- Thank you for visiting Dr. AFib.
I'm Dr. Morales.
In today's video segment we're going to be talking about
atrial fibrillation and congestive heart failure together.
February is heart month, and so I wanted to make some videos
where I discuss not just atrial fibrillation,
but how atrial fibrillation affects other heart conditions
and looking at your heart as a whole.
And so in this segment we're going to be talking about
atrial fibrillation and congestive heart failure,
which is commonly called CHF.
CHF can refer to a few things.
Most commonly, it's referred to a weak heart,
but it can also be referred to as a stiff heart.
In either circumstance the heart just doesn't pump blood
efficiently to the rest of your body and leads to a backflow
which can lead to fluid in your lungs
or swelling in your legs, which are the most common symptoms
of congestive heart failure.
So how does atrial fibrillation
affect congestive heart failure?
Well, there's two ways that it can affect that.
One, it can be the primary cause
of congestive heart failure, or two, it can be secondary
because of congestive heart failure.
So let's talk about the first one,
which is atrial fibrillation as the cause
of congestive heart failure.
Sometimes when patients are first diagnosed
with atrial fibrillation, they don't necessarily feel
the heart going fast or skipping, they just started feeling
more short of breath.
And so when they're finally diagnosed with atrial
fibrillation, their heart may have gone fast
for several weeks or even months at a time.
And as a consequence of the heart going consistently fast
all the time, the heart function becomes weak,
it becomes weaker than normal, and in those settings
the atrial fibrillation is the cause
of the congestive heart failure.
Now normally when the AFib is diagnosed,
you have to do things like looking at coronary
heart disease, make sure that that's not a cause as well,
but if in the end it points to only atrial
fibrillation being the cause of the congestive
heart failure, that's what would cause
a tachycardia mediated cardiomyopathy.
And in these patients where the AFib is the sole cause
of your congestive heart failure, there are a few ways
to manage this.
One is just making sure your heart rate
is better controlled, and that over time
can make your heart function get stronger again.
However, rhythm control, which would be getting you
out of atrial fibrillation, whether that be
with a cardioversion or a procedure like an ablation,
tend to work better to help improve your heart function
and get it back closer to normal,
and in some cases can actually bring your heart
all the way back to normal function again.
In some cases, atrial fibrillation is a secondary culprit.
Your weak heart or your stiff heart puts a lot of pressure
inside of your heart and increases the pressure
inside of the bottom chambers of your heart
as well as the top chambers of your heart,
which over time makes it stretch and dilated
that it ends up giving episodes of atrial fibrillation.
In these settings, treating the atrial fibrillation
is unlikely to make your heart function get stronger
because it was a secondary culprit
of the congestive heart failure.
However, when people are in atrial fibrillation
and they have congestive heart failure,
I often tell people it's like you have a weak heart
and the AFib just made it even weaker.
And so people get more symptoms,
they get more short of breath,
more swelling in their legs,
and keeping them in normal rhythm helps improve
or maximize that little bit of heart function
that they still have.
And so treating your AFib with medications
or with ablation procedures can also help
improve that little bit of heart function that you have
with people who have preexisting congestive heart failure.
Now in both of these settings, doing a procedure
can help maximize how much normal rhythm you have
and improve your symptoms of congestive heart failure.
However, doing an ablation procedure on somebody
who has congestive heart failure
can be an aggressive procedure, and it takes much longer
for patients to recover an ablation procedure
when they have existing congestive heart failure.
So in these settings, not everybody who has congestive
heart failure is a candidate for an ablation.
And I certainly, when I have patients who have both
congestive heart failure and they're being prepared
for an ablation procedure, you need to make sure that
that congestive heart failure is tuned up
as good as possible, that you bring it as good as possible
before doing the procedure.
This generally is a harder procedure
for people to recover from when we have
existing congestive heart failure.
But in the end it can improve symptoms.
And there was a recent article that I posted
on my Facebook page that showed that
people who have congestive heart failure
and improved the amount of AFib they had
with a catheter ablation have less hospitalizations
and they can live longer.
So there's certainly a benefit for patients
who have preexisting congestive heart failure as well.
But it can be difficult to manage
and please discuss with your doctor
to see if you are a candidate for ablation procedures,
especially if you have existing congestive heart failure.
Thank you for visiting this video segment of Dr. AFib.
I'll see you next time where we'll be talking about
atrial fibrillation as well as valve heart disease.