For most people, a fast-beating heart is a sign of excitement, exercise or anticipation. For approximately five million adults in the United States, however, it is a symptom of Atrial Fibrillation, or AFib. AFib is a serious medical condition. It's a major cause of stroke, congestive heart failure, heart attacks and hospitalizations.
"AFib is an abnormal heart rhythm that causes the heart to beat fast and chaotically, and at times even slow down and stop," explains Glenn Brammer, MD, a cardiologist at Augusta Health Cardiology and an expert in cardiac electrophysiology. "Our heart has four chambers. The top two are called the atria and the bottom two chambers are the ventricles. In a normal rhythm, all four chambers work together in a series with each other to achieve and maintain peak pumping function of the heart. In AFib, the electrical signals that drive the heart to beat become so disorganized that the heart's four chambers no longer work together. This decreases the heart's pumping performance and function. It's this decrease in function that produces the symptoms of atrial fibrillation."
Those symptoms range from fluttering and palpitations to dizziness, shortness of breath, chest pain and fatigue. Not everyone experiences these symptoms, though. Some patients have no idea that they are in AFib until it is found while being evaluated for other conditions. But whether symptomatic or not, AFib can have major impact on life expectancy and life quality.
Keith Cooper, a retired project manager for the federal government who lives in Stuarts Draft with his wife JoAnn, was one of those patients who did not realize he was in AFib. He did realize he had heart disease because he had a massive heart attack.
"I experienced a 'widow-maker' heart attack on November 2, 2010. I'm told only 10% of people with this major type of heart attack survive. I didn't have the classic symptoms of chest pain, but both my arms ached really bad. We called EMS, and I even walked to the ambulance. But on the way to Augusta Health, everything stopped and I had to be shocked. When we got to the hospital, they did an emergency cardiac cath. My door to balloon time was only 16 minutes," recalls Mr. Cooper.
Door to balloon time is the measurement used in cardiac care to that starts with the patient's arrival in the Emergency Department and ends when the blocked artery is open and blood is flowing in the cath lab. Sixteen minutes is an excellent time. The national standard for door to balloon time is 90 minutes.
While recovering in the hospital, Mr. Cooper's heart rate elevated and an EKG revealed he was in AFib. "I did not feel it at all," he says.
Dr. Brammer explains there are several treatment options that are used to help patients get their hearts back in rhythm. He develops treatments plans specifically and individually for each patient—with the goals of keeping AFib under control, easing symptoms, and allowing patients to get back to enjoying their lives. The options include medication to control the heart rate or restore the normal rhythm, lifestyle changes to reduce the risk of AFib, and blood thinners to reduce the risk of stroke. When medications do not work, Dr. Brammer uses minimally invasive treatment options such as ablation or implantable devices to keep AFib under control.
Mr. Cooper went through several treatment options, including two types of medications. When neither seemed to completely control his AFib. He had an ablation. "The ablation was one of the best things I've ever done," he says.
"An atrial fibrillation ablation is an outpatient procedure that works well for most patients," says Dr. Brammer. "The concept of ablation uses radiofrequency energy to heat or destroy abnormally active electrical tissue in the heart that is the origin of AFib, without damaging the normal healthy heart tissue. When compared to medications, the ablation procedure is much more effective long term at reducing the AFib symptoms and preventing the progression of AFib. It eliminates the need for some medications."
"I completely trusted Dr. Brammer to do the ablation," says Mr. Cooper.
Dr. Brammer adds that an ablation is done quickly and safely. It's an evolving technology, and Augusta Health stays current on all new tools and options. "The success rate with AFib is very good. AFib has stages from early through persistent to chronic. Earlier stages respond better to ablation than chronic phases, so 'the sooner the better' is a philosophy that applies to the treatment of AFib. Recurrence is always a possibility with AFib, so we follow all patients long term, even after a successful ablation."
Keith Cooper sees Dr. Brammer once a year, has an EKG, and has a check-up. He was on medication for a year after the procedure. "Everything is good," he notes. "But the best part is that Dr. Brammer has restored my way of life. I had been so tired all the time, and I would just feel like my body would give out. Now, I'm back to an active life. I spend a lot of time with my horses, and even shoe them with needed. For a while there, I had to watch what I was doing all the time, a bit fearful of what might happen. But those days are gone, and my 'old life' is back. It's a great feeling."
Dr. Brammer notes, "We are happy and honored to work with any patient with AFib. I believe we have the expertise, experience and ability to offer the best individualized treatment for each patient, whether that be a medication or a minimally invasive procedure such ablation. With the right treatment, AFib patients are able to get their lives back, enjoy the things that they like to do, and feel good again."
Glenn Brammer, MD, is a cardiologist and electrophysiologist at Augusta Health Cardiology. He graduated from Marshall University Medical School in Huntington, West Virginia and completed his residency at the University of Virginia. He also completed fellowships in Cardiology and Clinical Cardiac Electrophysiology at Wake Forest University School of Medicine. He is Board-Certified in Internal Medicine, Cardiovascular Disease and Cardiac Electrophysiology. He is married and has three sons and enjoys hiking, biking and running.
Originally published in the Staunton News Leader’s Heart Healthy Section on February 12, 2017.