Atrial fibrillation is the most common heart rhythm abnormality, and it results in the upper chamber of your heart beating extremely fast, 500, 600 beats a minute. This causes an irregular rapid heartbeat. It's very much of an age related problem. It's rare before 50,by the time you're 80, one in 10 people have Afib. It's also more common if you have other types of heart disease, if you're very obese,sometimes it runs in families. So it's a very commonimportant problem affecting about over five millionadults in the United States.
Diagnosis of atrial fibrillationis by obtaining an EKG, which will document atrial fibrillation. And so this is something thatyour internal medicine doctor may do, maybe picked up incidentally when you're getting a routine checkup, or you may have symptoms. Your heart may be racing. You may feel fatigued, knowthat something's not right, an EKG is obtained, and you're told you haveatrial fibrillation. The first thing you think about with atrial fibrillation is stroke risk. Because one of the mostdevastating complications of atrial fibrillation is having a stroke, which can change your lifeforever or even kill you. So that's the most importantmanagement question. Different patients havedifferent risks of strokes. Some have high risk of stroke. Some have low risk of stroke, but if you have atrial fibrillation, your stroke risk on averageis five fold increased. So there's a number ofdifferent treatments we can do to lower that risk of stroke. And that's the mostimportant treatment strategy. We also think about medications to control the atrial fibrillation or procedures to cauterizethe atrial fibrillation. And there's other medicationsjust to slow it down. So it's a conversation that you'll have to have with your physician if you're diagnosed with this condition. Atrial fibrillation on averageincreases your stroke risk five fold, but some patients are at very high risk ofstroke, maybe 10% per year. In other patients the riskof stroke is extremely low, despite having atrial fibrillation. The risk factors we think about are age, age over 65 diabetes, hypertension, a prior stroke or TIA, coronary disease. Those are the thingsthat we use to decide, is a patient high risk,or is a patient low risk, or are they somewhere in between? If a patient has atrial fibrillation and they have enough risk factors where their stroke risk iswe'll say 2% per year or higher, then we wanna do somethingto lower that risk. We can either use anticoagulantslike Coumadin, warfarin, the old drug that's beenaround for 40 years.
There's also newer anticoagulantswhere you don't have to monitor your blood levels. You don't have to adjust how much salad you have and so forth. We call those NOACs, these new oralanticoagulation medications. And then more recently there'sbeen techniques developed to lower stroke risk withouthaving to take a medication. And this is called appendage occlusion. So out of patients who haveAfib are at high stroke risk and should be on a blood thinner, only about 50% are becausethey have bleeding problems. They may have nosebleeding or GI bleeding, or they may be at risk of falls where they can't be on a blood thinner. And for these patients, the good news is, there's a new approach to lowering stroke risk called occlusion of the left atrial appendage. Now, this is a heart I brought with me and it shows the left atrial appendage, which is a little sock-like wind sock that comes off the left atrium. That's where the clotsform that cause strokes in patients with atrial fibrillation.
So there's a number of techniques to either put a plug inthis little wind sock from the inside, or go fromthe outside under the sternum, the chest bone, and tieit off or go in surgically and put a little clip on that structure. And that is as effective as blood thinners at lowering stroke risk. So it's an important new alternative that we have for all these patients that can't take blood thinners. So as we said, this appendageis where the strokes form. So there's a number ofdifferent techniques to get rid of that appendage. Either you can go in with a minimally invasivesurgical technique through your chest wall and put a little Barbiepin-like device on it, clamp it down and get rid of it that way. Or you can go in with asnare under the chest bone, in a cath lab setting andtie it off, cinch it off, using a percutaneous technique that does not involve surgery. Or the third way is to put a plug in from the inside of the heart, where we go up from the leg, thread this plug into the chamber, and then we just deployit like an umbrella. And that occludes the appendage and lowers the stroke riskback to a more normal level. So deciding which ofthese approaches is right for a given patient is a major decision, and it involves assessinga patient's anatomy.
What is this structure look like? And we have a team at Hopkinsof imaging cardiologists, cardiac surgeons, cardiologists, and we meet together todecide the right approach for the right patient. If someone's had prior chest surgery, then they aren't acandidate for the technique where we go into the chestor under the sternum bone. And for them we would use theplug approach through the leg. If someone can't be on a blood thinner, then we would use oneof the other techniques where we go in through the chest where you don't have tobe on a blood thinner for the first six weeks, which is the case with the umbrella-like devicewe deploy from the inside. So I think the important messages, it's a big question of thesedevices is the right device for a given patient. And that's where we have this team that will review your case andmake a formal recommendation.
John Hopkin - Bing News
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