AFib Care Is Advancing: Here’s What Patients Need to Know

Atrial fibrillation (AFib) is the most common type of irregular heartbeat, affecting millions of people worldwide. Despite its prevalence, AFib is a complex condition that can increase the risk of stroke, heart failure, and cognitive decline if left untreated. Fortunately, advances in detection and treatment are making AFib easier to diagnose and more manageable than ever before.

Cedars-Sinai cardiothoracic surgeon and nationally recognized AFib expert Armin Kiankhooy, MD, and electrophysiologist Mayer Rashtian, MD, who has researched and published multiple papers on this topic, recently sat down with Huntington News to discuss AFib and the latest advances in care.

What is AFib and why is it a problem?

AFib occurs when abnormal electrical signals in the heart's upper chambers, known as the atria, cause them to beat rapidly and irregularly.

"I compare the heart's pumping system to a car engine and its electrical system to spark plugs," shares Dr. Rashtian. "When the electrical system is not functioning properly, the heart may not pump blood as efficiently."

Dr. Kiankhooy agrees: "The heart relies on coordinated electrical signals to maintain a normal rhythm. In AFib, those signals become chaotic."

The condition can cause blood to pool inside the heart, increasing the risk of clot formation and stroke. AFib can also weaken the heart over time, leading to heart failure and symptoms such as palpitations, fatigue, shortness of breath and reduced exercise tolerance.

What causes AFib?

According to Dr. Kiankhooy, high blood pressure is the most common risk factor. Over time, increased pressure forces the heart to work harder, creating stress that can lead to scar tissue, or fibrosis, in the atria. This scarring disrupts the heart's electrical pathways and increases the likelihood of AFib.

Dr. Rashtian notes that AFib often develops because of multiple factors that place stress on the heart over many years. Additional risk factors include obesity, excessive alcohol use, sleep apnea, overactive thyroid disease, diabetes, heart attack, heart valve disease, and aging.

How is AFib diagnosed and treated?

Because AFib can come and go, diagnosis may require heart-rhythm monitoring. Physicians use tools such as EKGs, wearable monitors, implantable loop recorders, and even smartwatches that can detect irregular heart rhythms.

Although AFib can recur, it can often be successfully controlled with lifestyle changes, medications, and procedures such as catheter ablation. Both physicians emphasized that treatment typically combines lifestyle changes and medical therapies. Treatment options include:

• Healthy diet, exercise, and limiting alcohol
• CPAP therapy for sleep apnea
• Medications to control heart rhythm and heart rate
• Blood-thinning medications (anticoagulants) for appropriate patients to reduce the risk of stroke
• Cardioversion to restore normal rhythm
• Catheter ablation, including newer pulsed field ablation (PFA) technology, to target abnormal electrical pathways
• Minimally invasive surgical ablation for select patients
• Pacemakers in certain cases
• Left atrial appendage closure for selected patients who are not appropriate candidates for long-term anticoagulation

One of the most significant recent advances is pulsed field ablation (PFA), a newer form of catheter ablation that uses brief electrical pulses rather than heat or freezing to treat the heart tissue responsible for AFib.

"Pulsed field ablation has significantly changed how we approach AFib ablation," said Dr. Rashtian. "It allows us to treat the abnormal tissue efficiently while reducing injury to certain surrounding structures."

Both Dr. Kiankhooy and Dr. Rashtian emphasized that AFib treatment is not one-size-fits-all. The best approach depends on a patient's symptoms, overall health, risk factors, and goals.

"Today's therapies give us more tools than ever before to help patients live well with AFib," said Dr. Rashtian.

Dr. Kiankhooy added that early diagnosis and intervention are key. "The sooner we identify AFib and address both the rhythm problem and its underlying causes, the better the opportunity to prevent complications and improve long-term health."