AFib: Stabilizing heart rhythm to reduce stroke risk
In a recent Penn Medicine Physician Interview podcast, cardiothoracic surgeon Alexander W. R. Bridges, MD, discusses the program at Penn Medicine Lancaster General Health to manage patients with atrial fibrillation and protect them from the risk of stroke.
The incidence of atrial fibrillation (AFib) varies significantly across cardiac patients. While about 10 percent of all coronary disease patients have AFib, as many as 50 to 60 percent of patients with multivalvular disease have the disorder.
Often, people don’t realize they have AFib until they have a stroke, says Alexander W. R. Bridges, MD. A cardiothoracic surgeon at Penn Medicine Lancaster General Health, Dr. Bridges, is featured in a recent Penn Medicine Physician Interviews podcast (see links below).
Managing AFib, along with any comorbidities, is critical for reducing the risk of stroke and heart failure.
“These are treatable conditions, and treatments must be tailored to the individual,” Dr. Bridges says. “Ideally, our goal is to cure AFib.”
AFib treatment and left atrium appendage closure
AFib treatment includes a range of options, including medical management and invasive interventions. Many patients begin antiarrhythmic therapy and experience stable heart rhythm for years, while others are essentially cured after a single percutaneous ablation treatment.
A significant number of patients, however, require more complex treatments. Procedures targeting the left atrial appendage (LAA), for example, are an effective way to prevent blood clots and therefore reduce stroke risk in people with AFib. These approaches include implants that block the appendage, such as the WATCHMAN device, as well as surgical techniques like LAA ligation or excision.
Such procedures have a clear benefit in patients with AFib at risk of stroke, and there may be an even wider use for LAA management, Dr. Bridges says. Researchers at Lancaster General are involved in the national Left Atrial Appendage Exclusion for Prophylactic Stroke Reduction (LeAAPS) trial to investigate whether LAA exclusion or ligation can reduce stroke risk in patients who do not have AFib but are at high risk of developing the condition.
AFib and open-heart surgery
Open surgery is used less frequently as an option for AFib, though it is one that patients and providers should not rule out, Dr. Bridges says. The Cox-Maze IV procedure uses a pattern of precise alterations at the surface of the heart to block abnormal electrical signals.
“It cures AFib well over 90 percent of the time, and a lot of people still consider it the gold standard,” Dr. Bridges says.
In the United States today, the maze procedure is rarely used to treat AFib alone, but tens of thousands of patients have the procedure each year while they’re also undergoing open-heart surgery for another condition. Patients who have the maze procedure often report an improved quality of life.
“While we do these other necessary procedures, we can take care of the AFib and reduce your lifetime risk of stroke,” Dr. Bridges adds.
Holistic AFib treatment at Lancaster General Health
The spectrum of heart arrhythmias is complex, and expertise is important for tailoring treatment to individual patients, Dr. Bridges says.
The experienced interventional cardiologists, general cardiologists, and electrophysiologists at Lancaster General Health collaborate with one another and with patients’ referring providers to provide holistic treatment for patients with AFib.
Clinical consult and patient referral
To refer a patient to the Afib specialists at Penn Medicine, call the 24/7 provider-only line at 877-937-7366 or submit via the secure online referral form.
Atrial fibrillation: the search for equilibrium
Alexander W. R. Bridges, MD, offers the insight of a cardiothoracic surgeon to an engaging discussion of atrial fibrillation, its causes, risk factors, pathophysiology, populations affected, and treatments.
Listen to this episode on Apple Podcasts, Spotify or YouTube Music.