Matters of the Heart
Understanding Atrial Fibrillation
What began as a typical morning hike for Roberta Stein and her Chocolate Lab hiking buddy, Riggs, ended as anything but.
Roberta and Riggs were just getting started on their usual, almost-daily outing when Roberta realized she felt somewhat out of sorts.
“I was lightheaded, had shortness of breath and just felt funny,” she recalls, “so I didn’t want to get back in the woods by myself. We turned around and went home.”
A couple of hours later Stein visited her dermatologist for a scheduled procedure, and when the doctor asked how she was doing, Roberta mentioned feeling a bit off. The dermatologist listened to her heart and said her heartbeat was very irregular. The procedure was canceled and Roberta was instructed to see her family physician right away. At that doctor’s appointment, Roberta learned during an EKG that her heart rate was 150-160. She remembers feeling just fine at that point.
“The physician’s assistant taking care of me said, ‘There’s not going to be any lights and sirens, but an ambulance is coming to take you to the hospital. We don’t want you to drive or wait for somebody to get here.’”
Upon arrival at the Colorado Springs hospital, Roberta was hooked up to monitors and given magnesium. Electrodes were applied, and cardioversion—or electric shock—was delivered to restore a regular heart rhythm. Her husband, Richard, who met the ambulance at the hospital, will never forget seeing his wife rise up off the table with the delivery of the electric current.
“They told me I had atrial fibrillation and prescribed Atenolol (a beta blocker) and aspirin,” says Roberta, who was released from the hospital that afternoon with a plan to meet with a cardiologist.
“Atrial fibrillation is an irregular rhythm of the top chambers of the heart,” says Dr. Derrick Fansler, MD, Cardiac Electrophysiologist with Colorado Springs Cardiologists, a practice aligned with the Penrose hospital system. “Afib is the most common arrhythmia in the world and affects millions of Americans. It is more common in patients as they age.
“There are three areas of treatment that must be addressed for every patient with atrial fibrillation,” says Dr. Fansler. “First is assessment of stroke risk. There is an elevated risk of clot formation due to the irregular beating of the top chambers of the heart that can lead to stroke. We use algorithms to assess the risk of stroke and decide if a blood thinner would help to reduce this risk. This must be weighed against the risk of bleeding. Second is making sure that the heart rate is controlled. If the rate is too fast, it can lead to additional problems like heart failure. Rates that are too fast or too slow can both lead to worsened symptoms. Third is targeting the rhythm itself. This can be done with medications and ablation. Ablation is more effective at treating the symptoms of atrial fibrillation than medications alone. For patients who have bothersome symptoms despite medication treatment, ablation can be an effective option.”
One type of ablation, as described by the NIH National Heart, Lung, and Blood Institute, is a procedure where a series of catheters are put into a blood vessel in the arm, groin, or neck. The wires are guided into the heart and energy is sent to destroy small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.
Dr. Jaime Gonzalez, MD, Cardiac Electrophysiologist with UCHealth Cardiology out of Memorial Hospital, says, “The most common risk factors for atrial fibrillation are pre-existing heart disease, cardiac surgery, hyperthyroidism, hypertension, obesity and obstructive sleep apnea. There are other factors as well that can put people at increased risk, such as a family history of atrial fibrillation and alcohol consumption.”
The Afib experience can vary greatly among those diagnosed. “Every patient tells a different story,” says Dr. Gonzalez. “Some patients cannot tell that they are in atrial fibrillation. Other patients can tell you exactly when they are in atrial fibrillation. They experience a variety of symptoms. These can be palpitations, shortness of breath, fatigue, lack of energy and dizziness.”
Two and a half years after learning she has Afib, 72-year-old Roberta Stein goes for annual check-ups with her cardiologist, and she continues to hike and snowshoe regularly. She feels fine with the exception of an occasional minor flutter. In addition to the beta blocker, she now takes a blood pressure medicine, a blood thinner and a statin. “I hope that at some point I’ll be able to go off some or all of the meds,” she says.
“The most important things that help to prevent atrial fibrillation,” says Dr. Gonzalez, “are maintaining a healthy bodyweight, treating hypertension and sleep apnea and avoiding alcohol.”