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Dr. Edward Koomson

American Heart Month is the perfect time to focus on the health of your heart. Arrhythmias are abnormal heart electrical rhythms that affect millions of Americans. One of the most common is atrial fibrillation.

Atrial fibrillation or Afib, is an often fast, irregular rhythm typically emanating from one of the top chambers of the heart. Having Afib increases your risk for stroke by more than five times due to the possibility of clot formation within the heart. This arrhythmia may also increase the risk for developing heart failure.

What are the symptoms of Afib?

The most common symptom associated with Afib is heart palpitations or fluttering of the heart that includes thumping or pounding heartbeats. Other symptoms include tiredness or fatigue, shortness of breath and decrease in exercise tolerance. They may also include generalized weakness, lightheadedness and chest pain.

What are the risk factors for Afib?

There are several risks factors for Afib, some that can be modified or controlled and others that cannot. Age and family history are non-modifiable risk factors. You can mitigate other risk factors such as sleep apnea, obesity, high blood pressure and pulmonary diseases through proper management, a healthy diet and by not smoking.

How is Afib treated?

The first goal of atrial fibrillation management is reducing the risk for stroke through use of anticoagulation medication or, for some, implanting a device called Watchman in the left atrial appendage. The treatment decision is based primarily on your overall stroke risk using what is called the CHADS2-VASc score. For patients with an elevated CHADS2-VASc score and deemed not to be a good candidate for anticoagulation due to bleeding or falls — or those who want an alternative to long-term use of prescription medication — Watchman implantation may be recommended. This device is implanted in a small structure located in the left upper chamber of your heart that is responsible for 90% of Afib-related clot formation. It is implanted through a small nick made in the right big groin vein. Watchman provides similar stroke protection in Afib patients when compared to long-term medication use without the associated bleeding that is a risk of the medication.

Another goal in Afib management is symptom control. This can be achieved with medications called anti-arrhythmic drugs, with cardioversion (shocking heart back into rhythm) or through atrial fibrillation ablation. Ablation is generally considered in symptomatic patients who are intolerant to medications or who have tried medications with no success. Cryo-ablation (freezing) or RF-ablation (cauterization) both have similar success rates.

The most important thing to remember is that atrial fibrillation is a progressive disease that may occur with increasing risk as we age, so it is important to control other risk factors.

That means you shouldn’t smoke and you should maintain proper weight, comply with adequate blood pressure control and manage sleep apnea well.

Dr. Edward Koomson is an electrophysiologist at Phoebe Putney Memorial Hospital in Albany.

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