Arrhythmia Center

Atrial Fibrillation

At Boston Medical Center, we take your health concerns seriously by providing exceptional care to all our patients. The doctors and staff in our Electrophysiology Department will demonstrate our commitment to your care by diagnosing and treating your heart problems using state-of-the-art technology. If you are experiencing atrial fibrillation, our electrophysiologists will work with your cardiologist to see that you receive the best care in the New England region.

Atrial fibrillation is a disturbance in the heart's rate or rhythm. The atria (the upper chambers in the heart) send an impulse to the ventricles (the lower chambers) to cause your heart to beat. Normally, the atria and ventricles contract in a coordinated manner, and a normal heart beats between 60 and 100 times per minute. Atrial fibrillation is due to multiple electrical short circuits in the atria, and causes the atria to beat extremely fast and irregularly. This causes the atrium to quiver instead of contracting normally. In some cases of atrial fibrillation, the atria may signal the heart to beat more than 400 times per minute. This can create a very rapid heartbeat, lead to other heart problems, and increase the risk of stroke.

Atrial fibrillation is the most common type of arrhythmia (an irregular heartbeat) and affects more than 2 million Americans. There are three main types of atrial fibrillation. It can be episodic, which lasts from a few minutes to a few hours (intermittent or paroxysmal) and resolves on its own. Atrial fibrillation can also be persistent (lasts for days or weeks) and can be permanent.

Atrial fibrillation can cause serious health problems. In atrial fibrillation, blood does not fully pass through the atria. Instead, some blood pools in your heart, which can eventually enable an embolus (blood clot) to form and possibly enter your bloodstream. This clot can travel and block the blood flow in your brain, causing a stroke. Atrial fibrillation can also lead to cardiomyopathy (enlargement of the heart), which eventually weakens your heart.

The risk of atrial fibrillation is higher in people older than age 60, in men, and in people who have diabetes, high blood pressure or congestive heart failure or lung disease.

What are the symptoms of atrial fibrillation?
Atrial fibrillation may not always cause symptoms

  • Palpitations
  • Dizziness or feeling lightheaded
  • Fainting (syncope)
  • Weakness
  • Fatigue
  • Dyspnea
  • Angina

What causes atrial fibrillation?
Atrial fibrillation is most commonly caused by cardiovascular problems, such as:

  • Hypertension (high blood pressure)
  • Valvular disorders or disease
  • Ventricular hypertrophy (enlargement of the heart's lower chambers)
  • Cardiomyopathy
  • Atherosclerosis ("hardening of the arteries")
  • Sick sinus syndrome
  • Pulmonary embolism

How is atrial fibrillation diagnosed?
To help diagnose atrial fibrillation, Boston Medical Center's electrophysiologists use one or more of the following tests:

  • Electrocardiogram. An electrocardiogram tracks and graphs heart rhythm using electrical signals from your heart.
  • Trans-esophageal echocardiogram. This test produces real-time moving images on a monitor, taken from inside your esophagus and stomach.
  • Holter monitor. This device monitors your heart rhythm and records it to a cassette tape.
  • Event recorder. An event recorder is activated during episodes of fibrillation and records the heart rhythm at that time.

How is atrial fibrillation treated?
The goal of treating atrial fibrillation is to slow your heart rate and prevent blood clots from forming, and to correct your heart rhythm. You doctor may recommend:

  • Rate control and anticoagulation. These medications help return the heart to its normal rate and prevent clots from forming. Your doctor may prescribe rate-control medications, such as beta-blockers, calcium channel blockers, and digitalis, as well as anticoagulation medication such as Coumadin.
  • Anti-arrhythmic drug therapy. Anti-arrhythmic drugs restore normal heart rhythm by slowing the movement of the impulse through heart tissue or lengthening the shortest time possible between two connective beats.
  • Cardioversion. Cardioversion restores normal heart rhythm using a brief electric shock through the chest.
  • AV nodal ablation and permanent pacemaker implantation. This treatment destroys the atrioventricular (AV) node, a part of the heart's electrical system through which electrical signals pass from the atria to the ventricles. The electrophysiologist destroys the AV node with a burst of energy, stopping the signals from reaching the ventricles. Following the ablation, your doctor implants a pacemaker to control your heart rhythm.
  • Pulmonary vein isolation. Pulmonary vein ablation uses a burst of energy to destroy the tissue that produces the electrical signals that cause the arrhythmia and create scar tissue around the pulmonary vein, which blocks electrical signals from entering the atrium.



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