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What is Atrial Fibrillation (afib)?
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- 2. Afib isthe most common heart rhythm disorder It causes the top chamber of your heart to beat out of rhythm – or “flutter” very fast Afib can affect you: Causing many symptoms Increasing your risk of having a stroke Education is an important part of your treatment. It will allow you to participate and choose what’s best for you www.theafibclinic.com
- 3. What isNormal “Sinus” Rhythm? What is Atrial Fibrillation? What problems can be caused by Afib? Treatment options www.theafibclinic.com
- 4. Normal Heart Rhythm Howdoes the electrical system work? I. Sinus Node: o Controls the heart rhythm o That’s why when you are in normal rhythm we call “sinus rhythm” II. Atrioventricular Node: ◦ After a short delay, it transmits impulses to the ventricle ◦ Medications to slow down your heart when you are in afib act here III. His-Purkinje System: ◦ Takes the electrical activity to the entire lower chamber – the ventricles ◦ Triggering cardiac contraction www.theafibclinic.com
- 5. Atrial Fibrillation What isit? What does it cause? Abnormal rhythm in the top chambers of your heart, causing it to “flutter” at very fast rates, which will in turn cause: 1. No meaningful contraction in the atria, which increases: • Risk of blood clots Risk of Strokes 2. Fast heart beats / Fast pulse Symptoms: • Palpitations, shortness of breath, tiredness, fluttering, dizziness, etc. www.theafibclinic.com
- 6. 1. Reduce theRisk of Stroke a) Use of blood thinners b) Atrial Appendage occlusion 2. Improve Quality of Life a) Medications to decrease number of episodes or to slow down the heart b) Procedures to eliminate Afib Atrial Fibrillation Goals of Treatment www.theafibclinic.com
- 7. Manage AFib Rate Control Manage AF Related StrokeRisk Left Atrial Appendage Closure Ligation, Clips, LAA Closure Devices Watchman Device Blood Thinners Dabigatran Apixaban Rivaroxaban, Edoxaban Warfarin AND AFib Diagnosis Drugs for Rhythm Control Afib Ablation What is your CHADS2-Vasc Score? Rhythm Control Atrial Fibrillation What Are Your Treatment Options? www.theafibclinic.com
- 8. What symptoms doesAfib cause? • Fatigue • Palpitations • Chest pain • Shortness of breath • Dizziness • Increase risk of Congestive Heart Failure • Other symptoms www.theafibclinic.com
- 9. In order todecrease or eliminate the symptoms of afib, doctors can use medications or procedures. a) Anti-Arrhythmic Drugs: a) Medications to decrease number of episodes or to slow down the heart b) Procedures to attempt to eliminate Afib a) Afib ablation How do we treat your symptoms? www.theafibclinic.com
- 10. In many patientsAfib is triggered by abnormal electrical impulses firing from the pulmonary veins. Afib ablation Since afib is commonly caused by abnormal electrical activity Afib ablation consists of eliminating (or isolating) the abnormal impulses that trigger afib. Atrial Fibrillation Ablation www.theafibclinic.com
- 11. Goal of procedureis to electrically isolate the pulmonary vein a. Ablation is performed at the mouth of the vein. Using either: a. Radiofrequency catheter ablation b. Cryoballoon ablation b. 3D Mapping systems are used to guide the ablation. Afib Ablation Pulmonary Vein Isolation www.theafibclinic.com
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- 13. > 33M people withAF Worldwide1 Many patients are unprotected AF is the most common cardiac arrhythmia AF increases risk of stroke 5x greater risk of stroke with AF2 < 90% Thrombus Originate LAA 10% Non-LAA 15% 15% 70% Treated with Warfarin Contraindicated Intolerant 45% 55% Treated with Warfarin Untreated ~45% of patients eligible for warfarin are untreated (tolerance/adherence)4 1 Chugh, S et al. Circulation, 2014; 129: 837-847 2 Holmes DR, Atrial Fibrillation and Stroke Management: Present and Future, Seminars in Neurology 2010;30:528–536. 3 Blackshear JL. Odell JA., Annals of Thoracic Surgery. 1996;61:755-759 4 Waldo, AL. JACC 2005;46:1729-1736. / Holmes DR et al, Atrial Fibrillation and Stroke Management: Present and Future, Seminars in Neurology 2010;30:528–536 Atrial Fibrillation Stroke Risk in Patients with Afib www.theafibclinic.com
- 14. What are myodds of having a stroke? www.theafibclinic.com
- 15. In patients withAF, >90% of strokes may be caused by blood clots formed in the Left Atrial Appendage Thrombus in LAA The clot lodges itself in the blood vessels of the brain, restricting blood flow and causing a stroke The clot dislodges from the LAA and travels through arterial system The stagnant blood creates an environment for a thrombus or blood clot to form Fibrillation causes blood to stagnate in the left atrial appendage What Causes Strokes in Patients with Atrial Fibrillation? 1 2 3 4 www.theafibclinic.com
- 16. Atrial Fibrillation and Stroke Risk Whatis your risk of stroke? What are your options to reduce your risk? www.theafibclinic.com
- 17. Atrial Fibrillation What isyour risk of Stroke? CHADS2Vasc Score In order to predict your risk of having a stroke, we look at other conditions you may have. Add the points for each condition, to determine your score. www.theafibclinic.com
- 18. 0 0% 1 1.3% 22.2% 3 3.2% 4 4.0% 5 6.7% 6 9.8% 7 9.6% 8 6.7% 9 15.2% CHADS2-Vasc Score Yearly Stroke Risk The more risk factors you have, the higher the risk of having a stroke each year. Atrial Fibrillation What is your yearly risk of Stroke? www.theafibclinic.com
- 19. Many options areavailable to prevent strokes. The treatment choice is individualized and based on your risk factors and preference. Atrial Fibrillation What Can I do to Decrease my Stroke Risk? Blood thinners Meds to decrease chanecs of blood clots strokes Risk of bleeding and non- compliance are major issues Left Atrial Appendage Closure Closes the LAA, where most clots are formed www.theafibclinic.com
- 20. Warfarin and NewBlood Thinners Bleeding risk Many patients stop taking it Regular INR monitoring (warfarin only) Restricts your diet (warfarin only) Interacts with other drugs Complicates surgical procedures High cost of the new drugs Treatment Study Drug Discontinuation Rate Major Bleeding (rate/year) Rivaroxaban1 24% 3.6% Apixaban2 25% 2.1% Dabigatran3 (150 mg) 21% 3.3% Edoxaban4 (60 mg / 30 mg) 33 % / 34% 2.8% / 1.6% Warfarin1-4 17 – 28% 3.1 – 3.6% Oral Anticoagulation Less than Ideal in the battle against Strokes Although they can reduce the risk of strokes, many patients have problems or stop taking them www.theafibclinic.com
- 21. WATCHMAN™ Left Atrial AppendageClosure Device A first-of-its-kind, proven alternative to long-term warfarin therapy for stroke risk reduction in patients with non-valvular AF Designed to reduce the risk of embolism (blood clots) by closing off the left atrial appendage (LAA), which is believed to be the source of a majority of strokes in patients with Afib. Comparable stroke risk reduction, and superior reductions in hemorrhagic stroke, disabling stroke and cardiovascular death compared to warfarin over long-term follow-up www.theafibclinic.com
- 22. WATCHMAN LAA ClosureDevice 3000838-18 www.theafcenter.com
- 23. • One-time implantthat does not need to be replaced • Performed in a cardiac cath lab/EP suite • Transfemoral Access: • Catheter advanced to the LAA via the femoral vein • Similar to a Heart Cath (Does not require open heart surgery) WATCHMAN™ Left Atrial Appendage Closure (LAAC) Device • General anesthesia* • 1 hour procedure* • 1-2 day hospital stay* * Typical to patient treatment in U.S. clinical trials www.theafibclinic.com
- 24. WATCHMAN™ Left Atrial AppendageClosure (LAAC) Device Heart tissue grows over the device, typically within a few weeks Most Patients are able to discontinue blood thinners 45 days after the implant Watchman Device at the Left atrial appendage, shortly after implant. The LAA, the most common source of strokes in Afib patients, will be sealed off permanently www.theafibclinic.com
- 25. Afib isa very important condition It may affect your quality of life and increase your risk of having a stroke There are many treatment options for patients with atrial fibrillation When treating a patient with Afib, our goals are: 1. Make you feel better 2. Decrease your risk of having a stroke Alabama Cardiovascular Group Atrial Fibrillation Clinic
- 26. To learn moreabout atrial fibrillation, please check our website: www.theafibclinic.com If you would like to schedule a consultation to learn what the best treatment option for you would be, please call us: 205-939-0073 Alabama Cardiovascular Group Atrial Fibrillation Clinic