5 things we now know about atrial fibrillation
More than 37.5 million people worldwide are affected by this common type of heart arrhythmia—and by 2050, the number of cases will increase by 60%. For American Heart Month, learn the facts behind this heart condition, plus one patient’s diagnosis story.
After eating lunch one day in 2019, Kathy Foster noticed her heart rate “started going crazy.” She initially brushed it off and thought, “Maybe I had too much caffeine.”
She’d never experienced anything like it, though. “It was pretty significant,” says the 55-year-old, and she considered pulling over on her drive back to work. “But while it wasn’t getting better, it also wasn’t getting worse, and I thought I could manage through it and get back to my office.”
But then her Apple Watch alerted her that her heart rate was high. “I knew something was up. It was a scary feeling.”
Foster made an appointment with her doctor immediately and was diagnosed with atrial fibrillation (AFib), a type of cardiac arrhythmia—that is, an abnormal heart rhythm—that occurs in the upper chambers of the heart, known as the atria.
AFib is the most common type of cardiac arrhythmia and is a progressive disease; if left untreated, it worsens over time. When your heart beats irregularly, blood can’t move through the body as effectively. This can lead to a host of problems, like blood clots, stroke or heart failure.
While Foster was at genetic risk for AFib (her dad had the heart condition) and she previously had deep vein thrombosis, a type of blood clot, after having surgery, the diagnosis was still shocking, since she always tested normal on EKGs and saw a cardiologist regularly.
Across the globe, more and more people are developing AFib, so much so that it’s considered an epidemic in the making. Today, more than 37.5 million people worldwide are affected by AFib, and about one in four adults over 40 are at risk of developing the condition at some point in their lives. By 2050, it’s predicted that AFib cases will increase by more than 60%.
That’s why innovation in AFib treatment and diagnostics is more important than ever. Among the newest AFib innovations, developed by Biosense Webster, a Johnson & Johnson MedTech company, are diagnostic catheters that help doctors see inside the heart and ablation catheters, which help doctors treat arrhythmia and restore the heart to a normal rhythm.
Continued advancements help physicians deliver safer, more effective procedures than in the past. This keeps AFib from progressing and ensures that people like Foster can enjoy a healthy quality of life. For American Heart Month, here are five things to know about the disease, plus high-tech advances aimed at changing how AFib is diagnosed and treated.
Many people don’t realize they have AFib.
AFib symptoms may vary depending on the person, says Michael Porter, M.D., an electrophysiologist with Heart Care Centers of Illinois, who is affiliated with Biosense Webster.
The most common symptom of AFib is heart palpitations, sometimes described as skipped heartbeats, butterflies in the chest, a pounding sensation, chest pain and a racing heart. Other symptoms include fatigue, shortness of breath, dizziness and anxiety.
Yet 15% to 30% of people with AFib don’t feel any symptoms at all.
“AFib can fly under the medical radar,” says Brett Gidney, M.D., an electrophysiologist at the University of California, Los Angeles Health, who is affiliated with Biosense Webster. Often, people don’t know they have the condition until they see their doctor about another problem, such as experiencing a stroke.
Women are more likely to experience vague symptoms like fatigue, weakness and anxiety when they have AFib, which may make it tricky to notice that something is wrong. And, Dr. Porter has found, some patients may write off their symptoms as stress-related and might not seek treatment right away.
Any heart rate fluctuations, shortness of breath or fatigue that comes out of nowhere are warning signs that shouldn’t be ignored, Dr. Gidney explains. If you have any of these symptoms or have risk factors for AFib, it’s a good idea to get screened, and always stay up-to-date on your routine physicals.
There are three types of AFib.
Not all cases of AFib are the same: Irregular heartbeats associated with the disease can occur at different frequencies and last for varied lengths of time. Some people only experience abnormal heart rhythms sporadically, Dr. Porter notes, while others experience them every day.
Paroxysmal AFib refers to brief events that might come and go with or without symptoms. The events usually stop within 24 hours but may last up to a week. In some cases, the symptoms may go away on their own, but others may need treatment for paroxysmal AFib, including cardioversion, beta blockers and other medications.
When irregular heart rhythms last for more than a week, the condition is known as persistent AFib. If the heart rhythms don’t return to normal on their own, patients may need medication or catheter ablation (this procedure involves threading a catheter through a patient’s leg up to the heart and cauterizing the tissue in the heart that’s causing the AFib).
If a patient is experiencing abnormal heart rhythms that last more than a year without getting better, then they might have long-term persistent AFib. The condition is considered permanent AFib when irregular heart rhythms don’t improve, even after taking medication or getting a catheter ablation. Some treatments and lifestyle changes may slow symptoms and help patients manage the condition.
There are many risk factors for AFib.
Anyone can get AFib, but the risk increases after the age of 65. People are also at a greater risk if they have a family member diagnosed with AFib. In addition to age and genetics, certain lifestyle factors like drinking alcohol excessively, smoking and stress may also up the odds, says Dr. Gidney.
People with existing medical conditions, such as high blood pressure, sleep apnea, diabetes, obesity and coronary disease are also more likely to get AFib, since these health conditions may affect the structure of the heart and its functioning, making irregular heartbeats more likely. The good news is that “if you work to treat those underlying problems, a lot of times it reduces the risk for AFib or improves AFib symptoms,” Dr. Porter says.
Perhaps surprisingly, many elite athletes who participate in endurance sports, like running and cycling, are also at a higher risk for AFib. “We see people in their 20s who are incredibly fit with AFib,” Dr. Gidney says. While these athletes might have genetic risk factors, intense, prolonged exercise can change the structure of their heart and make some chambers larger. That structural change can put more demand on the heart and raise their risk of AFib.
And some people who get AFib and have no risk factors, says Dr. Porter.
In certain cases, it’s possible to prevent AFib by adopting heart-healthy habits, including maintaining a healthy weight, lowering your blood pressure, limiting alcohol, quitting smoking, reducing stress and getting treated for sleep apnea.
If not treated—or not treated properly—AFib can lead to serious health consequences.
When AFib isn’t treated, it can get worse.
“AFib is a progressive problem,” explains Dr. Porter. Prolonged AFib can damage the structure of the heart and lead to blood clots in the heart, putting patients at a five times higher risk for stroke and heart failure.
AFib may also affect quality of life; the symptoms of fatigue, shortness of breath and limited physical ability may affect individuals carrying out their daily responsibilities and other tasks, such as exercising or caring for loved ones.
After her AFib diagnosis, Foster tried multiple medications for about 10 months, but none of them helped her manage her symptoms. She says her normal heart rate is about 60 beats per minute, but it would jump to 150 to 200 from one beat to the next.
Sometimes her heart would race during the night while she was sleeping and would wake her up. Foster remembers having to sit at an important work meeting for hours while “my heart was pumping out of my chest.”
AFib consumed her thoughts and everything she did. “I never knew when it was going to happen,” Foster says of dealing with the daily heart rhythm fluctuations. “It would stop me in my tracks.”
Innovation in AFib treatment and diagnostics is more important than ever.
With 5 million new AFib cases diagnosed each year and the disease’s progressive nature, innovation in diagnosing and treating AFib patients is crucial.
The first step during a catheter ablation procedure? Identifying the areas of the heart that are beating irregularly. Doctors do this by inserting a catheter into the heart, which sweeps through the organ to find the locations that need treatment—a process that requires extreme precision. A diagnostic catheter from Johnson & Johnson MedTech is helping doctors perform this task more efficiently and effectively.
The Octaray™ Mapping Catheter with Trueref™ Technology features more mapping electrodes than most other catheters, as well as reduced electrode size and tight electrode spacing. This enables physicians to map arrhythmias in any chamber of the heart more quickly and with more precise information—all leading to greater accuracy.
“We can effectively use this catheter in areas where, previously, we were guessing in terms of how much tissue to get rid of,” Dr. Gidney says.
Another diagnostic catheter, the Optrell™ Mapping Catheter with Trueref™ Technology, features small electrodes that map complex cardiac arrhythmia cases like AFib. This catheter may help clinicians better understand complex cases to quickly identify areas that need treatment with ablation.
Once an arrhythmia is mapped, physicians often turn to ablation to treat it. This involves inserting a catheter into blood vessels to the heart and using targeted areas of radiofrequency to generate intense heat. This creates scars, which block abnormal electrical impulses and restore regular heartbeats.
The size of the tip of a pencil eraser, the Qdot Micro™ Catheter was designed to deliver high-power, temperature-controlled ablation in a short amount of time, allowing for more efficient ablation. In one study, 86% patients treated with the Qdot Micro Catheter didn’t see their symptoms recur for 12 months—an improvement over other previous Biosense Webster catheters.
Currently in clinical development is the new Pulsed Field Ablation (PFA) technology, which is designed to treat recurrent paroxysmal AFib. The PFA uses a controlled electric field to ablate cardiac tissue, which can potentially reduce the risk of damage to the esophagus, veins and nerves pertinent to other ablation catheters.
Innovations in AFib diagnosis and treatment help reduce procedure times and patient risks, says Dr. Porter. Patients don’t need as much anesthesia, see less radiation exposure and often return to their daily routines the following day.
“It’s very gratifying to be able to give people their lives back,” says Dr. Porter.
It’s something Foster can relate to.
After several months of taking medication and still experiencing symptoms, in February 2020 Foster’s cardiologist referred her to an electrophysiologist, who recommended catheter ablation.
“The idea of having a heart procedure was scary, but the reality is that it’s life-changing,” says Foster. “My AFib was gone after I had the ablation procedure.”
While she still visits her electrophysiologist once a year for a checkup, Foster says she hasn’t felt symptoms in the three years since the procedure. “It’s as if I never had it.”