Atrial fibrillation (AF, or “A-Fib”) is the most common type of arrhythmia, or irregular heartbeat. Often mistaken for normal heart palpitations or written off as the result of aging, AF usually increases in duration and severity over time if untreated. AF affects 2 million Americans and is responsible for one in four strokes among people over 80.
Early diagnosis and treatment cannot cure AF, but it can keep this progressive condition from reducing quality of life. Technological advancements just in the past decade paved the way for monitoring and controlling AF before it becomes permanent — with more precision and less medication.
“We often say that A-Fib begets A-Fib, meaning that once your heart shows this tendency, it usually does not reverse without intervention,” says Tom McElderry, MD, a cardiologist specializing in electrophysiology with the UAB Cardiovascular Institute (CVI). Electrophysiology is a medical specialty that focuses on the electric signals that control the heartbeat.
The three most common AF treatments are anti-arrhythmic drugs (to keep the heart out of AF), blood-thinners (to decrease stroke risk), and a procedure called cardiac catheter ablation, which has long been used only when medication doesn’t work.
“Our tools have improved over the past decade, and research has revealed that earlier intervention with ablation as a first line of treatment is often the best way to preserve quality of life while limiting risk to patients,” Dr. McElderry says. “We also have emerging stroke risk-reduction procedures that may reduce patients’ reliance on blood thinners in the future.”
Below are highlights of exciting developments that are changing doctors’ approach to AF:
1. Constant monitoring via a smartwatch
At one time, an AF diagnosis required an electrocardiogram (EKG/ECG) to record the heart’s electrical activity. Today, a smartwatch can do that. “A wait-and-see attitude is not best for patients,” Dr. McElderry says. “You don’t want to find out you have A-Fib by having a stroke.”
Numerous smartwatches have received U.S. Food and Drug Administration (FDA) clearance for ECG and heart monitoring usage due to their accuracy. Cardiologists use the data gathered from a single-lead rhythm strip to help make a diagnosis, judge the severity of the disease, and gauge the effectiveness of treatments. Dr. McElderry says he convinced his own father to wear a smartwatch with an ECG monitor, leading to a diagnosis and successful treatment at the UAB CVI.
2. Ablation procedure has greatly improved
Ablation — destroying faulty cells — is not a new approach to treating AF, but it has been greatly improved over the years. In this minimally invasive outpatient procedure that requires only small incisions (cuts), thin wires called catheters are inserted into large blood vessels and guided to the heart. The catheters have sensors that map areas of the heart and are equipped to ablate (destroy) abnormal heart tissue using radiofrequency energy.
“The mapping system, therapy delivery, and evolution of the procedure has dramatically increased our accuracy and speed,” Dr. McElderry says. “That is why we are beginning to see this as a first-line treatment rather than just what we use when medicines don’t work.” The majority of ablation procedures are successful and in many cases do not require an overnight hospital stay.
- Mapping: The UAB CVI uses magnetic-based navigation systems to create a real-time 3-D image of the heart and pinpoint electrical impulses. This technique allows Dr. McElderry and his colleagues to determine the impact of ablation during the procedure. It is performed without contrast dye or X-rays, unlike older mapping methods.
- Improved ablation catheter: The UAB CVI uses several new catheters available only at select hospitals for early evaluation, including the DiamondTemp and Q Dot Micro. These catheters use microelectrodes in the tip to pinpoint signals from the heart and allow precise control of tissue temperatures reached, which allows for faster results and less tissue damage.
- Clinical trials for non-heated ablation: Dr. McElderry was involved in some of the first human cases internationally that used pulse field ablation, an electrical ablation method that is non-heated and faster. UAB also participated in a recent clinical trial for this technique. “The most exciting thing about this technique is that we can tune the waveform to act on the heart only, preserving surrounding tissue,” he says.
3. A device that works like blood-thinning medication
Taking blood thinners to reduce stroke risk is a fact of life for most people with AF. A technique called left atrial appendage closure (LAAC) is an alternative method of reducing stroke risk by preventing blood from pooling in the area of the heart known as the left atrial appendage, where clots most often form. Currently, this method is only used for patients who cannot tolerate blood thinners. Recently, however, devices that do this have been improving. The UAB CVI is involved in the CHAMPION-AF research study, which compares patients on blood-thinner medication to those who undergo an LAAC with a new device called the Watchman FLX.
These new developments are making AF more manageable, but according to Dr. McElderry, “the main takeaway for adults over 60 and their physicians is to be proactive and get diagnosed, so that we can use the latest methods to keep your condition from advancing.”
Click here to learn more about the UAB Cardiovascular Institute.
SOURCES: National Institutes of Health and CABANA Trial Takeaways