Sunday, July 27, 2014

What is Atrial Flutter?

Atrial flutter is common heart rhythm problem that may cause the heart to race at very fast rates.  It typically causes fatigue, shortness of breath and other symptoms. Patients often end up seeking urgent medical care because of very fast heart rates and the symptoms it causes.

In many aspects atrial flutter and atrial fibrillation are similar (such as stroke risk, symptoms and risk of congestive heart failure), but they are in fact two distinct rhythm problems. Atrial fibrillation and atrial flutter are commonly seen together, but the treatment for these conditions can be different (specially in terms of catheter ablation).

Atrial Flutter
Atrial flutter: the normal electrical activation of the heart is replaced by
abnormal activity, where the impulse starts rotating around the tricuspid valve

What Causes Atrial flutter?

In patients with atrial flutter the electrical activation of the heart starts rotating around the tricuspid valve – a valve that separates that right upper and lower chamber. This starts what we call reentry, where the electrical activity spins around the valve in a never-ending fashion.

The AV node will regulate how many impulses will go down into the ventricles, and hence, how fast your heart will be. While most patients with atrial flutter have a fast heart beat, it is not unusual for some patients to develop very slow heart rates.

Problems caused by Atrial Flutter

Much like atrial fibrillation, atrial flutter can cause strokes, symptoms and congestive heart failure. Not uncommonly, patients with atrial flutter present with very fast heart rates and prompt treatment to slow down the heart or to restore normal sinus rhythm is very important in order to prevent other problems

Common symptoms of atrial flutter:

  • Palpitations
  • Irregular heart beat
  • Fatigue
  • Shortness of breath
  • Chest pain
  • Dizziness
  • Heart racing
  • Heart fluttering

Treatment for Atrial Flutter

Patients with atrial flutter need to be on some form of therapy to prevent strokes (read section about strokes and the new blood thinners).

Oftentimes prompt care is needed because the heart rate is very fast and needs to be slowed down quickly. IV medications and sometimes cardioversion can be used in these situations.

Atrial flutter commonly recurs after patients are cardioverted back into normal rhythm. Medications to prevent recurrences, called anti-arrhythmics may be used.

Most patients with atrial flutter are better treated with catheter ablation.

Atrial Flutter Ablation

Atrial flutter ablation is the only definitive treatment option for patients with flutter and it has very high cure rates (over 95%), with very low risks. The procedure is commonly done as an outpatient, same day procedure.

IV lines are inserted into the leg veins. We then introduce via those lines catheters that will go into the heart to “map” the arrhythmia. Mapping an arrhythmia means to study and find out what the pathway of the abnormal electrical impulses is.

Ablation of atrial flutter is performed by cauterizing a small area in the heart that is part of the flutter circuit. In other words, the cauterization is performed in an area that the electricity passes through when spinning around the valve. By cauterizing, we create a road block which won’t allow the abnormal circuit to continue and the arrhythmia stops.

Most patients can go home the same day, about 6 hours after the procedure.

In summary, atrial flutter is a condition that can cause some of the same problems seen with afib, such as increased risk of stroke and symptoms. However, flutter is caused by abnormal electrical activity around the tricuspid valve. Although it can be treated with medications, it frequently recurs. Catheter ablation is considered the best option for patients with atrial flutter.

Jose Osorio, MD

Thursday, March 27, 2014

What is Atrial Fibrillation?

Atrial fibrillation or afib, is a common heart rhythm problem that may cause many symptoms, and also increase the risk of having strokes. There are many treatment options available. Educating yourself to help choose the best option for you is very important.

Jose Osorio, MD
Cardiac Electrophysiologist
St Vincent's Hospital
Birmingham, AL

Wednesday, March 5, 2014

How do I do an afib ablation? Presentation for electrophysiology fellows of techniques to minimize radiation and complications

Atrial fibrillation Ablation is a procedure that can significantly improve the quality of life of patients with afib. Traditionally, radiation is used to visualize catheters. Radiation exposure has its own problems and today newer techniques are available to minimize and eliminate it.
This was a presentation for an audience of fellows in training in electrophysiology. The goal was to raise awareness of the dangers of radiation exposure for patients and staff, and teach techniques to minimize it.

Wednesday, February 26, 2014

Atrial FIbrillation - Patient Symposium

ACG and St Vincent's Hospital first Symposium for patients with atrial fibrillation was a success! Many patients had the opportunity to learn about atrial fibrillation and treatment options available today to decrease the risk of stroke and improve quality of life.
If you have missed our symposium you can review our slides below. Stay tuned as we will have many more opportunities in the future

Wednesday, February 19, 2014

Atrial Fibrillation - Community Seminar

Atrial Fibrillation Education Program

Are you or one of you family members one the 3 million Americans who suffer from atrial fibrillation?

We invite you to an educational seminar on atrial fibrillation. 

Tuesday, February 25th 7:00 - 8:00
St Vincent's Birmingham Bruno Conference Center
Please RSVP by calling 205-930-2071

Afib seminar

Monday, January 13, 2014

Afib Ablation

Atrial fibrillation is the most common sustained cardiac arrhythmia. The number of patients with afib continues to grow and many treatment options are available. Patients with afib can be extremely symptomatic or have no symptoms at all. Some patients have few spells a year, while others have many spells a week or are even in afib all the time. These are the factors that will determine what option is the best one for you.

We now know that in the majority of patients afib is triggered by abnormal impulses originating in the pulmonary veins. These impulses will go into the left atrium and trigger the arrhythmia.

Atrial fibrillation is often caused by abnormal electrical activity coming from the pulmonary veins. Afib ablation is a procedure used to block these impulses by ablating either with heat or cold energy. After ablation the abnormal electrical impulses can’t go into the heart and cause afib.
Atrial fibrillation is often caused by abnormal electrical activity coming from the pulmonary veins. Afib ablation is a procedure used to block these impulses by ablating either with heat or cold energy. After ablation the abnormal electrical impulses can’t go into the heart and cause afib.

Patients that are symptomatic with afib can be treated with medications. If drugs fail there are other options, such as atrial fibrillation ablation.

Afib ablation 

Atrial fibrillation ablation is a procedure aimed at eliminating afib triggers. This is accomplished by ablating at the ostium (or the mouth) of the pulmonary veins. The goal is to electrically isolate the veins – while there is still blood flow,  the abnormal electrical signals in the veins can’t go to the heart anymore. In order to achieve that we can either use radiofrequency energy or cold delivered via a balloon (cryoballoon ablation).

RF ablation of the pulmonary veins for afib

Radiofrequency Ablation of the pulmonary veins:

Ablation catheter is positioned at pulmonary vein and ablation is performed by heating the tissue. Ablation is guided by a circular catheter called Lasso

Cryoballoon afib ablation performed by positioning balloon at the pulmonary vein ostium

Cryoballoon ablation of the pulmonary vein:

Cryoballoon positioned at the pulmonary vein and ablation is performed by getting the tissue around the vein down to very cold temperatures.

Afib ablation is the best option for patients that have failed or have not tolerated medications.  Ablation is the only treatment option that could cure afib.

Afib ablation and X-ray Exposure

Afib ablation is typically performed using fluoroscopy (X-ray image) and a 3D mapping system. High exposure to X-ray can be detrimental, and it may even cause cancer or blood disorders. At St Vincent's Hospital we perform afib ablations using minimal or even no fluoroscopy at all. Most procedures at our center use about 30-40 seconds of fluoroscopy, while in most centers in the country over 30 minutes are used for each case.

We have experience in performing procedures using minimal or no fluoroscopy, and over 300 procedures have been performed using this novel technique.

Atrial fibrillation ablation is a great option for patients whose quality of life was affected by afib. 

Jose Osorio, MD
Cardiac Electrophysiologist
St Vincent's Hospital
Birmingham, AL


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