Health Chats
Atrial Fibrillation - Surgical and Nonsurgical Advances
Monday Apr 13, 2009, 12:00PM - 01:00PM (EST)
799883?1332371730
Cleveland Clinic
Cardiac Electrophysiology and Pacing, Cleveland, OH
Cleveland Clinic cardiovascular specialists are at the forefront of development and utilization of the newest therapies for treating atrial fibrillation (AF), the most common of all irregular heart rhythms. At the Center for Atrial Fibrillation, one of the nation's busiest AF programs, our staff provides a full array of approaches to diagnose and treat atrial fibrillation, whether medical, catheter based, or surgical. Please join us to chat with Dr. Bruce Lindsay as he takes your questions about the causes and new treatment options for atrial fibrillation.<br><br> Dr. Bruce D. Lindsay is Section Head, Cardiac Electrophysiology and Pacing at the Cleveland Clinic Sydell and Arnold Miller Family Heart & Vascular Institute. He is board-certified in Internal Medicine, Cardiology, and Clinical Cardiac Electrophysiology.He served as President of the Heart Rhythm Society 2007-2008 and chaired the Heart Rhythm Society's Annual Scientific Program in Boston in 2006, which was attended by more than 13,000 international physicians, scientists, and allied health professionals. Dr. Lindsay recently completed a term on Board of Trustees for the American College of Cardiology, and formerly chaired the College's Board of Governors. He also serves on the ABIM test writing committee for Clinical Cardiac Electrophysiology
Bilbo1933:
What is on the horizon for advances in A-fib ablations?
Bruce D. Lindsay, MD:
We have made a great deal of progress in developing ablation techniques for atrial fibrillation over the past 10 years.  Recent work involves improved 3 dimensional imaging to help position catheters and identify scar tissue.  Robotic and magnetic navigation may help to improve control of the catheter and reduce the risk of complications.  We are still working on developing new technologies that will make these procedures more effective and safer.
raksha69:
Hello Dr. Does anxiety or stress cause palpitations?
Bruce D. Lindsay, MD:
Anxiety and stress may provoke atrial fibrillation in patients who are susceptible to this problem.  Sometimes lifestyle changes help to reduce the frequency of atrial fibrillation though it generally does not eliminate the risk.  
MedHelp:
Thank you everyone for participating in today's chat.
MedHelp:
Unfortunately, we are now out of time
Bruce D. Lindsay, MD:
Thank you for having me.   We will look at the remaining questions and if on topic will try to post the answers over the course of the next week.
MedHelp:
Thank you, Dr. Lindsay, for taking the time to answer so many of our members' questions and for continuing to answer the questions post-chat.
Shiaya:
Can you ever get rid of a-fibs, or does it require on going treatment?
Bilbo1933:
Do they ever do surgery just for A-fib?  Other than when doing maze procedures while going valves, etc?  
Bruce D. Lindsay, MD:
Shiaya, atrial fibrillation generally recurs if it is not treated. Medications suppress it but do not offer a cure. Ablation procedures are performed to cure atrial fibrillation and eliminate the need for medications.
Bruce D. Lindsay, MD:
Bilbo1933, the Maze operation is performed in patients who are not good candidates for catheter ablation. In recent years the Maze operation has been modified to become less invasive. The long term results require further study.
Bruce D. Lindsay, MD:
The so called Mini Maze is not really a Maze operation. It is analogous to a limited catheter ablation procedure. Results will vary depending on the experience and skill of the surgeon.
MEMZE:
Hi. I'm 17 and having breathing difficulties, palpitations and coughing, which wake me up at night. I also feel like there is blood in my throat. Should I be worried?
Bruce D. Lindsay, MD:
It is difficult to say what this is, but I certainly recommend that you see you doctor and discuss these symptoms.
terk:
What are the long-term effects on the heart of intermittent a-fib episodes? At what point is ablation recommended?
Bruce D. Lindsay, MD:
Brief intermittent episodes of atrial fibrillation are not dangerous.
Bruce D. Lindsay, MD:
Over time (months to years), the episodes tend to become more frequent and last longer.
Bruce D. Lindsay, MD:
Most patients tolerate them well if the heart rate is controlled.
Bruce D. Lindsay, MD:
Ablation is recommended for patients with symptoms that are not alleviated by medical therapy.
Chris2519:
I am 41, have sleep apnea and am using the C pap machine, but otherwise healthy. I was dx'd with paroxysmal a-fib and take 50 mg metroprolol 2x a day plus one 81mg aspirin. Since I started the meds, my palps have become more frequent (every day) and I get lightheaded when I get up too fast. I lift weights 4x a week and walk 6x per week but feel sluggish when training. I cannot lay back flat or in a 45 degree angle without palps. Have taken a nuclear stress test, holter test, blood work, chest x ray and ECG (all ok). My heart is slightly enlarged (4.7) but the cardiologist said it was nothing to be concerned about. The cardiologist wants to do cardio version and also commented that we should consider Cardiac catheterization. What alternatives do I have? I read that 80% of the people that do cardio version end up back in fibrillation within 1.5 yrs. Could the metroprolol make the palpitations worse? Would something natural like vitamins help? If I wanted a 2nd opinion, what facility/doc would you recommend?
Bruce D. Lindsay, MD:
If you chose to seek a second opinion, my recommendation is to see a board certified electrophysiologist who treats a large number of patients with atrial fibrillation. Some patients do not tolerate metoprolol, but it is likely that the palpitations are worse because you are having more atrial fibrillation or the rate is not well controlled.
Bruce D. Lindsay, MD:
Cardioversion does not cure atrial fibrillation. Sometimes it must be repeated on other medications that are more effective in preventing atrial fibrillation. There is no evidence that vitamins will help.
Lishibelle:
My mother has atrial fibrillation. Her doctors disagree as to whether she should be on warfarin. Cardiologist says definitely. Neurologist / trauma surgeon say definitely not. (She is very unsteady on her feet and has already had a serious fall that resulted in subdural hematoma.) Why is a-fib associated with increased risk of stroke? How high is this risk?
Bruce D. Lindsay, MD:
Atrial fibrillation is associated with strokes because clots tend to form in the left atrial appendage where the blood flow is "stagnant" during atrial fibrillation. The risk is in the range of 1-8% per year depending on specific risk factors.
Bruce D. Lindsay, MD:
Unfortunately, the patients who are at greatest risk of stroke often have greater risk of complications from warfarin. A history of falls resulting in a subdural hematoma is a genuine concern. The decision becomes a matter of judgment and sometimes physicians have different opinions when there is not absolute right or wrong answer.
terk:
Besides a-fib, I have a clogged artery that I'm taking low dose Metoprolol and low dose statin as well as aspirin. My doc said low dose aspirin (81 mg) would be enough but this forum has mentioned the full or 325 mg. aspirin. Which do you recommend and if the concern is that the full dose might be irritating to the stomach, what do you feel about alternating between low and full doses? Is the full dose 4x more effective?
Bruce D. Lindsay, MD:
There is no definitive answer to your question. Most of the stroke prevention trials used a dose of 325 mg, but 81 mg is an option if you cannot tolerate the higher dose.
Pam:
My Dad had open heart surgery last Sunday, after a massive heart attack the day before.  He needed a triple bypass because 2 of the 3 major ateries were 100% blocked and the other was about 95% blocked.  He is still in the hospital and his heart rate is high.  They are having trouble lowering it and keeping it that way.  For a while yesterday, it was at about 112, but lately it's back in the  130's and 140's.  I'm very worried about my Dad. Any suggestions?
Bruce D. Lindsay, MD:
I cannot make specific recommendations without knowing more about your father. In general, it is feasible to control the heart rate by adjusting medications. Unfortunately, this is easier to do in some patients than in others.
Kent29946:
Thank you for your response to my earlier question.  As a follow up question--when I was taking solotol, although I would experience episodes, I could, with moderate exercise--15 to 20 minutes on a treadmill or elliptical machine--restore my regular heartbeat.  My cardiologist said this was unusual, but after reporting the same results over a year and a half, it was clear that the exercise was having a positive result.  Is there an explanation for what was happening while exercising to restore my regular heartbeat?
Bruce D. Lindsay, MD:
I have heard other patients say the same thing. It may be related to the effects of nerve reflexes on the heart, but nobody knows the exact answer.