What is Atrial Fibrillation (afib)?

Jose Osorio, MD
www.theafibclinic.com

 Afib is the 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

 What is Normal “Sinus” Rhythm?
 What is Atrial Fibrillation?
 What problems can be caused by Afib?
 Treatment options

Normal Heart Rhythm
How does 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

Atrial Fibrillation
What is it? 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.

1. Reduce the Risk 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

Manage
AFib
Rate Control
Manage
AF Related
Stroke Risk
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?

What symptoms does Afib cause?
• Fatigue
• Palpitations
• Chest pain
• Shortness of breath
• Dizziness
• Increase risk of
Congestive Heart Failure
• Other symptoms

In order to decrease 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?

In many patients Afib 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

Goal of procedure is 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

Atrial Fibrillation
and Strokes

> 33M
people with AF 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

What are my odds of having a
stroke?

In patients with AF, >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

Atrial Fibrillation
and
Stroke Risk
What is your risk of stroke?
What are your options to reduce your risk?

Atrial Fibrillation
What is your 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.

0 0%
1 1.3%
2 2.2%
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?

Many options are available 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

Warfarin and New Blood
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

WATCHMAN™
Left Atrial Appendage Closure 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

WATCHMAN LAA Closure Device
3000838-18
www.theafcenter.com

• One-time implant that 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

WATCHMAN™
Left Atrial Appendage Closure (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

 Afib is a 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

To learn more about atrial fibrillation, please check
our website:
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

What is Atrial Fibrillation (afib)?

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