Lankenau cardiac surgeons are among only a handful in the nation using
the AtriClip procedure to treat atrial fibrillation. During this
approach, a small clip that resembles a woman’s hair barrette is used to
clamp off blood flow to the left atrial appendage – a thumb-sized pouch
on top of the heart where the majority of blood clots are thought to
form. By cutting off blood flow, the chance of a clot forming in this
high-risk area and causing a stroke are greatly reduced. The AtriClip
can be implanted through an open surgical procedure or using a minimally
invasive “keyhole” approach through the ribs.
Arrhythmias (or dysrhythmias) are abnormal rhythms of the heart that
cause the heart to pump less effectively.
Normally, as the electrical impulse moves through the heart, the heart
contracts–about 60 to 100 times a minute in adults. Each contraction
represents one heartbeat. The atria (the upper chambers of the heart)
contract a fraction of a second before the ventricles (the lower
chambers of the heart) so their blood empties into the ventricles before
the ventricles contract.
Under some conditions almost all heart tissue is capable of starting a
heartbeat, or becoming the pacemaker. An arrhythmia occurs when:
The heart's natural pacemaker develops an abnormal rate or
The normal conduction pathway is interrupted.
Another part of the heart takes over as pacemaker.
The electrical activity of the heart is measured by an electrocardiogram
(ECG or EKG). By placing electrodes at specific locations on the body
(chest, arms, and legs), a graphic representation, or tracing, of the
electrical activity can be obtained. Changes in an ECG from the normal
tracing can indicate arrhythmias, as well as other heart-related
Almost everyone knows what a basic ECG tracing looks like. But what does
The first little upward notch of the ECG tracing is called the
"P wave." The P wave indicates that the atria (the two upper
chambers of the heart) are electrically stimulated to pump blood
to the ventricles.
The next part of the tracing is a short downward section
connected to a tall upward section. This spike-like section is
called the "QRS complex." This part indicates that the
ventricles (the two lower chambers of the heart) are
electrically stimulated ("depolarization") to pump out blood.
The next short flat segment is called the "ST segment." The ST
segment indicates the amount of time from electrical signal for
contraction of the ventricles to the beginning of the "T wave".
The next upward curve is the T wave. The T wave indicates the
electrical recovery period of the ventricles ("repolarization").
When your doctor studies your ECG, he or she looks at the size and
length of each part of the ECG. Variations in size and length of the
different parts of the tracing may be significant. The tracing for each
lead of a 12-lead ECG will look different, but will have the same basic
components as described above. Each lead of the 12-lead is "looking" at
a specific part of the heart, so variations in a lead may indicate a
problem with the part of the heart associated with that lead.
Atrial fibrillation is a type of arrhythmia. With atrial fibrillation,
the electrical signals in the atria (the two upper chambers of the
heart) are fired in a very fast and uncontrolled manner. The atria
quiver instead of contracting normally. The electrical signals then
arrive in the ventricles in an irregular fashion. When the atria do not
contract effectively, the blood may pool and/or clot. If a blood clot
becomes lodged in an artery in the brain, a stroke (brain attack) may
occur. About 15 percent of strokes occur in persons with atrial
fibrillation. Aspirin, warfarin, and other cardiac medications may be
used to treat atrial fibrillation.
Current guidelines recommend a patient-specific approach to treating
atrial fibrillation. A rate control (allowing the patient to remain in
atrial fibrillation, ensuring the heart rate is controlled) or rhythm
control (using specific medications or procedures to restore normal
rhythm) strategy may be adopted. Your doctor will decide which treatment
approach is most appropriate for you.
Medications are usually used with the rate control strategy, commonly
including beta-blocker medication, such as atenolol or metoprolol, or
calcium-channel blockers, such as diltiazem or verapamil, to slow down
the heart rate.
The rhythm control strategy may include the use of medications
(anti-arrhythmics) or electrical cardioversion to restore normal rhythm.
Catheter ablation (a catheter is guided through a blood vessel to the
heart and energy is sent through the catheter to destroy small areas of
heart tissue that may cause the arrhythmia) is a nonsurgical procedure
that is commonly used when medications are not working to control the
heart rhythm. Your doctor may also recommend a surgical treatment
approach, although this is less common.
Patients with atrial fibrillation should also be evaluated for their
stroke risk and receive appropriate blood thinners, such as aspirin,
clopidogrel, warfarin, dabigatran, or rivaroxaban, to prevent stroke.
Some patients may have a condition (such as alcoholism with frequent
falls) that would make blood-thinning medications dangerous and,
subsequently, they may not be used. Your doctor will have a detailed
discussion with you about which blood-thinning medications are most
appropriate for you.
For more information, call 1.866.CALL.MLH.