Getting the Right Heartbeat
Once stroke risk is under control in a patient with AFib, doctors turn their attention to the actual heart rhythm problem. Not everyone needs their AFib corrected. Some people with atrial fibrillation can go years without any treatment other than stroke prevention.
“A lot of people have so-called chronic AFib, where it’s there all the time, but as long as their heart rate isn’t too fast, they’re able to live their lives normally, and in some cases don’t even notice it,” says Whang.
So if you don’t have symptoms from your AFib and your heart function is normal, your doctor may not try to get your heart back into a normal rhythm. “There’s no evidence showing that doing this will make a person live longer or have a lower stroke risk,” Wylie says. "So it’s hard to make the case for prescribing drugs and surgical interventions, which have their own risks."
If you do have symptoms, that’s a different story. Symptoms of atrial fibrillation include:
- Fatigue and lack of energy
- Shortness of breath
- Heart palpitations
One of the first options to convert atrial fibrillation to normal heart [sinus] rhythm is a procedure called cardioversion. The patient is placed under anesthesia and doctors deliver an electrical shock to the chest to reset the heart’s rhythm back to normal.
“This isn’t a permanent fix,” says Whang. “Sometimes a person could have a recurrence of their AFib by the time they get home from the procedure. But getting the person back into normal rhythm, even for a short time, can tell us whether or not that makes them feel better. That tells us what we should do about treatment.”
That’s particularly helpful in a young person who may not think that their AFib is causing them symptoms but notices a dramatic difference after cardioversion. “They’ll say, ‘Wow, I didn’t realize I was feeling so bad! I thought I was just getting lazy, but it was really the AFib that was sapping my energy,’” Wylie says.
Prior to performing a cardioversion, doctors must make sure that there are no clots lurking in the atria that could be dislodged by the procedure and cause a stroke. Usually a month on blood-thinning medications will dissolve any hidden clots. If symptoms are too severe to wait that long, cardiologists will perform a procedure called a transesophageal echocardiogram (TEE).
Traditional echocardiograms use ultrasound transducers placed on the outside of the chest. A TEE gives a more detailed picture of the heart’s left atrium, where clots associated with AFib usually hide. Doctors guide the ultrasound transducer, attached to a long flexible tube called an endoscope, through the mouth and down the patient’s esophagus, which runs right behind the left atrium. This outpatient procedure is usually performed under IV sedation. If the TEE does not identify any blood clots, the doctor usually proceeds with the cardioversion.