Ask the Doctors 9/25

Dear Doctor: I’m 65 years old, and I’ve been diagnosed with a-fib, and also atrial flutter. It used to come and go, but now it’s staying with me. I have a patch from an atrial septal defect repair as a child, so ablation may not be an option. If not, can I live with these and still have a good life?

Dear Reader: Your question has taken us into the ever-fascinating realm of electrophysiology. That’s the study of electrical activity throughout the body. This can range from the movement of charged particles at the cellular level to complex and sophisticated systems, such as the one that powers the heart.

A-fib, or atrial fibrillation, and atrial flutter are both forms of atrial tachycardia. That’s when something has gone awry in the electrical system of the heart’s upper chambers, which initiate the heartbeat. Atrial flutter results in a rhythm that’s too fast but remains regular. In a-fib, the heart beats too fast and is also irregular in a way that negatively affects the health of the heart tissue.

When your heart is functioning properly, each beat begins in a cluster of cells in the right atrium known as the sinus node, creating an orderly and efficient heartbeat. In atrial tachycardia, the impulse begins outside the sinus node, which leads to a disorganized and abnormal heartbeat.

Atrial tachycardia can cause a sensation of fluttering in the chest, fatigue, shortness of breath, chest pain and fainting. Prolonged atrial tachycardia can weaken the heart muscle and, in severe cases, may lead to heart failure.

Ablation can be an effective fix for atrial tachycardia. It involves the use of extreme heat – via radio waves – or extreme cold to zap the rogue cells. This creates scar tissue, which blocks the signals telling the heart to behave erratically.

You’ve mentioned a childhood ASD – or atrial septal defect – repair. That’s a procedure closing a hole in the wall between the left and right atria. This type of repair can be needed when the small opening between the two upper chambers of the heart, which is present in all newborns, fails to close soon after birth.

You’re correct that, due to the altered cardiac anatomy after an ASD repair, ablation is often not an option. In that case, the goal is to manage both heart rate and heart rhythm. This typically involves the use of blood pressure medications such as beta blockers or calcium channel blockers, which dilate the blood vessels and also slow the heart rate, and rhythm control medications such as amiodarone. Patients are also often asked to use an anticoagulant to reduce the overall risk of stroke.

With the proper use of these medications, you can live with a-fib and atrial flutter and have a good quality of life. It’s important to make regular visits to your cardiologist and be vigilant about your treatment plan. And, as all should, maintain a healthy weight, don’t smoke, eat a healthful diet and manage stress.

Send your questions to askthedoctors@mednet.ucla.edu.