Are You Living with Unrecognized AFib?

Atrial fibrillation (AFib) is a chaotic rhythm in the heart's top chambers (atria) that can increase your chances of stroke, heart failure, and other heart-related problems. Stay ahead of AFib by getting to know the symptoms and learning more about innovative therapies available through our AFib Center.

“Atrial Fibrillation or AFib happens when "bad electrical wiring" between the heart's chambers interferes with the timing of the heart's contractions,” explains Dr. John D. Harding, a cardiac electrophysiologist (heart rhythm expert) and the director of Doylestown Health’s Electrophysiology lab.
“This irregular heartbeat can cause blood to pool in the heart’s upper chambers (the atria) where it can become stagnant and more likely to clot, increasing your chance of a life-threatening condition, such as a stroke,” says Dr. Harding. AFib can also lead to structural damage, weakening the heart, and poor blood flow. This can lead to fluid buildup in the lungs, making breathing hard.

AFib Symptoms

About 2.7 million people in the United States have AFib, and that number is on the rise. The Centers for Disease Control and Prevention (CDC) predicts that 12.1 million people will be living with the condition by 2030. Unfortunately, many people are not aware that they have AFib. Symptoms include the following:

• Abnormal heart rhythm
• Chest pain or abdominal pain
• Fatigue
• Heart palpitations
• Lightheadedness
• Shortness of breath
• Sometimes, no symptoms

If you experience AFib symptoms, it is vital to seek immediate consultation with a primary healthcare provider who can discuss the symptoms and refer you to a specialist, if needed, recommends Dr. Harding.

Don’t Wait to Treat AFib

The sooner you get your AFib corrected, the easier it is to fix, and the better your outcome. “Treatment goals for AFib include resetting the heart's rhythm, controlling heart rate, and preventing blood clots," says Dr. Harding.

Many people manage their AFib with medication and lifestyle changes. An active, heart-smart lifestyle includes exercising regularly, not smoking, maintaining a healthy weight and blood pressure, lowering cholesterol, and managing diabetes or prediabetes. But, when lifestyle changes are not enough to control your AFib, you have several treatment options starting with cardioversion therapy. Though not a permanent solution for AFib, cardioversion therapy can help restore a normal heart rhythm by sending electric shocks to the heart through electrodes placed on the chest.

Treating with Ablation

Ablation delivers different forms of energy to create scar tissue that isolates the faulty signals causing AFib. Treatments include:

• Cryoablation – A minimally invasive procedure that freezes the heart tissue that is causing the erratic electrical signals. Doylestown Health is a center of excellence for cryoablation
• Radiofrequency ablation – Uses electrical current (heat) to scar tissue in the heart
• Convergent ablation – The electrophysiologist and cardiac surgeon simultaneously operate on the heart through a small chest incision

Dr. Harding and his colleague, electrophysiologist Dr. Robert Sangrigoli, were among the first in the United States to test a new ablation technology in the PULSED AF clinical trial. Pulsed ablation delivers very short-duration (nanoseconds to milliseconds) energy pulses, eliminating only the targeted tissue with essentially no change in temperature, thereby protecting nearby tissue, according to Dr. Sangrigoli.

Protecting Against Blood Clots

A small opening in the heart called the left atrial appendage (LAA) serves no known purpose, but clots tend to form there in people with AFib, which increases their risk of stroke. For people who cannot tolerate blood-thinning medications, LAA closure offers an alternative. Options include:

• WatchmanFLX - A parachute-shaped device implanted into the heart to close the LAA opening in a minimally invasive procedure
• Left atrial appendage (LAA) closure – A procedure to seal the left atrial appendage, where blood clots typically form

Pacing for a Normal Heart Rate

Traditional pacemakers, designed to treat a slow heart rate (bradycardia), are surgically implanted devices about the size of a half dollar. They have wires called leads that run from the pacemaker through a vein into the heart's right ventricle. 

“Conduction system pacing, a more recently described technique, involves implantation of permanent pacing leads along different sites of the cardiac conduction system to help preserve and, in some cases, improve pumping function of the heart,” Dr. Sangrigoli adds.

“Cardiac leads travel from the generator box through a vein to deliver electric pulses of energy to the heart. These wires are usually designed to stay in but need to be extracted in some instances.

When Leads Need to Come Out

“Over time, the body forms scar tissue around the lead, anchoring it firmly to the heart and the vessels. This helps the lead to stay attached to the heart permanently. Leads may need to be taken out for reasons such as infection, malfunction, or a recall. If there is no scar tissue, lead removal is straightforward. However, if scar tissue has formed around the leads, removal becomes difficult and is done with specialized tools in a process called lead extraction.

Lead Extraction

Available only at very highly specialized cardiac centers, Doylestown Hospital has a multidisciplinary team, state-of-the-art equipment, and the facilities needed to perform laser lead extraction. Lead extraction is a minimally invasive procedure that involves disconnecting the wires from the generator and placing specialized laser over the leads to free them from the scar tissue. The laser delivers energy around the lead to cut the scar tissue a few nanometers at a time, allowing for safe removal of the wires. A nanometer is about the length your fingernail grows in one second, according to the National Nanotechnology Initiative.

Leadless Pacing Technology for AFib

Doylestown Health offers groundbreaking, leadless pacemaker options, including the world’s smallest pacemaker, the Medtronic Micra VR. This leadless pacemaker does everything a regular pacemaker does, but it’s one-tenth of the size and can be implanted directly into the heart wall without invasive surgery. The leadless design reduces infection risk and allows people to return to regular activities sooner.

In 2020, the Food and Drug Administration approved the Micra AV, expanding leadless pacing capabilities by adding a sensor that can detect activity in the atrium.

Regional Center for AFib Treatment

Many patients come from outside of the community to the AFib Center at Doylestown Health's Woodall Center for Heart and Vascular Care due to our expertise, experience, and advanced treatment options. Our AFib Center features:

• One of the highest volume ablation centers in the Philadelphia region and the highest for cryoablation
• Success rates better than the national average
• National physician training site for cryoablation
• Excellent outcomes with a repeat procedure rate for paroxysmal AFib patients under 4 percent*
• Involved in groundbreaking research involving new therapies for atrial fibrillation

Learn more

Call our AFib Center at 267.880.DHAF (3423).