Atrial fibrillation: New options to prevent stroke

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CASSOPOLIS, Mich. (WNDU) - At least 2.7 million Americans are living with atrial fibrillation, an irregular heartbeat that can lead to a stroke.

For years, the go-to treatment for preventing a stroke in these patients was the blood thinner warfarin. But now, researchers say there's something better.

Three years ago, Donna Marie Robinson was the picture of good health.

"I was working out three times a week, high intensity," she said.

But then, she was diagnosed with atrial fibrillation, or AFib for short. That meant she had to slow down.

"Yeah, it's a little depressing. You don't have control over it," Robinson said.

With AFib, the upper chambers of the heart beat irregularly and don't effectively move blood into the ventricles.

"The problem is that the blood sits without moving through the heart, and as it sits, it has a tendency to form clots," Sanford Burnham Prebys Medical Discovery Institute assistant professor Dr. Karen Ocorr said.

If a clot breaks off and lodges into an artery leading to the brain, a stroke happens.

For years, the gold standard medicine to prevent a stroke in AFib patients was the blood thinner warfarin.

But now, the American Heart Association recommends a class of medicines called nonvitamin K oral anticoagulants. It includes the drugs Eliquis, Pradaxa, Xarelto and Savaysa.

With these newer therapies, patients don't need regular blood tests like they do with warfarin. Also, studies show they may be more effective than warfarin and less likely to cause bleeding.

Robinson takes Eliquis to lower her risk of stroke. So far, so good.

"I have a new normal," she said.

Under the new guidelines, patients with AFib who have moderate to several mitral stenosis or an artificial heart valve should still take warfarin. Talk to your doctor to see if you're a candidate for the newer medicines.

RESEARCH SUMMARY
AFIB: NEW OPTIONS TO PREVENT STROKE REPORT #2638

BACKGROUND: Atrial fibrillation, often called AFib, is the most common type of heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast, or in an irregular way. When a person has AFib, the normal beating in the upper chambers of the heart is irregular, and blood doesn't flow as well as it should from the atria to the lower chambers of the heart. AFib may occur in brief episodes, or it may be a permanent condition. An estimated 2.7 to 6.1 million people in the United States have AFib. With the aging of the U.S. population, this number is expected to increase. Approximately 2 percent of people younger than age 65 have AFib, while about 9 percent of people aged 65 years or older have AFib. African Americans are less likely than those of European descent to have AFib. Because AFib cases increase with age and women generally live longer than men, more women than men experience AFib. (Source: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm)

SYMPTOMS AND TREATMENT: Some people with AFib have no symptoms and are unaware of their condition until it's discovered during a physical exam. Those who do have symptoms may experience palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest, weakness, fatigue, lightheadedness, dizziness, confusion, shortness of breath or chest pain. AFib could be occasional, called paroxysmal atrial fibrillation. You may have symptoms that come and go, lasting for a few minutes to hours and then stopping on their own. It may also be persistent. With this type of AFib, your heart rhythm doesn't go back to normal on its own. If you have persistent AFib, you'll need treatment such as an electrical shock or medications in order to restore your heart rhythm. It can also be long-standing persistent. This type is continuous and lasts longer than 12 months. Finally, there is permanent AFib. In this type, the abnormal heart rhythm can't be restored. You'll have AFib permanently, and you'll often require medications to control your heart rate. The atrial fibrillation treatment that is most appropriate for you will depend on how long you've had it, how bothersome your symptoms are and the underlying cause of your AFib. Generally, the treatment goals are to reset the rhythm or control the rate, prevent blood clots, and decrease the risk of strokes. (Source: https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624)

A CLEAR MAP FOR AFIB TREATMENT: A team at The Ohio State University Wexner Medical Center, using hearts from organ donors, were able to devise a method to clearly map the heart, and ultimately interrupt its ability to produce irregular heartbeats. The clear mapping of the heart allows experts to find new areas to perform helpful ablations. During an ablation, tiny cuts or burns are made to form scar tissue that can disrupt the heart's electrical circuitry and stop irregular beats. Vadim Fedorov, PhD, an associate professor who studies anti-arrhythmic treatments, and his team, devised a way to better image the heart. The organ is injected with dye and placed in a dish with four high-speed optical cameras around it. A camera normally can capture about 200 recordings, but this technology records 40,000 images in 3-D. The improved imaging lets doctors find ideal areas for ablations. "While this technique may pave the way for more precise ablation procedures for atrial fibrillation, and improve their success rates, the approach has not been validated in real-life humans with atrial fibrillation," Dr. Regina Druz, a cardiac imaging doctor from New York, said. The hearts used in the study were donated by patients that received transplants, and they probably had structural issues that come with cardiac disease. Druz says that Fedorov's technique may find fewer clinical applications in actual patients with AFib because their hearts are not structurally damaged. (Source: https://www.healthline.com/health-news/map-for-afib-treatment#3)