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The Latest in Cardiac Arrhythmia Treatments

Most of us aren’t consciously aware of our heart beat until it speeds up due to physical exertion, fear, or excitement. However, for people with a condition known as cardiac arrhythmia, the heart may suddenly start to beat too quickly, too slowly or without a regular rhythm. While minor arrhythmias may require no treatment, more serious types may increase the risk of stroke and require medical care.

Atrial fibrillation (AF), the most common type of serious arrhythmia, occurs when the electrical impulses that control the heart become erratic. In a normally beating heart, the two upper chambers (the atria) contract, followed by the two lower chambers (the ventricles) in a organized rhythm. When the electrical impulses become irregular, they interfere with the atria’s ability to effectively pump blood from the heart. The heart beat may become very fast, sometimes exceeding 200 beats per minute. Some people experience symptoms including shortness of breath, fatigue, dizziness or chest discomfort. But even if there are no symptoms, blood that should be pumped from the heart instead pools in the left atrium, creating an ideal environment for blood to clot.

For people with AF, clots are most likely to occur in a part of the left atrium called the left atrial appendage. If they break loose and travel through the bloodstream and up to the brain, they can cause a stroke. This is why patients with AF have a risk of stroke that is six times greater than normal.

In order to reduce the risk of stroke, many AF patients take medications to thin their blood; the two most commonly used medications are Warfarin and Pradaxa. While both are effective, they may also have undesirable side effects. Warfarin has dietary restrictions and requires frequent blood tests to monitor blood thickness. Pradaxa does not, but there have been concerns about internal bleeding. Although blood thinning medications are considered life saving therapy they all place patients at higher risk for life threatening bleeding.  Some patients are at higher risk that others while taking blood thinning medications.

Patients that cannot or do not want to take blood thinning medications may be interested in two new procedures to reduce the risk for stroke.  These procedures are generally referred to as left atrial appendage occlusion procedures. The first procedure involves implanting a tiny, parachute-like device into the heart. This device closes off  the area of the heart where blood tends to stagnant, thereby preventing blood clots from going to the brain.  The patient is given a local anesthetic, and then the device is implanted using a thin, flexible tube called a catheter. The catheter is inserted through a small incision in the groin and threaded through a vein up to the heart. Patients usually spend one night in the hospital and can generally can discontinue their blood-thinning medications 45 days after the procedure.  The second procedure is a similar procedure but a small piece of thread is used to tie off or ligate the region of the heart where blood clots form.

Another option for treating some types of arrhythmia is catheter ablation. As with left atrial appendage closure, a catheter is inserted through a vein in the groin, arm or neck and guided to the heart. Energy is then sent through the catheter to the specific areas of the heart that are causing the irregularity to target and destroy the problematic tissue. Catheter ablation may use either heat or freezing cold energy to correct the arrhythmia; radiofrequency ablation uses heat energy, while cryoablation uses cold.

Both left atrial appendage closure and catheter ablation have some risks, such as bleeding or infection where the catheter is inserted, but in general these procedures are very safe for the treatment of cardiac arrhythmia.

Talk with your doctor to determine the best course of action.

By: Douglas Gibson, MD, Scripps Health

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"Most of us aren’t consciously aware of our heart beat until it speeds up due to physical exertion, fear, or excitement. However, for people with a condition known as cardiac arrhythmia, the heart may suddenly start to beat too quickly, too slowly or without a regular rhythm. While minor arrhythmia may require no treatment, more serious types may increase the risk of stroke and require medical care."

Stroke Prevention
Manage your controllable risk factors with regular medical checks-ups. Managing the following factors will reduce your risk of stroke:
Control Blood Pressure

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