Sometimes atrial
fibrillation comes on
and it's an emergency.
The patient rushes to the hospital
because they feel this chest discomfort.
And other times, atrial fibrillation
can be without symptoms
or like it just sort of crept up over time.
For some patients,
they used to be able to say, run a mile,
and now they can't walk around the block
without getting short of breath.
Atrial fibrillation
is a very common disturbance
of the heart rhythm.
Instead of having
a coordinated conduction of electricity,
atrial fibrillation is actually random firing
of different electrical points in the top part of the heart.
Normal sinus rhythm is when we have that
1-to-1 ratio.
Atrial fibrillation has the fast,
irregular heartbeats
that come through
because of that
electrical disorganized rhythm.
The problem of atrial fibrillation
has been around
for a very, very long time.
All forms of life are directly
dependent upon
the condition of their hearts.
At the time,
it wasn't really well known
or really paid attention to.
You know,
Uncle Bob has a heart condition
and isn't feeling well today.
Our understanding of it really began
a century ago
when we had a very important tool
that enabled us
to actually make the diagnosis,
and that's the electrocardiogram itself.
Back then, it involved the person
placing their hands
and one of their feet
in a bucket of salt water.
And it was, you know,
the size of a piano.
Once we were
able to identify
that a lot of these irregular heart
rhythms were atrial fibrillation,
we were offering treatments to control
heart rates with beta‐blockers,
calcium‐channel blockers,
these are staples in our regimen
that were developed 50 plus years ago.
That did a lot of good.
However, it wasn't
until we realized the association
with atrial fibrillation and stroke
that we really made a difference
in people's mortality
by preventing stroke with anticoagulants.
Drugs to control the speed of the heart,
and then, antiarrhythmic drugs,
to actually control the heart rhythm,
have been around for a long time.
And one early question investigators have was,
if we give antiarrhythmic drugs versus
simply rate control,
does the patient actually do better?
There've been a number of studies
that looked at this,
but one of the larger ones
really made the point that
it was ok to just rate control patients.
That really informed us into
how we should treat atrial fibrillation
at that time.
Almost in parallel to those efforts
was the development
of ablation.
We now asked whether or not
if we gave antiarrhythmic drugs,
versus ablation,
was there a difference?
The bulk of the data showed us
slightly better outcomes
with catheter ablation,
and there was a compelling
bit of evidence that the quality of life
was much better.
Catheter‐based therapies
are actually a tremendous
breakthrough in the field.
It's done
what we call percutaneously,
which means that we do not
have to open the chest.
We're able to
get to the heart safely
by going through a femoral vein.
We place a sheath in that vein,
just like an IV
that we place in your wrist or hand,
but instead of giving medicine or fluid,
we deliver the catheters
to perform the ablation.
We are able to isolate the pulmonary vein
by delivering a series
of ablation lesions in a circle
that act like a perimeter fence.
And that perimeter
fence controls
any electricity
that may come into or out of the vein.
There is another technology,
called cryoballoon ablation,
where we place a balloon in the vein
and where that balloon touches
it freezes it.
And that freezing
does the same exact thing
that we were doing
with radiofrequency ablation.
Most of my patients are able to go home
the same day.
The patient has to recognize
the ablation can get you
back to sinus rhythm
but it doesn't mean that
you can stop all medications,
and it doesn't mean you can stop anticoagulation.
We've come a long way in understanding
atrial fibrillation.
The mobile technology
that we have available to us today
changes things in many dramatic ways.
I have patients who can be traveling
and they can record
their electrocardiogram
and they can send it to me,
and together
we can figure out
whether they're actually having
any recurrences
of atrial fibrillation
and make the appropriate adjustments.
No longer is it the physician prescribing
in a semi-authoritative manner
what a patient should do.
They're taking
a much more active role.
Patients, for the most part,
really want that,
and that's a very rewarding thing for doctors.