Caffeine: You’re probably well aware that coffee can cause erratic or rapid heartbeats. It can also lead to atrial fibrillation in susceptible people. Some feel palpitations when they consume caffeinated soda, tea, or chocolate.

Overeating: For some individuals over-indulging at the buffet table may cause symptoms. Why? A full stomach can irritate nearby nerves, stimulating the heart and triggering extra heartbeats.

Red Wine: Small amounts of alcohol, particularly red wine, can benefit the heart. In excess, however, alcohol may cause heart arrhythmias and “holiday heart,” or palpitations on Monday after a weekend binge.

Supplements: It’s impossible to say which dietary supplements can potentially affect the heartbeat (or interfere with heart medicines) because most are unregulated and untested. “Natural” does not mean “safe,” and consumers can unknowingly take products that contain hidden and potentially harmful ingredients. Diet pills can be especially dangerous. For example, the FDA warned last October that 20 brands of dietary supplements for weight loss were tainted with sibutramine—the active ingredient in prescription weight-loss drug Meridia that was linked to elevated blood pressure, heart rhythm problems, heart attacks, and stroke and removed from the U.S. market in 2010.

Common Causes of Irregular Heart Rhythms The Saturday Evening Post

According to the Mayo Clinic, more than five million Americans live with atrial fibrillation, a condition that occurs when errant electric signals cause the upper part of the heart (the atria) to beat much faster than the rest of it. While some patients experience no symptoms, others describe AF as skipped heartbeats—or even like a “fish flopping” in the chest. Still others feel over-tired, dizzy, or chest discomfort. (See AF Symptoms, below.)

The first line of treatment, drugs help restore a normal beat and reduce the risk of clots that can potentially form as blood swirls chaotically throughout the heart. When pills don’t work, cardiac ablation to short circuit irregular heartbeats offers a long-term solution.

“In general, most AF patients are eligible for cardiac ablation,” says leading heart rhythm expert and Post contributor Douglas Zipes, M.D. “Heart rhythm experts generally prefer patients to have tried and failed at least one antiarrhythmic drug, but that is not mandatory. If ablation appeals to a patient, patients should discuss their risk and potential benefit with the doctor.”

During conventional ablation therapy, surgeons use x-ray images to thread a flexible yet firm tube through the blood vessels into the upper heart chambers. Once there, they send energy via the catheter to zap errant signals at the source and in the process potentially stop atrial fibrillation. However, there are limitations to the revolutionary procedure.

“Traditional ablations utilize a catheter with a certain degree of stiffness,” explains cardiologist Rodney Horton who is affiliated with Texas Cardiac Arrhythmia and UT Southwestern Medical School. “Obviously the stiffness provides a bit more control as the catheter is advanced around the heart. However, a stiffer catheter is more likely than a softer one to cause mechanical injury to the blood vessels and heart.  As a result, there are limits to where a firm catheter can be guided easily and safely.”

The Stereotaxis Remote Navigation System is designed to overcome these problems. Stereotactic procedures use 3-D, GPS-like technology to locate small targets inside the body—in this case, specific areas of the heart known to generate abnormal heartbeats.

The advanced system presently in use at 140-plus medical centers and FDA approved to treat patients with cardiac arrhythmias comprises of: 1) a catheter equipped with a magnetically sensitive tip; and 2) two magnets that pivot on either side of the patient table. Using sophisticated computer-guided technology, physicians direct the catheter to the targeted area.

“With Stereotaxis, we no longer depend on stiffness to get the catheter tip to a certain location,” says Dr. Horton, “Instead, physicians utilize the magnetic field across the patient’s chest to pull a flimsy catheter into the desired, precise location with a lower risk of complications—and less x-ray exposure.”

Image Courtesy of Fr. Bill Diltzer.

In 2008, Fr. Bill Diltzer became one of the first heart patients in Wisconsin to benefit from advances in cardiac ablation technology for heart rhythm disorders. Despite a family history of heart disease (“Everyone on my mother’s side dies of a heart attack or stroke between age 55 and 65,” says the pastor, now in his 60s,) Fr. Bill was initially unconvinced when a routine EKG discovered atrial fibrillation (AF). “I said, ‘that tracing can’t be mine! It’s all over the place,’ but the specialist assured me that it was,” he recalls. “Looking back, my health was deteriorating for quite some time. But I had no specific symptoms of AF, and any earlier episodes were overlooked.”

After an initial course of medicines, Fr. Bill’s heart rhythm expert recommended cardiac ablation using the Stereotaxis Magnetic Navigation System.  He agreed. And it’s a decision for which he is very grateful.

“I was told that either the procedure will work, or my life will be very short,” he says. “My doctor expected tremendous results, but my experience still astounds her. My recovery was longer than anticipated. But within one year I was walking close to 2 miles a day. Now I walk 3 miles a day and don’t think anything of it.”

No one can say whether Fr. Bill’s arrhythmia is gone for good. Outcomes of ablation therapy improve symptoms in 83 to 87 percent of AF patients but remain “tantalizingly unpredictable” in those with persistent or longstanding symptoms, according to a 2011 British single-center study that followed 100 patients for three years after an initial ablation.

“My ablation has held perfectly for 3 ½ years now,” the pastor reports enthusiastically. “They say we may need to do something else later. But if they can control my AF for the next 40 years, I’m fine with that!”

Putting the Brakes on Atrial Fibrillation The Saturday Evening Post

“If you feel your heart consistently skip a beat over time, or experience chest pains, palpitations, dizziness, or fainting, you may have an abnormal heart rhythm linked to atrial fibrillation and should seek medical help,” advises Dr. Bruce L. Wilkoff, President of the Heart Rhythm Society (HRS).

Atrial Fibrillation. Image courtesy of the Heart Rhythm Society

Causes of AF

Reversible triggers: Overactive thyroid, heart attack, recent cardiac surgery, smoking, and sleep apnea. Additionally, a weekend of excess alcohol consumption can set off transient AF, or “holiday heart.”

Other risk factors: Diabetes, high blood pressure, obesity, and being over 60.

One in four cases occurs with no known cause.

Why AF is Serious
Left untreated, AF carries an increased long-term risk of stroke and heart failure, especially in women.

Treatments for AF
Prescription medicines such as beta blockers to control the heart rate.

Anticoagulants such as warfarin (Coumadin) or dabigatran (Pradaxa) to stave off stroke.

Success rates of ablation, or burning specific areas of the heart responsible for the arrhythmia, depend on the type of AF, the patient’s overall health, and the physician’s expertise.

Atrial Fibrillation The Saturday Evening Post

A: The Maze procedure is open heart surgery to eliminate rapid heartbeats. It involves making a series of incisions in the top portion of the heart, the atria. In experienced hands, the procedure is successful in more than 90 percent of patients. A far less invasive option, ablation, utilizes heart catheterization for the same purpose. While its success rates are somewhat lower (60 percent to 75 percent), catheter ablation is often recommended unless the patient is scheduled for surgery to bypass a clogged vessel or correct a valve during which the Maze procedure can also be performed.
To find an expert near you, visit hrsonline.org.

Surgery Corrects Heart Rhythm The Saturday Evening Post

AF occurs when the heart’s two upper chambers (the atria) quiver instead of beating effectively. In paroxysmal AF, the abnormal heart rhythm starts and stops on its own.

When drugs to control erratic heartbeats don’t work, doctors may use electric shock or thread catheters through blood vessels to zap cardiac cells with heat, a therapy called radiofrequency ablation.

The innovative therapy reported at the American College of Cardiology (ACC) 2010 Scientific Sessions utilizes freezing technology, or cryoablation, instead.

“Cryoablation could offer a straightforward and significantly simplified treatment for patients with very symptomatic and obnoxious atrial fibrillation,” says Dr. Douglas Packer, professor of Medicine at the Mayo Clinic in Rochester, Minnesota, and principal investigator of the Stop AF (Sustained Treatment of Paroxysmal Atrial Fibrillation) study.

In the pivotal trial, the Arctic Front Cardiac CryoAblation Catheter System from Medtronic kept nearly 70 percent of AF sufferers symptom-free for one year, compared to 7.3 percent of those given the usual drug therapy.

“There are 150,000 to 200,000 new cases of AF in the U.S. every year, Dr. Packer explained to Post editors. “Some will be asymptomatic and treated with blood thinners to prevent strokes. Others might be treated with anti-arrhythmic drugs. But the target population for ablation is people who don’t respond to drug therapy—and there are a lot of them.”

To date, more than 9,000 patients have been treated worldwide with the Arctic Front Cryocatheter. The treatment is not yet approved in the U.S., however.

“Seeking FDA approval for the system is the next step,” says Dr. Packer. “Data from Europe support the approach, but the FDA requires a large U.S. trial to demonstrate the device’s effectiveness and safety,” he explains. “This is the hallmark clinical trial in the U.S.”

Other ACC News on Atrial Fibrillation

Ablation therapy: Dr. Packer also reports that the CABANA pilot study of 60 patients with persistent or long-standing AF and underlying cardiovascular disease found that catheter ablation more effectively prevented recurrent AF than drug therapy. But the NIH-funded study is just getting started.

“The 4 to 5 year Cabana trial will consider longer-term issues of ablation: Does it reduce mortality, does it prevent strokes, and how much does it cost,” notes Packer.

Drug therapy: Analysis of pooled data from the EURIDIS and ADONIS trials suggest that it’s safe for doctors to prescribe dronedarone (brand name: Multaq) for their patients with atrial fibrillation within two days after discontinuing treatment with the drug amiodarone (brand name: Cordarone).

“Many doctors want to switch their AF patients from amiodarone to dronedarone,” says Dr. Peter Kowey, lead investigator and chief of the division of cardiovascular diseases at the Main Line Health System in Wynnewood, Pennsylvania. “These data will give some guidance until a randomized trial is completed.”

Atrial Fibrillation The Saturday Evening Post

Balancing the Benefits: Drug therapies for Atrial Fibrillation and Depression The Saturday Evening Post

I am not certain about what is causing your symptoms. My first thought is that patients with heart failure are often more short of breath lying down than sitting or standing. A check by your cardiologist would resolve that issue. I assume that by “heart flutter” you mean atrial flutter, not just a fluttering feeling in your chest. If you had successful ablation of the AV node, then the atria (top portion of your heart) should not be conducting to the ventricles (bottom chambers), whether you have atrial fibrillation or atrial flutter. If there is conduction, then the atrial flutter can be ablated also. If my comments do not answer your questions, find out more about your condition from your doctor and write in again.

Ablation Helps Flutter, Too The Saturday Evening Post

Ablation procedures are usually catheter approaches designed to eliminate tissue in the heart responsible for causing, or contributing to, an arrhythmia—in your case, atrial fibrillation. This is commonly achieved with radio-frequency-produced burns and sometimes by freezing, delivered over the catheter tip. At times the first ablation procedure doesn’t destroy all the necessary tissue, and the arrhythmia recurs. Other times, the tissue appears dead during the first procedure but recovers over time to cause the arrhythmia again.

Whichever, a second ablation attempt is often successful. We perform such procedures in octogenarian patients, but it depends on how “young” the 80-year-old is. Your own doctor is in the best position to make that judgment call. Without question it would be nice for you to be able to stop your medications. That is why ablation procedures have become so popular. In fact, electrophysiologists are among the very few physicians in cardiovascular medicine who can produce an actual cure of a problem. However, there are some risks, particularly in the elderly and with second procedures, which is why your doctor is being cautious. I would suggest you and your doctor discuss the pros and cons and come to a decision with which you are both happy.

Second Ablations Often Succeed The Saturday Evening Post

It sounds like you underwent an electrical cardioversion (a shock to the heart delivered through patches on the chest, or done with drugs) for atrial fibrillation, and your heart is now in a regular (sinus) rhythm. If that is not the case, or your heart is no longer in a sinus rhythm, perhaps the cardioversion needs to be repeated. Many heart murmurs are “functional,” that is, noises caused by swirling blood, and are unimportant. Also, some heart defects that cause a murmur at birth correct themselves over time. Regardless, you are now seventy-six, so it is possible that the heart murmur heard at birth is related to your present problem. A careful physical examination or echocardiogram would tell.

Swelling of the legs and knees is usually due to fluid that escapes from the blood vessels and leaks into the tissue, making them “puff up.” The most common causes of the edema you describe include heart problems such as heart failure, kidney troubles, and local leg problems such as phlebitis, or stasis—that is, legs in a dependent position (such as when you are sitting down) for prolonged time periods. The latter is common in older women who have had children. If the edema is due to stasis, the fluid is usually noticeably less in the morning after being recumbent during sleep. Sitting with your legs elevated on a hassock or something similar, and the use of elastic support hose available in most drugstores, can be helpful. If that doesn’t work, a mild diuretic can be tried. However, if the swelling is due to heart or kidney disease (atrial fibrillation can cause heart failure that can cause edema), you need to see your doctor and get professional advice from a specialist.

Leg Swelling The Saturday Evening Post

Coumadin (trade name warfarin) “thins” the blood by interfering with its normal clotting processes. This action is important in patients who have a condition that may predispose to the development of blood clots, such as some forms of phlebitis, a heart-rhythm problem called atrial fibrillation, foreign bodies in the bloodstream such as artificial heart valves, and a host of other conditions. In these patients, Coumadin can prevent blood clots from forming, and thus prevent dangerous complications such as strokes. The degree to which Coumadin is affecting clotting is monitored by a blood test called INR (international normalized ratio), generally checked monthly. Changes in the dose of Coumadin, diet, and the action of other drugs that can affect the metabolism of Coumadin can reduce or augment its actions.

When you say your blood was “dangerously thin,” it sounds like something enhanced the effects of Coumadin and your blood became excessively anticoagulated. Think back to whether you added a new medication, changed doses, altered your diet, or did something else that might have affected the Coumadin. Go over this with your doctor because it is important to prevent excessive anticoagulation from happening again. It sounds like you did not have a permanent complication, but that can happen if your blood gets too thin, and such a bleeding complication needs to be avoided.

Aspirin (Bufferin is just a trade name for aspirin) also affects the normal clotting process but by a different mechanism. Aspirin interferes with the ability of platelets to clump together to form clots. Sometimes aspirin and Coumadin are taken together, but that can increase the chance of bleeding.

Thinning Blood and Coumadin The Saturday Evening Post

A: Leading cardiologist Dr. Douglas Zipes replies: Premature ventricular contractions are extra heartbeats coming from the bottom chambers of the heart (ventricles). In the vast majority of people, these beats are completely benign and nothing to fear. They are the commonest cause of palpitations affecting all age groups, and generally increase in number as one ages. I spend a lot of time in my practice reassuring patients that the palpitations they are feeling are nothing to worry about. Be happy you don’t sense them, because they can be a nuisance. I feel them occasionally, focus on what I am doing, and forget about them.

Question (and Answer) About Extra Heartbeats The Saturday Evening Post