Atrial Fibrillation | Baylor Scott & White Heart and Vascular Hospital

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An estimated 2.7 million Americans currently have atrial fibrillation (AFib)

Atrial fibrillation (AFib or AF) is a condition where the electrical impulse that causes the heart to beat at a normal rhythm is overridden by chaotic signals causing it to beat in a disorganized, irregular manner. AFib originates in the atria—the upper part of the heart—and is the most common heart arrhythmia. Millions of Americans currently have this arrhythmia, and the American Heart Association estimates 12 million people will have atrial fibrillation by 2050.

Atrial fibrillation increases a person’s risk of stroke by 4–5 times and can lead to blood clots, heart failure or other heart-related conditions. Baylor Scott & White Heart and Vascular Hospital – Dallas has the expertise to critically manage and alleviate—or in many cases—eliminate AFib in this particular patient population. Our goal is to partner with atrial fibrillation patients to help them overcome the heart arrhythmia’s negative effects and improve their quality of life.

Watch Dr. Jay Franklin give an overview of atrial fibrillation

A physician on the medical staff discusses atrial fibrillation

Atrial fibrillation risk factors

Atrial fibrillation risk factors include:

Age
Sex
Ethnicity
Genetic
Diabetes mellitus
Insuficiencia cardíaca congestiva
Obesidad
Apnea del sueño
Hipertensión

To reduce your atrial fibrillation risk factors, maintaining a heart-healthy lifestyle is the best defense.

Avoid drinking excessive amounts of alcohol or caffeine, quit smoking, exercise regularly, maintain a healthy weight and manage your stress levels to reduce your chance of developing AFib.

A man in a blue T-shirt and a woman in a gray sweatshirt ride bicycles in the park

Possible atrial fibrillation causes

Excessive amounts of alcohol or caffeine
Recent operation
Miocardiopatía
Coronary artery disease (heart disease)
Valvular heart disease
Hipertensión
Congenital heart defect
Chronic obstructive pulmonary disease (COPD, lung disease)
Thyroid disease
Viral infection
Sick sinus syndrome
Wolff-Parkinson-White syndrome (WPW)
Congenital predisposition

Apple Watch detects woman’s atrial fibrillation

Technology has the potential to help us lead a healthier life, and that couldn't be more true for Elizabeth Turner, a North Texas woman who credits her Apple Watch with helping detect a potentially serious heart condition.

Diagnosing atrial fibrillation

Atrial fibrillation is diagnosed by an electrophysiologist using one or more of the following tests:

Echocardiogram

Sound waves are utilized to produce a video image of the heart. This test is used to diagnose various structural abnormalities of the heart for patients with atrial fibrillation (AFib).

Electrocardiogram (ECG or EKG)

An ECG or EKG records the electrical activity of your heart, which is vital information for patients with atrial fibrillation.

Event Recorder

An event recorder is a portable device that typically records the AFib patient’s heartbeat while they experience symptoms and transmits the information to their doctor.

Holter Monitor

A portable device worn by patients under their clothing for continuous monitoring of their heart’s electrical activity. A Holter monitor is typically ordered for 24–72-hour periods.

How to treat atrial fibrillation with medication

In our Dallas heart center, elecrophysiologists use several medications to treat atrial fibrillation, including:

Rate-controlling medications

These are used in an effort to slow the heart rate down to a more normal level. Some examples of drug classes used to control the heart rate for patients with atrial fibrillation (AFib) are beta-blockers, calcium-channel blockers and cardiac glycosides (ex: digoxin).

Rhythm controlling medications

These medications are prescribed to maintain a normal rhythm by preventing atrial fibrillation relapses. Rhythm-controlling medications, or antiarrhythmic drugs, are divided into four different drug classes—Common drugs used to control the rhythm are flecainide (Tambacor), propafenone (Rythmol), amiodarone (Cordarone), dofetilide (Tikosyn), dronedarone (Multaq) and sotalol (Betapace).

Anticoagulation

Patients who experience atrial fibrillation are at high risk of developing a blood clot, and many will require medication to prevent clots from forming. AFib patients may be asked to take blood-thinning medications (anticoagulants), such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto) or edoxaban (Savaysa). AFib patients may also be asked to take medications that inhibit platelet function, like aspirin, clopidogrel (Plavix), ticagrelor (Brilinta) or prasugrel (Effient).

A patient in a red shirt holds an open pill bottle

Atrial fibrillation treatment procedures

CT Scan

A CT scan provides invaluable, detailed information about the heart and renders 3D images that help us treat atrial fibrillation in Dallas.

Cardioversion

Cardioversion is a non-invasive procedure during which an electrical shock is delivered to the heart. Doing so resets the heart and, most times, will restore a normal rhythm. Cardioversion does not cure atrial fibrillation, but is part of a treatment approach in many patients. This procedure is performed under sedation so that the patient doesn't feel or remember anything.

Ablación por radiofrecuencia

Radiofrequency (RF) ablation is a procedure that can cure many types of heart arrhythmias, such as atrial fibrillation. RF uses a low voltage, high-frequency electrical energy in many applications, including electrocautery. The electrophysiologist uses special catheters to deliver the energy to specific locations within the heart to provide curative interventions for AFib.

Cryotherapy ablation (cryo)

Cryotherapy ablation (cryo) provides is a similar procedure to radiofrequency ablation except in the type of energy used. Instead of using RF (heat) energy, cryotherapy uses extremely cold temperatures applied through specialized catheters to alter the cardiac cell’s capacity to conduct electrical impulses. The latest technology for the treatment of paroxysmal AF—the cryoballoon—is an efficient approach in the treatment of AF and is associated with successful ablation and low complication rates. The Baylor Scott & White Heart and Vascular Hospital - Dallas electrophysiology department was the leading research site in the United States for the cryoballoon and performed the first procedure in North Texas.

Convergent hybrid ablation

The convergent procedure is used to treat patients with both early and longstanding persistent atrial fibrillation. The procedure is performed by a cardiac surgeon and electrophysiologist using radiofrequency to block irregular electrical signals by creating scar tissue on the heart. Benefits of the minimally invasive convergent hybrid ablation include:

A shorter hospital stay and faster recovery
Increased reduction in returning atrial fibrillation
A complete ablation on both the inside and outside of the heart
Decreased risk of stroke

Listen to Dr. Dan Enter give an overview of the convergent procedure.

Laser lead extraction

A laser lead extraction is the removal of one or more leads from inside the heart that is connected to the implantable device. A lead may be removed for any of the following reasons:

Damage to the inside or outside of the lead
Large amounts of scar tissue forming at the tip of the lead
An infection at the site of the device and/or lead
Blockage of the vein by a clot or scar tissue

The lead is extracted through the subclavian vein. A laser light is attached to a sheath to serve as a guide to the lead. Once there, the light will break up the scar tissue and the lead will be removed.

Surgical Maze procedure

This procedure is performed in the operating room and requires one or more incisions. During this procedure, the surgeon will apply energy to the outer surface of the heart and pulmonary veins in an effort to eliminate the conduction pathways of AFib. Some patients may be candidates for a minimally invasive approach while others may necessitate surgical treatment here in our Dallas heart center. For more information about the Maze procedure, visit Arrhythmia Surgery.

Left atrial appendage (LAA) occlusion therapy

The left atrial appendage is the main source of blood clots in patients suffering from atrial fibrillation. LAA occlusion is supported by research to significantly reduce a patient's risk of having a stroke. Closure methods include surgical and catheter-based approaches.

One of these approaches is using the Watchman™ device. This quarter-sized device is inserted through a catheter and placed on the left side of the heart permanently sealing the LAA and preventing clots from entering the circulatory system.

A close-up of a hand holding a Watchman device, a type of LAA occlusion therapy used to treat atrial fibrillation

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Atrial Fibrillation (AFib)

Baylor Scott & White Heart & Vascular Hospital – Dallas