Atrial Fibrillation (Afib) Lecture Notes

Overview

• Atrial Fibrillation (Afib) is the most common heart rhythm abnormality.
• Causes the upper chamber of the heart to beat extremely fast (500-600 beats per minute).
• Results in an irregular rapid heartbeat.
• Predominantly an age-related issue:
  • Rare before age 50
  • Affects 1 in 10 by age 80
• More common with other heart diseases, obesity, and familial tendencies.
• Affects over five million adults in the US.

Diagnosis

• Diagnosed via an EKG which documents atrial fibrillation.
• May be incidentally picked during a routine checkup or due to symptoms like racing heart or fatigue.

Main Concerns

• Stroke Risk: Afib increases the risk of stroke by fivefold on average.
  • Stroke can be life-altering or fatal.
• Treatment strategies focus on lowering stroke risk.

Risk Stratification for Stroke

• Different patients have different stroke risks:
  • High-risk: potentially up to 10% per year
  • Low-risk: extremely low despite Afib
• Factors influencing risk:
  • Age over 65
  • Diabetes
  • Hypertension
  • Prior stroke or TIA
  • Coronary disease
• If risk is 2% per year or higher, interventions are recommended.

Treatment Approaches

Medications

• Anticoagulants:
  • Traditional: Coumadin, Warfarin
  • Newer: NOACs (New Oral Anticoagulants) that do not require monitoring.

Non-Medication Approaches

• Appendage Occlusion: A new technique to lower stroke risk without medication.
  • Only about 50% who should be on blood thinners actually are, due to bleeding risks.

Techniques for Appendage Occlusion

• Plug Insertion: Minimally invasive, deploys a plug like an umbrella inside the heart to occlude the appendage.
• Surgical Clip or Tie: From the outside or through the chest bone, using a clip or snare to tie off the appendage.
  • Involves techniques through the chest wall or under the sternum.
• All methods aim to reduce stroke risk comparable to blood thinners.

Decision-Making Process

• Choice of technique is critical and depends on:
  • Patient anatomy and medical history.
  • Whether the patient can be on blood thinners.
• A multidisciplinary team at Hopkins (imaging cardiologists, cardiac surgeons, and cardiologists) review and recommend the best approach.
• Patients with prior chest surgeries may prefer the plug approach.

Conclusion

• Selecting the appropriate device is a key decision.
• The team provides recommendations based on individual patient needs and conditions.

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