FREQUENTLYASKED QUESTIONS

When discussing with your doctor, you may want to use this document to help guide the conversation

When discussing with your doctor, you can guide the conversation with this document.

When discussing with your doctor, you may want to use this document to help guide the conversation

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To consult with your doctor, you can guide the conversation with this document:

Find here the answer to the most frequently asked questions about atrial fibrillation.


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GETTING TO KNOW ATRIAL FIBRILLATION (AF)


Detecting and measuring atrial fibrillation (AF) can be challenging. Your doctor may use one or more of the following tests to determine if you have atrial fibrillation:

  • Electrocardiogram (ECG)
  • Stress Test
  • Holter Monitor
  • Insertable Cardiac Monitoring System

Electrophysiology is the most common medical specialty that treats heart rhythm diseases such as AF.

When not treated in a timely manner, people with AF are up to five times more likely to have a stroke and a higher chance of developing heart failure1. In addition, due to ineffective heart pumping, AF can cause other heart rhythm problems and chronic fatigue.

1Fuster, et al. Journal of the American College of Cardiology. 2006; 48:854-906

Medications are considered to be the first-line treatment for Atrial Fibrillation (AF). These medications can work very well in many people; however, there are new medical technologies that have the potential to provide patients with different treatment options when the medications are not working.

Atrial fibrillation (AF) can be a serious medical condition that should be treated regardless of the level of symptoms you experience. Without effective treatment, AF can cause strokes, heart failures or other health complications. If your AF does not improve after using antiarrhythmic medications, talk to your doctor about whether a catheter ablation procedure is the next step for you or not.

  • Medication to control heart rate or heart rhythm.
  • “Anticoagulants” (anticoagulation therapy) to prevent blood clots from forming.
  • Cardioversion (electric shock delivered to the heart) while sedated, or with medications, to reset an abnormal heart rhythm back to normal.
  • Catheter Ablation to terminate (ablate) abnormal electrical pathways in the cardiac tissue.
  • Pacemakers and defibrillators (implantable heart devices), to detect and treat early atrial fibrillation and suppress the onset of atrial fibrillation.
  • Minimally invasive surgical ablation (only atrial fibrillation) or open-heart surgery (in combination with others cardiac surgeries) to create lesions that block the abnormal electric circuits causing atrial fibrillation.

IMPLANTABLE DEVICES


When people refer to a pacemaker, they are referring to a pacing system, which includes the pacemaker and leads.

  • A traditional pacemaker is a small device that is implanted under the skin, typically just below the collarbone. The device delivers therapies to treat irregular, interrupted or slow heartbeats.
  • Leads are thin, soft, insulated wires about the size of a spaghetti noodle. The leads carry the electrical impulse from the pacemaker to your heart and relay information about the heart’s natural activity back to your pacemaker.

The procedure to implant a pacemaker does not require open heart surgery, and most people go home within 24 hours. Before the surgery, medication may be given to make you sleepy and comfortable. Generally, the procedure is performed under local anesthesia.

When people refer to an implantable cardioverter defibrillator, they are referring to a system – the defibrillator and the leads.

  • A pulse generator (defibrillator) works like a small computer and continuously monitors the heart and automatically delivers electrical pulses or shocks to correct fast heart rhythms. It is a small device about the size of a matchbox and is usually inserted just under your collarbone.
  • Leads are thin soft insulated wires about the size of a spaghetti noodle. They are placed in your heart through a vein and are connected to the defibrillator. Leads carry the electrical impulse from the defibrillator to your heart and relay information about the heart’s natural activity back to the defibrillator.

If your doctor suggested you need an ICD, you may have experienced or are at risk of abnormal heart rhythms (arrhythmias), known as ventricular tachycardia or ventricular fibrillation. These potentially fatal fast rhythms can cause a Sudden Cardiac Arrest (SCA), which can lead to death if not treated immediately.

An implantable defibrillator is designed to monitor your heart rhythm 24 hours a day. If your heart is beating too fast or irregularly, the device will first send electrical signals to correct your heart rate. If the fast heart rate continues, the defibrillator will deliver a shock to restore your heart to a normal rate. The implantable defibrillator can also be used for slow heart rhythms by sending electrical impulses to the heart to correct it. Your doctor will program the ICD to deliver the most effective therapies for your heart condition.

A defibrillator implant procedure does not require open heart surgery and most people return to their homes in less than 24 hours. Before surgery, you may be given medications to make you feel numb and comfortable. The procedure is usually performed under local anesthesia.

The implant procedure includes the following general steps:

A small incision, approximately 5 to 10cm long, will be made in your upper chest area, just below your collarbone.

One or two leads will be guided through a vein into your heart, and the leads will be connected to the implantable cardioverter defibrillator.

    • A single chamber ICD means you have one lead inserted into the lower right chamber (ventricle) of the heart
    • A dual chamber ICD means that you also have a lead inserted into the upper right chamber (atrium) of the heart

The pulse generator (defibrillator) will be inserted beneath your skin, and the incision in your chest will be closed.

When people refer to a cardiac resynchronization therapy (CRT) device, they are referring to a system – the CRT device and the leads.

A CRT device is a device implanted under the skin, typically just below the collarbone. The device delivers therapies to coordinate the heart’s pumping action and treats fast, irregular or slow heart rhythms depending on the type of CRT device. This device may also be referred to as a heart failure device, a pacemaker for heart failure, biventricular device, three-lead CRT device, CRT-P (pacemaker) or a CRT-D (defibrillator).

Leads are thin, soft insulated wires about the size of a spaghetti noodle. The leads carry the electrical impulse from the CRT device to your heart and relay information about the heart’s activity back to the CRT device.

You can resume most or all activities after recovering from an implant procedure. However, there may be certain activities your doctor will ask you to avoid, like rough contact sports. Be sure to discuss your activity and lifestyle goals with your doctor to find a plan that works best for you.

It is unlikely that the implantable cardioverter device (ICD) will be affected by metal detectors (walk-through archways and hand-held wands) or full body imaging scanners (also called millimeter wave scanners and 3D imaging scanners) such as those found in airports.

To minimize the risk of temporary interference with your ICD while going through the security screening process, do not stop or linger in a walk-through archway; simply walk through the archway at a normal pace. If a hand-held wand is used, ask the security operator not to hold it over your implantable defibrillator and not to wave it back and forth over your ICD. You may also request a hand search as an alternative.

If you have concerns about these security screening methods, show your device identification card, request alternative screening, and then follow the instructions of the security personnel.

While most electromagnetic fields in the home environment rarely affect the operation of an implantable cardioverter defibrillator (ICD), it is recommended you keep items containing magnets at least 15 centimeters (6 inches) away from your implantable device.

CATHETER ABLATION


  • To relieve symptoms and improving quality of life.
  • To avoid blood clots to lower the risk of strokes.
  • To check your heart rate in order to provide enough time for the ventricles (lower chambers of the heart) to fill completely with blood.
  • To restore heart rate to allow atria (upper chambers of the heart) and ventricles to work together more effectively.

There are several reasons your doctor may recommend an ablation procedure:
• Patients with Paroxysmal Atrial Fibrillation (PAF) have better results when treated with Ablation early2
• AF is a progressive disease3. Some patients treated with Ablation had a minor disease progression compared to those who received only medications4

2 Bunch TJ, et al. Increasing time between first diagnosis of atrial fibrillation and catheter ablation adversely affects long-term outcomes. Heart Rhythm. 2013; Sep; 10(9):1257-62.
3 de Vos CB, et al. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol. 2010; Feb 23; 55(8):725-31.
4Jongnarangsin K, et al. Effect of catheter ablation on progression of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2012; Jan; 23(1):9-14.

  • Relieving symptoms and improving quality of life.
  • Avoiding blood clots to lower the risk of strokes.
  • Check your heart rate to provide enough time for the ventricles (lower chambers of the heart) to fill completely with blood.
  • Restore heart rate to allow atria (upper chambers of the heart) and ventricles to work together more effectively.

Cryoballoon ablation and radiofrequency ablation have been shown to treat Paroxysmal Atrial Fibrillation (PAF) effectively, improving the symptoms and quality of life of many patients6. Usually, after AAM, the earlier the PAF is treated by ablation, the greater the success of therapy. Of course, each patient’s experience is different. Sometimes, after the procedure, you will still have an arrhythmia and may need to repeat the procedure. You may also need to continue taking medication. Be sure to check about this and other concerns you may have with your doctor.

6Calkins H, et al. 2017 HRS/EHRA/ECAS/APHRS/ SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. Heart Rhythm. 2017; Oct; 50(1):1-55.

Cryoballoon ablation is often considered a safe and effective treatment for Paroxysmal Atrial Fibrillation (PAF) after the use of antiarrhythmic medications (AAM) 5. It’s a minimally invasive procedure, which means there is no need to open the chest or make big incisions. The most common problem is local irritation or bleeding at the incision site. The risk of more serious complications is low, but you must talk to your doctor to see if the procedure is right for your case.

5 Packer DL, et al. STOP AF Cryoablation Investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013; Apr 23; 61(16):1713-23. 13 Calkins H, et al. 2017 HRS/EHRA/

Your doctor may order some routine tests such as electrocardiograms (ECG), x-rays, blood tests, and transesophageal echocardiogram on the day of the procedure, if you didn’t have them in advance. In most cases, you’ll be asked not to eat or drink anything after midnight before the procedure.

Your doctor will recommend that you continue or stop any medications you are taking. Be sure to notify your doctor if there are any changes in your health before the procedure.

An Electrophysiologist (EP) is a heart doctor who specializes in heart rhythms and performs catheter ablation procedures. You’ll receive fluids and any necessary medication through an intravenous (IV) line inserted in your arm. You may either be anesthetized -or sedated for the procedure.

A local anesthetic will be applied to the site where the ablation catheters will be inserted. In most cases, the major blood vessel in your groin is used for catheter insertion (catheterization). Blood vessels in your arm, chest, or neck area may also be used for catheterization.

The Electrophysiologist will carefully maneuver the catheter through the blood vessel to the left atrium. The catheter in the left atrium is used to map the abnormal electrical pathways in the heart tissue. When the targeted area is located, the distal end of the catheter delivers cryo or radiofrequency energy to isolate the abnormal electrical pathway causing the atrial fibrillation.

When the procedure is completed, the catheters are removed, and pressure is applied to the catheter insertion site to prevent bleeding.

In most cases, you will stay overnight for monitoring. You may feel some soreness in the chest or bruising or pain at the insertion site. When you return home, you may need to limit your activity for a couple of days, but most people return to their usual routines quickly. Your doctor will talk to you about activities to avoid during recovery.

When discussing with your doctor, you may want to use this document to help guide the conversation

When discussing with your doctor, you may want to use this document to help guide the conversation

Take care of your heartbeat is an educational initiative designed to inform people about heart rhythm disorders. It is brought to you by Medtronic.
Information on this site does not constitute medical advice.
Always consult with your physician about treatment options and if you have any questions or concerns about your health.

Last updated March 2021

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    TERMS AND CONDITIONS

    Information on this site does not constitute medical advice. Ask your doctor about diagnosis and treatment information.