Ask the Doctor: Teferi Mitiku, M.D.

Q. I’ve been diagnosed with atrial fibrillation (AFib). What does that mean for me and what can I expect long-term?

A. Atrial fibrillation (AFib) is a heart rhythm disorder that causes the heart’s two upper chambers (the atria) to beat chaotically and out of coordination with the heart’s two lower chambers (the ventricles). It is the most common heart rhythm disorder and affects approximately 2.7 million people in the United States.

For someone with AFib, the atria may beat as much as 400-600 times a minute, which is four times faster than a person who does not have a heart rhythm disorder. Although AFib is not immediately life threatening, it can lead to other rhythm disorders, cause fatigue, dizziness, shortness of breath, and increase your risk of congestive heart failure and stroke. In most cases, AFib is a chronic progressive disease, so it is important to get treatment as soon as possible and to follow your treatment plan.

Generally, the goal with treating AFib is to control the heart rate/rhythm, prevent blood clots and reduce the risk of having a stroke. Your treatment plan will vary depending on the severity of your AFib, your symptoms, your age, if you have had a prior stroke or mini stroke, and if you have any other medical conditions such as high blood pressure (hypertension), congestive heart failure, diabetes or vascular disease. The most common treatment options your physician may recommend include medication therapy, electrical shock (cardioversion), or invasive therapies/surgeries in some cases.

Medication Therapy: There are many effective medications available today, which are prescribed based on your individual symptoms and disease condition. Some medications are designed to control heart rate, and others are designed to control heart rhythm. Although medication does not cure AFib, it can help to reduce symptoms and stabilize your heart rate or rhythm. Your physician will also assess you for the risk of stroke, and may prescribe a blood-thinning medication (anticoagulants).

Electrical Shock (Cardioversion): Sometimes AFib patients may not be able to achieve a normal heart rhythm with medication therapy alone. In that case, your physician may suggest electrical cardioversion, which delivers an electrical shock to the chest wall to synchronize the heart to create a normal rhythm. This procedure is performed in a monitored setting, and patients are given medication to relax them during the procedure, so there's no pain involved.

Invasive Therapies/Surgeries: To effectively control heart rhythm, a catheter ablation may be required, especially for patients who do not respond to antiarrhythmic medication trials. During a catheter ablation, an electrophysiologist will thread thin, flexible catheters through a vein or artery in the upper thigh, arm or neck, and guide it to your heart, placing it at the location where the arrhythmia begins. The catheter emits a burst of energy to destroy (ablate) very small areas of tissue that cause rapid and irregular heartbeats. In rare difficult cases, surgical ablation (i.e., Mini Maze) procedures may also be used as part of your treatment. Mini Maze is an open-heart surgery ablation procedure, where a cardiothoracic surgeon will make small incisions near your heart to create an electrical block along the pathway that is causing your arrhythmia.

Often, when treatment interventions control the heart rhythm, the heart rate is typically controlled as well. However, in some cases when the rhythm cannot be controlled, the heart rate cannot be controlled either. As a result, the electrical connection between the atrium and the ventricle is ablated, and a permanent pacemaker is required to manage AFib. The pacemaker is implanted under the skin near the collarbone and is connected to the heart through small wires that pace the heart.

Lifestyle choices are also an important part of arrhythmia management. Living a heart-healthy life by exercising regularly, maintaining a healthy weight and diet, not smoking, avoiding unnecessary stress, and reducing your intake of caffeine and alcohol will all help you to control your AFib.

While there are many options available, your physician will create the best treatment plan for you. This may change overtime depending on your overall health and if you develop any other medical conditions.

Teferi Mitiku, M.D., earned his medical degree at UCLA, followed by his residency at Stanford University. He also completed a fellowship in cardiovascular disease and electrophysiology at Yale. He is triple board certified by the American Board of Internal Medicine, and the American Board of Cardiovascular Disease, in both Cardiology and Cardiac Electrophysiology. He is currently practicing Electrophysiology in Orange County, CA.