HJAR Sep/Oct 2022

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2022 57 Mangaraju Chakka, MD Cardiologist CHI St. Vincent Heart Institute AGE is but a number, and as that number increases, so too can one’s risk for atrial fi- brillation, or AFib. As hearts grow older, scar tissue may begin to form in the chambers of the heart. This stiffening and the triggers as- sociated with atrial fibrillation become more present. The No. 1 cause, unfortunately, is age. To illustrate this point, 1 in 25Americans over the age of 60 haveAFib, and this escalates to 1 in 10 for those over the age of 80. Approxi- mately 33.5 million people around the world are currently living withAFib. WhileAFib can happen to anyone, risk factors such as high blood pressure, diabetes, valvular heart dis- ease, overactive thyroid, excessive alcohol intake, sleep apnea, and obesity, make it more likely for someone to develop this condition. Atrial fibrillation occurs when someone experiences rapid, disorganized electrical activity in the two upper chambers of the heart, known as the atria. These pulses can increase to rates three to six times that of a normal resting heart rate. This fibrillation causes blood to pool in the upper chambers instead of circulating to the lower chambers. When this happens, the heart begins to lose efficiency because it is out of sync. No matter the age of the patient when diagnosed, risks associated with AFib are very real. Essen- tially, the condition is an irregular heartbeat, but this irregular heartbeat can lead to other conditions like heart failure, blood clots, or even stroke. In younger patients, symptoms can present themselves as a racing heart, palpitations, or fluttering in the chest. They may also com- plain of shortness of breath in some cases. As patients become older, their symptoms Catheter ablation is a minimally invasive pro- cedure where a catheter is inserted into the groin to reach the blood vessels to the heart. Electrodes at the tips of the catheter use ra- diofrequency energy to destroy the regions that cause AFib. For patients with complex AFib, HybridAblation, which combines a sur- gical procedure and catheter ablation, may be the best option. Another approach, thoracic ablation, uses a camera and surgical instruments that are inserted into the chest through several small incisions. CHI St. Vincent’s is the only center in Arkansas to offer this procedure. For patients that need valve repair or re- placement or coronary bypass surgery, the surgical maze procedure may be the best course of action. This procedure makes sev- eral small incisions in the upper chamber of the heart to create a pattern of scar tissue to interfere with the electrical impulses that cause the atrial fibrillation. Atrial Fibrillation diagnoses increase as patients get older; in fact, age is the great- est risk factor. This understanding leads to awareness, research, education, treatments, and improved outcomes. We inform our pa- tients of the importance of prevention by liv- ing a heart-healthy lifestyle, and when this path proves unsuccessful, there are a mul- titude of treatment options at the ready. n Mangaraju Chakka, MD, is a cardiologist with the CHI St. Vincent Heart Institute treating patients in Little Rock and Hot Springs. He specializes in cardiac electrophysiology and performed the first catheter-based radiofrequency ablations for atrial fibrillation at CHI St. Vincent. Chakka earned a medical degree from New York University School of Medicine. “While the treatment should be tailored to each individual patient’s needs, the prevention is fairly universal — good cardiovascular health.” change. In conjunction with these other in- dicators, you may hear concerns regarding breathlessness and fatigue. Since we know that the diagnosis of AFib tends to increase as patients age, it is impera- tive to look at treatment and prevention op- tions as soon as possible. While the treatment should be tailored to each individual patient’s needs, the prevention is fairly universal — good cardiovascular health. No matter if a patient is in their 30s or in their 60s, it is im- portant to emphasize this approach. Exercise, monitoring blood pressure, and a proper diet all lower the risk of developing AFib. While prevention is the ideal approach, that is not always possible. As mentioned earlier, treatment should be individual- ized with the needs of the patient. What do these treatment options look like? The use of medication is often the first plan devel- oped. One form of medication that can be used to treat AFib is blood thinners. This is an approach taken considering the increased risk of stroke-associated complications. If your patient is unable to tolerate blood thin- ners, he or she may be a candidate for the WATCHMAN device, which helps prevent stroke-causing blood clots. Medications can also be used to slow the heart rate, such as beta-blockers and calcium channel block- ers. Other medications to consider can con- trol heart rhythm, which, in turn, can reduce symptoms of fatigue, shortness of breath, or dizziness. As with any medication treat- ment plan, careful monitoring is imperative to manage the condition. Electrical cardioversion can even be used to shock the heart back into a normal rhythm.