Holter monitors are used for one to two days of monitoring. This monitor is used to obtain a snapshot of your heart rhythm when you are experiencing daily symptoms.
- Ambulatory monitors are used for one to two weeks. This gives us heart rhythm information when a longer duration is required to capture intermittent symptoms.
- Event Monitors record information for two to four weeks. This type of monitor records information only when patients are symptomatic or when the monitor’s algorithm detects an abnormal rhythm over an extended period.
- Implantable monitors may be used when there is a need for longer term monitoring of up to three years. The monitor is implanted in a minimally invasive outpatient procedure and inserted under the skin in the left chest under local anesthesia. It may be recommended if you have passed out, have a history of stroke or mini-stroke, where AFIB is suspected, or for other indications requiring longer term monitoring.
Treatments
Lifestyle Modification
Research indicates that controlling the risk factors for atrial fibrillation can help with treatment:
- If weight management is an issue, we refer you to a dietician and when appropriate, to our wellness center for a fitness assessment and an exercise prescription.
- For patients with diabetes, if it is not well-controlled, you may work a diabetes specialist.
- Patients at risk of sleep apnea may work with a sleep medicine specialist.
- For those patients with hypertension, your primary care physician can often help regulate your high blood pressure, but specialty cardiologists are available if you need more help.
- Finally, reducing or eliminating alcoholic drinks can have a positive effect on atrial fibrillation.
When lifestyle changes are not sufficient, we individualize treatment according to the type of atrial fibrillation, impact on your lifestyle and personal preferences.
Medication
For some patients, medication can control both heart rate and rhythm. If you have problem tolerating on-going medication for atrial fibrillation, an approach called “pill in the pocket”, in which you take the medication only when you are having a run of symptomatic atrial fibrillation, can help to shorten the duration of the attack. However, because sometimes you can’t tell if you are having atrial fibrillation, this approach may not be appropriate.
Catheter ablation (non-surgical)
This procedure uses radio frequency (heat) or cryotherapy (freezing) to interrupt the pathways that cause atrial fibrillation
Hybrid/MAZE Procedure for Atrial Fibrillation
This is a minimally invasive surgery performed through an incision below the breastbone. It is often performed along with catheter ablation in patients with difficult to control AFIB, who may have had prior ablations.
MAZE Procedure
In patients undergoing other open-heart surgeries such as coronary bypass or surgery to repair leaky or narrowed heart valves, a surgical MAZE procedure can be done during the same operative session if your atrial fibrillation requires treatment.
Re-Ablation of Arrhythmias Related to Prior AFIB Catheter Ablation
Scar tissue from a prior catheter ablation can actually cause newatrial arrhythmias months or years later. Our techniques for catheter ablation for AFIB minimize occurrences of new arrhythmias. However, if patients had prior AFIB ablations with occurrences of new atrial arrhythmias, we have experience in treating these patients in what is considered a difficult procedure.
Stroke Prevention
Atrial fibrillation can cause blood to pool in the left upper chamber of the heart, an area called the left atrial appendage (LAA). That pooling can cause the blood to clot and get into the blood stream, potentially causing a stroke. If you have AFIB and are considered at risk for strokes, you may need medication to thin your blood and prevent blood clots. If you cannot take anticoagulants due to severe bleeding problems, we offer a minimally invasive surgical technique to tie off the LAA to lower your risk of a stroke.
Ventricular Tachycardia (VT)/Premature Ventricular Contractions (PVC)
Implantable Defibrillator
Ventricular tachycardia is a serious arrhythmia that in some patients causes rapid palpitations, and in others, loss of consciousness. For some patients, VT can lead to ventricular fibrillation and sudden cardiac death. For those patients at risk for sudden cardiac death, we recommend an implantable defibrillator.
For all patients, we do a comprehensive assessment of your overall cardiac and coronary function and structure. We try to identify a precipitating cause of of ventricular tachycardia or PVCs and treat any underlying condition that may be a causative factor. Depending on the individual, if the VT or PVCs persist, we may then recommend drug therapy, catheter ablation, implantable defibrillator, or a combination thereof.
Cardiac drug or ablation therapy
PVCs are extra premature heartbeats that originate from the bottom chambers causing a premature contraction. While you may have no symptoms, you could also have intolerable palpitations, fatigue or shortness of breath. An excessive number of PVCs can lead to deterioration of heart function and congestive heart failure. Sometimes, treatment by drugs or ablation can be beneficial.
Cardiac Pacemakers/Defibrillators/Cardiac Resynchronization Therapy
Implantable pacemakers or defibrillators may help restore normal rhythm and prevent sudden death.
Why Choose UHealth?
One of the only Comprehensive Atrial Fibrillation Risk Factor Management Clinics in Florida. We use a multidisciplinary approach to diagnosis and treatment that includes lifestyle modifications.
Remote monitoring available. The Pacemaker and Defibrillator Center and pacemaker outpatient clinic are dedicated to optimizing cardiac implantable devices. With remote monitoring, if you have one, you don’t need to come into the clinic.
Newest 3-D technology and ablation equipment. We treat patients with various heart rhythm disorders to ablate the abnormal heart tissue responsible for producing the abnormal cardiac rhythm.