To learn more about atrial fibrillation, please click on the following links.

• What is atrial fibrillation?
• What causes atrial fibrillation?
• What are the symptoms of atrial fibrillation?
• Types of atrial fibrillation
• How is atrial fibrillation diagnosed?
• Treatment of atrial fibrillation
  • Medications
  • Cardioversion
  • Ablation Therapy
  • The Ex-Maze ablation procedure
• Ex-maze Outcomes

In a properly working heart, the right side pumps blood to the lungs where the blood cells are enriched with oxygen. The left side of the heart then pumps the oxygen rich blood to the rest of the body.

Each side of the heart has two chambers—the atrium (upper) and the ventricle (lower). A healthy heartbeat results when an electrical impulse generated by specialized cells in the upper chamber travels in an organized pathway through specialized conduction cells to the lower chamber.

Atrial fibrillation occurs when the normal, organized pathway for the electrical impulse between the two chambers becomes disorganized and/or disrupted. The atrium quivers and is no longer coordinated with the ventricle. The resulting “storm of energy” causes a rapid and/or irregular heart rate.

Heart in normal rhythm	Heart atrial fibrillation Note the rapid and disorganized atrial contraction and therapid and irregular ventricular response.

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The causes of atrial fibrillation include high blood pressure, coronary artery disease, heart valve disease, pulmonary embolism, congenital heart disease, cardiomyopathy, infection, surgical procedures, stress, excessive caffeine or alcohol use, and imbalances in body chemistry.

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• Irregular heartbeat
• Fatigue or weakness
• Dizziness or lightheadedness
• Chest pain
• Racing heart
• Shortness of breath

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There are three different types of atrial fibrillation. The difference depends on the frequency and duration of the episode.

• Paroxysmal –– lasts from 30 seconds to a week but the heart returns to normal rhythm on its own.

• Persistent –– continual periods of atrial fibrillation requiring medication or electric shock to restore normal rhythm.

• Permanent –– a permanent condition that does not respond to treatment.

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Tests to diagnose atrial fibrillation may include:

• Electrocardiogram (ECG, EKG) – a test that records the heart's activity by measuring electrical currents through the heart muscle
• 24-Hour Holter Monitoring – wearing a heart monitor that records the heart rhythm for 24-hours
• Echocardiogram – a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
• Coronary Angiography – x-rays taken after a dye is injected into the coronary arteries
• Chest X-ray – to look for underlying conditions
• Blood Tests – to look for underlying conditions

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The goal of atrial fibrillation treatment is to restore a regular rhythm; keep heart rate as close to normal as possible; and to prevent blood clots from forming. Treatment begins with services provided by a cardiologist, including medication, electric shock cardioversion (using shock to re-set the heart’s rhythm), pacemaker therapy and catheter ablation (add ehealth link to Ablation Therapy) .

In addition to the treatments outlined above, FirstHealth Moore Regional Hospital offers the new Ex-Maze ablation, which uses heat generated by radio frequency to create an extensive pattern of scar tissue that corrects the electrical impulses in the heart muscle.

Medications

The first line of treatment for atrial fibrillation is rate and rhythm drugs, medications that are designed slow and regulate the heart rate.

Cardioversion

Cardioversion is a procedure that uses an electrical current or drugs to help normalize the heart rhythm. If atrial fibrillation has lasted 48 hours or more, you may be given blood thinners before this procedure.

Ablation Therapy

In some cases, an area of the atria that is deemed to be responsible for the atrial fibrillation may be surgically removed or altered (ablated) with various techniques, including cryoblation or radiofrequency ablation, to prevent it from persistently generating the rhythm disturbance.

The Ex-Maze ablation procedure [ View Details at www.Ex-Maze.com ]

Andy C. Kiser, M.D., a heart surgeon at FirstHealth Moore Regional Hospital and medical director of the FirstHealth Arrhythmia Center has pioneered the development of a procedure that corrects atrial fibrillation. The Ex-Maze ablation procedure creates an extensive pattern of scar tissue on the beating heart to properly direct electrical impulses through the muscles of the heart.

Like many heart-cauterizing instruments, the Ex-Maze device uses heat generated by radio frequency. The heating coil is inside a plastic tube that is pressed against the heart surface.

The Ex-Maze device is different in that it has a vacuum system that keeps it in direct contact with the heart. This helps ensure that the pattern of scar tissue is consistent and unbroken, so stray electrical impulses can’t travel far enough to cause a problem.

A saline solution flows continuously through the plastic tube that contains the Ex-Maze device’s heating coil. This prevents the surface of the heart from being burned while the deeper muscle is cauterized.

Advantages of the Ex-Maze
The maze procedures used to date typically create scar tissue only on limited areas of the heart and/or they are only performed after the heart is stopped and the patient is placed on a heart-lung machine.

The Ex-Maze procedure creates a pattern of scar tissue that completely encircles the heart and blocks all errant electrical impulses. Because the Ex-Maze procedure is performed on a beating heart, the surgeon can see the change from atrial fibrillation to normal heart rhythm and know that the procedure has been successful. The procedure can be used to treat both “persistent” atrial fibrillation and “permanent” atrial fibrillation, for which there is no other reliably effective treatment

The Ex-Maze device was developed by nContact Surgical Inc. of Morrisville, N.C.

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