Specialties: Minimally invasive mitral valve, aortic valve, and tricuspid valve surgery; mitral valve repair, surgical treatment and minimally invasive surgery for atrial fibrillation; off-pump coronary artery bypass surgery; and high-risk mitral valve surgery.
I’m Dr. Marc Gillinov from the Miller Family Heart & Vascular Institute at the Cleveland Clinic.
Atrial fibrillation is the most common abnormal heart rhythm experienced by individuals. It affects more than 2.5 million people in the United States and at some point will affect approximately one in four people. Atrial fibrillation is an irregular rapid heart rhythm that frequently causes palpitations or the sensation of a racing heart. Some people develop shortness of breath and fatigue and some people develop no symptoms whatsoever. The diagnosis of atrial fibrillation is established easily by standard EKG, or electrocardiogram.
If the atrial fibrillation comes and goes, some people may require a halter monitor, which is a continuous heart rhythm monitor for 24 or 48 hours.
The reason that atrial fibrillation requires treatment is that it is associated with certain dangers. Atrial fibrillation causes in inefficient heart beat, it may cause heart failure, is associated with strokes, and it is associated with early death.
A variety of treatment options are available for the person who has atrial fibrillation. It usually begins with medical treatment. The medical treatment may consist of antiarrhythmic medications or drugs designed to restore sinus rhythm. If these fail, the patient is treated with blood thinners to prevent stroke like Coumadin, and, in addition, medications to control the heart rate like beta blockers.
Patients who fail medical management, or who still have symptoms or complications with medical management, can be treated by interventions. These interventions are catheter and surgical based ablation. Ablation means a treatment designed to restore sinus rhythm. Surgical ablation is indicated in patients who are having heart surgery for other reasons, and also have atrial fibrillation. In such patients, we have demonstrated that treating both the atrial fibrillation and the primary surgical problem results in a better outcome.
The operation performed for atrial fibrillation is termed a Maze procedure. In addition, though, there are new, easy, more rapid operations that have been termed mini- Mazes or minimally invasive Maze procedures.
Some patients present for cardiac surgery to treat only the atrial fibrillation. These are people who have had failed catheter ablations or failed medical therapy. Many of them have had previous strokes, and some of them have blood clots in the heart. These individuals are candidates for new, minimally invasive approaches that frequently do not include the heart lung machine and may be performed through tiny incisions, or with an endoscope.
Today, because we have new technology and improved understanding of atrial fibrillation, we have a wide variety of treatment options and we can offer virtually every patient with atrial fibrillation and excellent outcome.
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