Treatment of atrial fibrillation focuses first on controlling the heart rate, and second on using blood thinners where appropriate to reduce the risk of stroke. There are times when restoring normal rhythm may improve outcomes including reducing symptoms. Managing atrial fibrillation requires careful monitoring and appropriate treatment to reduce the risk of serious health issues.

Symptoms of A-fib

In a patient with A-fib, the heart rate is irregular and often faster than normal. In comparison, a normal heart rhythm has a steady and regular heart rate, typically between 60 to 100 beats per minute at rest.

Symptoms of A-fib may include:

1. Irregular heartbeat
2. Heart palpitations
3. Fatigue
4. Dizziness or lightheadedness
5. Shortness of breath
6. Chest pain
7. Weakness
8. Confusion
9. Exercise intolerance
10. Fainting or near-fainting episodes

If you are experiencing any of these symptoms, you should consult a health care provider for proper diagnosis and management. Call 911 if you are experiencing sudden chest pain, weakness, confusion or shortness of breath.

Types of A-fib

1. Paroxysmal atrial fibrillation: This type of A-fib is intermittent and typically resolves on its own within seven days. Episodes may occur occasionally and stop spontaneously.

2. Persistent atrial fibrillation: Persistent A-fib lasts longer than seven days and requires treatment to restore a normal heart rhythm.

3. Long-standing persistent atrial fibrillation: When A-fib continues for over a year, it is classified as long-standing persistent A-fib.

4. Permanent atrial fibrillation: In permanent A-fib, the irregular heartbeat becomes constant, and efforts to restore a normal rhythm have been unsuccessful or deemed unnecessary.

By understanding the different types of A-fib, you and your health care providers can tailor treatment plans to manage your condition effectively.

A-fib blood clot risk

A-fib significantly increases the risk of blood clots forming inside the heart. The irregular and rapid heartbeat in A-fib can cause blood to pool in the atria, which can form blood clots. If a clot dislodges and travels to other parts of the body, it can cause serious health complications, such as stroke or heart attack. Managing your A-fib involves assessing your risk of blood clots and often involves strategies to reduce the risk of blood clots, such as blood-thinning medications, also called anticoagulants.

Living with A-fib

Not unlike an electrician who repairs wiring in your home, a doctor has options when it comes to treating the irregular electrical rhythm of your heart.

According to Kent E. Morris, M.D., electrophysiologist with Norton Heart & Vascular Institute, treatment options for A-fib are not one-size-fits-all and depends on severity of symptoms, associated health conditions, and the impact on quality of life.  A multi-faceted approach tends to work best.

“Risk factor modification is critical for successful treatment of A-fib,” Dr. Morris said. “Maintaining a healthy weight, treating sleep apnea, avoiding excess alcohol intake, and controlling high blood pressure and diabetes can increase the chances of staying in normal rhythm for longer periods of time.”

In addition to addressing risk factors, medications often are the initial treatment. If the medication isn’t effective or if side effects are impacting quality of life, there are other options. Catheter ablation is a minimally invasive technique where a catheter is placed in the heart and used to modify or ablate the abnormal signals that lead to A fib.

“By working together with patients, we can find a solution to living with A-fib,” Dr. Morris said.

A-fib treatment options

There are several common A-fib treatment options available to manage the condition. These include:

1. Medications: Antiarrhythmic drugs can help control the heart’s rate or rhythm, while anticoagulants often are prescribed to reduce the risk of blood clots and stroke.

2. Cardioversion: This procedure involves restoring the heart’s normal rhythm through electrical cardioversion (shock delivered to the chest) or pharmacological cardioversion using medications.

3. Catheter ablation: In cases where medications are ineffective, catheter ablation may be recommended. This minimally invasive procedure creates scarring in the heart to interrupt abnormal signals that trigger A-fib. It is performed using a catheter inserted into a blood vessel in the leg and guided to the heart. The electrophysiologist then carefully destroys malfunctioning tissue creating scar in the problematic areas so they can no longer transmit abnormal signals.

4. Lifestyle changes: Managing A-fib may involve lifestyle modifications such as reducing alcohol and caffeine intake, quitting smoking, maintaining a healthy weight and regular exercise.

5. Surgical Interventions: In certain cases, surgery like the hybrid ablation may be discussed. During hybrid ablation, the heart surgeon treats areas along the outside of the heart, and the electrophysiologist treats inside the heart. This approach can be more effective for patients with more persistent A-fib.

6. Left atrial appendage closure procedure: This procedure might be recommended in certain A fib patients who are not a good long term candidate for blood thinners to reduce the risk of stroke by closing off the left atrial appendage where blood clots commonly form.

If you have A-fib, it is crucial to work closely with your health care providers to determine the most suitable treatment plan, based on your specific condition and medical history.

A-fib vs. atrial flutter

Atrial flutter is a type of abnormal heart rhythm that is closely related to A-fib. Both conditions originate in the atria, the two upper chambers of the heart, and are characterized by irregular heartbeats. While A-fib involves chaotic electrical signals causing the atria to quiver, atrial flutter is characterized by a very rapid but regular beating of the atria.

Patients with atrial flutter are at an increased risk of developing A-fib, and vice versa. Both conditions share some similar risk factors, such as age, high blood pressure, heart disease and obesity. Some treatment options for atrial flutter and A-fib are similar, including some medications, electrical cardioversion, catheter ablation and lifestyle modifications.

Living a fulfilling life with A-fib is possible with the proper treatments and medical support. Making healthy lifestyle choices, following your treatment plan and keeping up with regular visits to your provider can help manage your condition effectively.

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When the fast heart rate begins in the upper heart chambers, it is called supraventricular tachycardia (soop-rah-ven-TRICK’-yoo-lar TAK-ih-KAR-dee-ah), also known as SVT. When it starts in the lower chambers, it’s called ventricular tachycardia or VT.

When the heart is beating too fast, it doesn’t have a chance to fill up with blood between beats. As a result, the heart has a hard time pumping enough blood. The reduced blood flow sends less oxygen out to the body, causing lightheadedness or dizziness, chest pain, weakness or fatigue, and shortness of breath.

“Though the symptoms are similar, the outlook is very different for patients with supraventricular tachycardia and those with ventricular tachycardia,” said Hassan Khan, M.D., Ph.D., an electrophysiologist with the Norton Heart & Vascular Institute Heart Rhythm Center. “SVT is usually not serious. VT, on the other hand, can lead to sudden cardiac death and needs to be monitored closely.”

A rapid heartbeat or pounding heart also can be a sign of a panic attack, which should not be taken lightly and warrants medical attention.

A normal resting heart rate is 60 to 100 beats a minute. With SVT and VT, the heart will beat much faster, often in the range of 170 or more beats per minute. SVT, VT and bradycardia (a slow heartbeat) are forms of cardiac arrhythmia or irregular heartbeat. Atrial fibrillation, another heart rhythm disorder, is a form of supraventricular arrhythmia.

Premature beats, or ectopic beats, may feel like your heart skipped a beat. These typically are not a serious medical condition.

Treatment options for arrhythmias depend on your symptoms and the cause of your heart condition. Options include: lifestyle modification, medications and cardiac ablation to interrupt the errant electrical signals causing the irregular heartbeat or a surgically implanted cardioverter defibrillator to reset your heart if you develop a dangerous ventricular arrhythmia episode.

Supraventricular tachycardia

SVT is rare, with 2 in 1000 people estimated to be affected. In a normal heart rhythm, electrical signals follow a specific pathway through the heart, regulating the heart rate and rhythm. However in SVT, abnormal pathways or circuits can form, causing the heart to beat faster than normal.

SVT can affect children or adults, but many people have their first symptoms between the ages of 25 and 40. SVT can be initiated by stress, drinking large amounts of caffeine or alcohol, certain medications, and hormonal imbalances, such as hyperthyroid disorder. In some cases, the cause is not known.

With SVT, the rapid heart rate can occur daily or only once a year. It can be sporadic. SVT typically lasts for a couple of minutes but can last for several hours.

Symptoms of SVT may be difficult to see in infants and very young children. In addition to a rapid pulse, signs of SVT in infants and very young children include sweating, poor feeding and pale skin.

SVT is usually not serious, but it may require treatment. In rare cases, it can cause you to lose consciousness or go into cardiac arrest.

Ventricular tachycardia

VT can occur in an otherwise healthy heart but is usually more common in abnormal heart muscle tissue, which can be result of other cardiovascular issues. These include coronary artery disease, an enlarged heart or abnormal heart valves.

If you’ve had a heart attack or heart surgery, that can contribute to VT. If you’re older or have a family history of cardiac arrhythmia or sudden death you’re also more likely to develop VT.

VT begins in the heart’s lower two chambers, called ventricles. It can be caused in two ways. VT can happen when an abnormal heart circuit within the ventricular muscle becomes triggered, or it can occur when an abnormal ventricular muscle self-activates.

VT is defined as three or more beats in a row at a rate of more than 100 beats per minute. VT that lasts for only a few seconds may not need to be treated. VT that lasts more than a few seconds at a time can become life-threatening.

VT in a structurally normal heart is not serious if the fast heartbeat stops on its own.

When to call a doctor

Call your health care provider if you experience an abnormal heart rhythm or very fast heartbeat for the first time.

With VT, you should call 911 if you feel lightheaded, have chest pain or experience a sustained rapid heartbeat that lasts 30 seconds or more.

With SVT, you should call 911 if you have an episode of SVT that lasts for more than a few minutes or if you also have chest pain, have trouble breathing or are feeling very faint.

If you think your infant or child has SVT, ask your child’s pediatrician about an SVT screening.

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An abnormal heart rhythm doesn’t always require treatment. However, if the arrhythmia is causing significant symptoms or putting your health at risk, an electrophysiologist can help.

One common way electrophysiologists treat heart rhythm disorders is with a minimally invasive procedure called cardiac ablation or catheter ablation.

“Without having to perform open-heart surgery, electrophysiologists use this minimally invasive technique and tools to address the cause of arrhythmias at their source,” said Kent E. Morris, M.D., electrophysiologist with the Norton Heart & Vascular Institute Heart Rhythm Center. “We thread a tiny tube, or catheter, through a blood vessel and up to the heart, where we apply either heat or cold, depending on the situation, to small areas of heart tissue to block abnormal electrical signals that is causing the arrythmia.”

The heart uses electrical impulses to control the timing of your heartbeats. The tiny scars created by cardiac ablation block the electrical impulse causing the arrhythmia. By blocking these abnormal electrical signals at their source, electrophysiologists can restore a normal heart rhythm.

Catheter ablation can be used to treat a wide range of arrhythmias, including supraventricular tachycardia (SVT), atrial fibrillation (A-fib), atrial flutter, ventricular tachycardia (VT) and premature ventricular contractions (PVCs).

Preparing for cardiac ablation

Before the heart ablation procedure, you will be given medication to sedate you and make you sleepy. These medications are meant to reduce your anxiety and relieve your discomfort.

The cardiac ablation procedure typically takes from one to four hours, but sometimes can take longer. After the procedure you will need to lie still in recovery for several hours to decrease the risk of bleeding.

You may go home the same day or spend the night in the hospital for monitoring. You likely will feel some soreness after the procedure but typically can resume normal activities in a few days.

Other treatments for arrhythmia

Medications also can be used to treat heart arrhythmia.

With tachycardia, an electrophysiologist may prescribe a type of medication called a beta blocker or a calcium channel blocker to slow down your heart and restore a normal rhythm.

For A-fib, quivering or irregular heartbeat, or atrial flutter, a similar heart rhythm disorder, you may receive a blood thinner to prevent blood clots and reduce the risk of stroke, and heart rate-controlling medications such as beta blockers or calcium channel blockers, which both slow the heart rate.

One cause of a fast heart rate is supraventricular tachycardia or SVT, which can cause the heart to beat from 150 to 200 beats a minute. SVT occurs when the fast heart rate begins in the upper chambers.

If you have a known diagnosis of SVT, you may be able to stop this by doing something called a vagal or Valsalva maneuver. You may be able to stop an abnormal heart rhythm simply by coughing, holding your breath and straining, dunking your face in ice water, or putting a cold towel on your face. Patients should only try this technique if they have a known diagnosis of SVT.

A procedure called cardioversion also can restore your normal heart rhythm for atrial fibrillation and also in more arrhythmias including ventricular tachycardia (VT), where a fast heart rate begins in the lower chambers of the heart.

During a cardioversion procedure, an electrophysiologist delivers a shock to your heart through paddles or a patch on your chest. This shock essentially can “reset” the electrical impulse in your heart.

Implantable devices  can also be use to monitor for or correct an arrhythmia.

An implantable loop recorder is a small device the size of a paper clip that can be implanted under the skin on the chest wall to monitor your heart rhythm for evidence of any abnormal rhythm.

A pacemaker can correct a slow heart rhythm. An electrophysiologist typically implants the pacemaker through the vein under the collarbone, with wires running to the heart. If the heart beats too slow or stops, the pacemaker can send a tiny electrical signal to stimulate the heart. There are also newer “leadless” pacemakers that can be implanted through a vein in the leg. These are small devices that sit only inside the heart and do not have any wires attached.

An implantable cardioverter-defibrillator (ICD) is designed to correct a dangerous potentially life threatening fast heart rhythms that originate in the bottom of the heart. Like the pacemaker, it is typically powered by a device implanted near the collarbone. If the ICD detects an abnormal fast rhythm, it sends out a shock to reset the heart’s rhythm to normal to prevent you from dying from the abnormal rhythms.

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“Stretching from Thanksgiving to Christmas and even into the new year, there is about a 5% increase in heart attacks or emergency room visits due to heart-related concerns,” said Abdolreza Agahtehrani, M.D. , cardiologist with Norton Heart & Vascular Institute. “Some studies even show about a 15% increase just between Christmas Day and New Year’s Day.”

Many theories may explain the increase in heart attacks during this “most wonderful time of the year.” Most involve overindulging in rich meals and drinking too much alcohol, emotional stress, and cold temperatures that can put a strain on blood vessels. All of these raise blood pressure and contribute to heart issues.

Dr. Agahtehrani explained that a week or two of celebrations doesn’t equal a case of sudden cardiac arrest. More than likely, heart disease has been developing for a while.

“Most people who experience a heart attack have unknown symptoms, such as diabetes or uncontrolled hypertension [high blood pressure], that have been taking a toll on the cardiovascular system overall,” Dr. Agahtehrani said. “In fact, they may have even experienced a few symptoms and either didn’t realize it or ignored it, therefore putting them at even greater risk.”

“Holiday heart syndrome” is the term sometimes used to describe cardiac arrhythmia — an irregular heartbeat — brought on by binge drinking, often during a weekend or holiday. Research has found that holiday heart syndrome can occur in those who rarely drink, but binge on occasion.

Arrhythmia typically causes minor symptoms, but can lead to heart attack, cardiac arrest and death.

Holiday stress makes matters worse

Although more research is needed to determine exactly how stress factors into heart disease, it is known that when you don’t manage stress, it impacts your heart health. Healthy stress management tools include exercising or talking through the situation.

Unhealthy forms of coping, such as overeating, consuming too much alcohol or internalizing stress, can increase blood pressure and heart rate, putting more stress on the heart muscle.

If you fall into a high-risk category for heart disease, pay extra attention to your body during the holiday season. Many people may have early warning signs of a heart attack, so knowing the symptoms is critical.

Heart attack warning signs

Early signs of a heart attack, or “beginnings,” occur in more than 50% of people who have a heart attack.

• Chest pain or discomfort with heaviness, pressure, aching, burning, fullness or squeezing pain
• Pain or discomfort in one or both arms, left shoulder, neck, back, throat, jaw or stomach
• Shortness of breath
• Sudden fatigue, weakness or lightheadedness
• Nausea or vomiting
• Similar symptoms to indigestion
• Cold sweat or perspiration
• Unexplained anxiety
• Heart palpitations or increased heart rate

If you experience any symptoms, call 911 for emergency medical attention.

Take care of your heart this holiday season

• Pay attention to your mental health. Meditation, deep breathing, a warm bath and getting enough sleep are all great ways to help reduce your holiday stress.
• Eat healthfully. Limit portions and fill your plate with more fruits and vegetables to help reduce fat and salt intake and prevent excess weight gain during the holidays.
• Moderate your alcohol consumption. Binge drinking can increase blood pressure and trigger atrial fibrillation, a common but dangerous heart arrhythmia.
• Fit in exercise. Thirty minutes of exercise each day will help reduce stress and maintain weight. If you are pressed for time, break up exercise into 10-minute increments.
• Don’t smoke. Help is available if you want to quit. If you smoke, make a New Year’s resolution to join Norton Healthcare’s free smoking cessation class.
• Don’t forget to take your medications during the busy holidays.
• If you experience symptoms, be sure to communicate those to your family or friends.
• Get prompt care. Put your heart first and don’t delay care in fear of missing holiday season celebrations.

Hands-Only CPR can save a life

Should someone near you show signs of a heart attack, call 911. Emergency medical services can begin treatment en route to the hospital. Also, know how to save a life by learning Hands-Only CPR.

According to the American Heart Association, immediate CPR can double or triple the chance of survival. Follow these two steps if you see a teen or adult who suddenly collapses and isn’t breathing:

• Call 911.
• Push hard and fast in the center of the chest.

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Call 911 if your blue fingernails are accompanied by any of the following symptoms:

• Shortness of breath or difficulty breathing
• Chest pain
• Sweating
• Dizziness, lightheadedness or fainting

Fingernails are good for scratching itches, but they are also a window into your health. If the skin under your fingernails has a blue or purple tinge, you might need to see a health care provider or a heart specialist.

Why are my nails blue?

The medical term for blue nail beds is cyanosis. Cyanosis can occur when there is not enough oxygen circulating in the bloodstream, or circulation is poor. Oxygenated blood is red, while blood depleted of oxygen has a blue hue.

What causes blue nails?

There are several reasons your nails could be blue, including heart conditions. Sometimes a heart murmur will cause blue nail beds. When a health-care provider listens to your heart and hears a certain swooshing sound, it’s an indication that the blood is flowing through the heart abnormally.

Heart murmurs can be innocent, or harmless. But murmurs also can be an indication of a structural heart condition such as a hole between two or more of the heart’s chambers — atrial septal defect or ventricular septal defect. While this defect is present at birth, patients can grow into middle age with little or no symptoms. Many aren’t even aware they have the condition.

Other causes of heart murmurs include:

• Anemia affecting the thickness of the blood and blood flow
• Carcinoid heart disease, a slow-growing tumor that can affect the heart’s valves
• Endocarditis, an infection that harms heart valves
• A faulty heart valve that isn’t closing all the way or is stiff, allowing blood to flow in the wrong direction
• Hyperthyroidism (an overactive thyroid) resulting in a rapid heartbeat and a murmur
• Hypertrophic cardiomyopathy, which makes your heart muscle thicker and stiffer

Another cause of cyanosis could be cold temperatures that can make blood vessels constrict, resulting in fingers and toes taking on a blue tint.

“This will go away when you warm up,” said Tara U. Mudd, APRN, nurse practitioner with Norton Heart & Vascular Institute. “Numbness and tingling when you’re cold is common, and as long as it stops when you go inside or get warm, it’s not a concern.”

When should I see a doctor?

“If you have blue nails, call your health care provider,” Tara said. “Evaluation may include using a device called a pulse oximeter, which measures the amount of oxygen in your blood. Your provider may use this data to help diagnose the underlying cause of your cyanosis and recommend treatment options.”

If your blue nail beds are caused by a serious heart issue, your physician may refer you to the Norton Heart & Vascular Institute Structural Heart Program, which brings together the talents of cardiothoracic surgeons, interventional cardiologists and imaging cardiologists to one location on the Norton Audubon Hospital campus. With the input and viewpoints of many specialties, each patient gets a customized treatment plan.

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This was the first study to show and measure the real-time relationship between alcohol and A-fib episodes. Other studies have established a link between drinking and developing A-fib and that abstinence could improve symptoms.

The most recent study found that the effect of drinking on A-fib is almost immediate and that the more alcohol consumed the greater the risk of an episode.

“This further confirms what we’ve known about the tie between A-fib and alcohol,” said Tara Mudd, APRN, nurse practitioner with the Atrial Fibrillation Clinic, part of the Norton Heart & Vascular Institute Heart Rhythm Center. “Even those who drink moderately can greatly improve their A-fib symptoms by further limiting or eliminating alcohol from their diet altogether.”

The 100 study participants who had reported consuming one or more drinks per month wore an alcohol sensor on their skin and an electrocardiogram device that continuously monitored their heart. For four weeks, study volunteers would press a button on their device to mark each drink consumed. The individuals also underwent periodic blood testing to help corroborate their self-reported drinking.

A-fib and alcohol can trigger episodes in hours

The study found that the chances of A-fib episode doubled in the four hours following a single drink. Two or more drinks increased the risk by threefold. For every 0.1% increase in blood alcohol over the previous 12 hours, the odds of an A-fib episode increased about 40%.

According to the study’s authors, other factors, including genetics, gender, race/ethnicity and environmental factors also could play a part in how A-fib and alcohol interact.

For those already dealing with A-fib, this highlights the importance of working with your health care provider to assess your risk of more progressive A-fib and devise strategies to help manage the condition.

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“I never expected to hear anything serious from my exam,” Barry said.

His primary care provider, Alice H. Johnson, M.D., an internal medicine specialist at Norton Community Medical Associates – Audubon East LL2, listened through her stethoscope and didn’t like what she heard — atrial fibrillation or A-fib. The upper chambers of Barry’s heart, the atria, were out of sync with the lower chambers, the ventricles.

Dr. Johnson referred Barry to Wayne M. Shugoll, M.D., cardiologist with Norton Heart & Vascular Institute.

“I was shocked. I had no idea there was something major going on,” Barry said. “I had been feeling tired, but I thought that was because I was getting old. Had I not gone to the physical, this probably would not have been detected and I wouldn’t be here today.”

Dr. Shugoll ordered tests and imaging that showed Barry had a bicuspid aortic valve that was causing his A-fib. A valve in Barry’s heart that regulates blood flowing out to his body had two flaps instead of three. It’s a condition he inherited and that often goes undetected until adulthood.

With a bicuspid aortic valve, blood doesn’t move through the heart as easily and actually can flow backward. Sometimes surgery is needed to repair the aortic valve.

READ MORE: Study of atrial fibrillation (A-fib) and alcohol shows chance of an episode increase dramatically within hours of drinking

Dr. Shugoll brought in cardiothoracic surgeon Steven W. Etoch, M.D., a colleague at Norton Heart & Vascular Institute.

Barry also had a large aortic aneurysm. The bulge in his aorta could cause internal bleeding and burst, leading to death.

From an annual checkup to open heart surgery

In November 2019, Barry underwent open heart surgery to contain the bulge in his aorta with a sleeve. Surgeons also etched a maze of scar tissue onto the outside of his heart to interrupt the irregular heart rhythm (the A-fib). That would be enough to address his condition without having to go inside his heart to address the bicuspid aortic valve.

Barry is feeling like his old self again. His wife, Robin, is glad she encouraged Barry to get his annual exam.

“Scheduling an annual visit with your primary care provider allows us to catch issues as quickly as possible,” Dr. Johnson said. “Patients often underestimate the importance of these exams. We want to get ahead of issues. Preventive care is always the goal.”

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Heart specialists at Norton Heart & Vascular Institute were the first in the area to perform a Hybrid A-fib ablation in 2017. Norton Heart & Vascular Institute is also recognized as a top 10 site in the nation for this type of procedure. Since 2017 the Norton Heart & Vascular Team has completed more than 100 Hybrid A-fib procedures.

This hybrid ablation therapy that providers at Norton Heart & Vascular Institute have performed for the past four years encompasses two separate minimally invasive procedures. One procedure is performed by a cardiothoracic surgeon on the outside of the heart and the other by an electrophysiologist on the inside of the heart. By treating the inside and outside of the heart, the Hybrid A-fib therapy targets two key trigger areas or sources for A-fib.

“Ablation inside the heart has been performed in the cardiac catheterization lab to treat A-fib for years. This new procedure also treats the outside of the heart, potentially providing a more effective treatment,” Steven Peterson, M.D., cardiothoracic surgeon, Norton Cardiothoracic Surgery. “The hybrid procedure using this inside/outside approach has been shown to be more effective treating patients with more persistent A-fib than a catheter ablation procedure alone. Our goal with this procedure is to help reduce the burden of A-fib and its impact on quality of life.”

READ MORE: Study of atrial fibrillation (A-fib) and alcohol shows chance of an episode increase dramatically within hours of drinking

For the first part of the hybrid ablation procedure, a cardiothoracic surgeon uses heat generated by radio frequency to create small amounts of scar tissue on the posterior wall outside of the heart a common trigger area of  A-fib.

The second procedure is performed several weeks after the first and is a standard catheter ablation. Heat is applied to the tissue inside the left atrium often including the pulmonary veins, another source of A-fib. By doing both procedures, physicians are able to address these triggers for A-fib from the outside as well as the inside of the heart.

“The American Heart Association estimates there are at least 2.7 million people in the United States with A-fib. Approximately 45% of those patients have long-term, persistent A-fib and have not had many treatment options until the advent of hybrid ablation,” said Kent Morris, M.D., MBA, electrophysiologist and associate director, cardiology, Norton Heart & Vascular Institute. “If not treated, A-fib can lead to an increase in the risk for stroke, heart failure and other symptoms or complications. We’re glad to have this procedure in our arsenal to help treat these patients where previously there were limited options.”

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A-fib is an irregular heart rhythm starting from the atria — the top of the heart — sending out fast, erratic signals that cause the top chambers of the heart to quiver, or fibrillate. It’s the most common heart rhythm abnormality.

“Patients who have A-fib are at a much higher risk of having a stroke, but not everyone’s risk is the same,” said Tara U. Mudd, APRN, nurse practitioner with the Norton Heart & Vascular Institute Atrial Fibrillation Clinic. To determine the level of risk, practitioners at the A-fib clinic use the CHA2DS2-VASc score to determine stroke risk.

The assessment will return a score based on age, gender, medical history and other factors to arrive at a score of zero to nine, with the lowest score meaning you may not need blood thinners.

Having A-fib for a long time or having very fast heart rates for a long time can make the heart weaker. Sometimes a weakened heart is the cause of your A-fib.

“It’s our job to figure out which came first, but we also will use some medications to help prevent heart failure,” Tara said.

Once the risks of stroke and heart failure have been addressed, treatments for A-fib can include medication, catheter ablation, cardioversion or surgery.

READ MORE: Study of atrial fibrillation (A-fib) and alcohol shows chance of an episode increase dramatically within hours of drinking

Medications in the AV nodal blocker family can help get the heart rate down and are the first line of treatment. As a second line of medication treatment, anti-arrhythmic drugs specifically target the A-fib.

The third tier of treatment is ablation — surgical or minimally invasive. It involves cauterizing the abnormal areas of the heart that are causing the Afib.

Cardioversion is a procedure sometimes used in conjunction with medications or ablation. Patients usually go home the same day after cardioversion, which essentially shocks the heart back into normal rhythm.

A newer procedure introduced to the Louisville and Southern Indiana areas by Norton Heart & Vascular Institute is the convergent or hybrid ablation that combines a minimally invasive ablation through a small incision in the chest to cauterize precise spots on the outside of the heart.

“We have a surgeon who is specially trained in this, and all our cardiac electrophysiologists are experienced with the minimally invasive part of the procedure,” Tara said.

“This particular procedure is not for everyone, but there are certain patients who we feel would really benefit, and have benefited from doing this,” she said. “We’ve been doing this procedure at Norton Heart & Vascular Institute since 2017 with lots of patients who are now free from their A-fib or have reduced it enough that it doesn’t bother them anymore.”

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Denny’s first stroke occurred in 2017 during a fishing trip in Alaska.

“I stood up in the boat and I just collapsed; I blacked out,” he said. Fortunately, Denny’s fishing guide knew he needed to get help right away — a feat, given the group was hours from the nearest hospital. The guide called 911 and began rowing the boat to the nearest point where a helicopter could land. A medevac crew met them and took Denny to the nearest hospital, about a 15-minute flight.

“In a vehicle, it would have taken two hours minimum,” Denny said. “I don’t know what the outcome would have been if it had taken that long. Knowing now it was a stroke, time is of the essence.”

In the hospital, Denny received a lifesaving drug called alteplase, or tPA, which dissolves blood clots. It was successful in restoring blood flow to his brain.

“With acute ischemic stroke, sometimes a clot lodges in the brain vessels and blocks life-giving oxygen from flowing,” said Nadeem A. Talpur, M.D., Denny’s neurologist at Norton Neuroscience Institute in Louisville. “Administering tPA can significantly minimize and even reverse the effects of stroke if administered within the first three hours, ideally, of the onset of symptoms.”

Without any lasting side effects from his stroke, Denny flew back to Louisville after a few days in the hospital. But the stroke wasn’t going to keep him from his love of the great outdoors. The day after he returned home, he was out deer hunting.

The second time, his wife was there and knew what to do

Aside from atrial fibrillation (or A-fib), a common heart rhythm issue that can increase the risk for stroke, which Denny took medication for, he was in otherwise good health and led an active life. That’s why his second stroke in May 2019 came as a shock.

“I woke up that morning and didn’t think anything was wrong,” he said. “I started talking to my wife, and she said, ‘You’re not making yourself clear.’ I could talk, but nobody could understand me. At that point, she said we’ve got to get you to the hospital.”

After Denny’s first stroke, his wife, Susan, had educated herself about the signs: face drooping, arm weakness and speech difficulty. Denny went to Norton Brownsboro Hospital, which is prepared to treat the most complex stroke cases and certified as a Comprehensive Stroke Center.

Doctors knew right away that Denny had had a stroke that probably started in his sleep the previous night

“This time Denny had suffered a brain bleed, called a hemorrhagic stroke, for which tPA would not help,” Dr. Talpur said. “Many times, surgery is indicated, but in Denny’s case he was able to recover on his own.”

The bleeding was in the upper left side of Denny’s brain, which affected the right side of his body, especially his right hand. It also affected his ability to swallow. He spent about a week in the hospital followed by inpatient and outpatient rehabilitation.

“This stroke was a whole lot tougher than the first one,” he said. “The thing that bothered me most is I couldn’t communicate.”

Don’t put off getting stroke care

Part of Denny’s recovery included getting a Watchman device, a heart implant that can lower the chance of a blood clot forming due to A-fib.

The Watchman device allowed him to stop taking blood thinners. While he doesn’t have the energy he used to, he confesses, with a grin, to skipping workouts.

For now, Denny is staying safe at home, although he has gotten back to fishing close to home. He worries for those who put off stroke symptoms for fear of catching the coronavirus.

“The most important thing is immediate care. I think if you downplay that, then you’re probably going to be behind the eight ball,” he said. “You may recover and you may not, or you may have all kinds of other side effects.”

Denny continues to make progress with the effects of his stroke — and he knows how lucky he is.

“If my wife wasn’t paying attention to my symptoms and didn’t take me to the hospital as quickly as she did, I don’t know what would have happened,” Denny said. “I probably would have died.”[templatera id=”89477″][vc_video link=”https://www.youtube.com/embed/AOhTA16IrJI” el_class=”col-md-8 offset-md-2″]

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