Printer-friendly format

Just about every publication and media outlet is using the term "aging population," a perpetual reminder that the majority of the people in the United States are getting older. Moreover, they are living longer. While healthcare innovations have made it possible to prolong life, the downside for many people is that living longer in our modern hectic American lifestyle is a recipe for chronic health conditions.

A common disorder that cardiologists often address in senior patients is atrial fibrillation (AF). Many patients experience uncomfortable symptoms such as fatigue, palpitations, lightheadedness and shortness of breath; although some patients feel no symptoms and can go undiagnosed until it's detected during a checkup. The American Heart Association (AHA) reports that AF is found in about 2.2 million people, and the likelihood of developing it increases with age. Three to five percent of people over age 65 have AF.

"It's the most common rhythm problem you see in the senior population, by far," said Jeff Kerlan, MD, electrophysiologist and cardiologist at Memphis Heart Clinic.

As people age, various scenarios can lead to AF – for instance, anatomy changes. The electrical and structural properties of the atria can change which can lead to a breakdown in the normal rhythm. Other chronic conditions like hypertension, thyroid problems and sleep apnea can initiate AF. Other risks include heart disease, valve problems, alcohol abuse and a family history.

Patients have either a sporadic rhythm, (paroxysmal atrial fibrillation) in which symptoms come and go, or chronic AF, in which symptoms do not go away until treated. The disorder is not fatal by itself, but it can precipitate life-threatening co-morbidities such as stroke and heart failure.

"What's important among seniors, and I can't emphasize this enough, is the risk of stroke," said Kerlan.

AF can cause blood clots in the heart which can travel to the brain. According to the AHA, about 15 percent of strokes are caused by AF.

But even healthy living can't always prevent future AF, explained Kerlan. It's important that senior patients receive annual physicals and an EKG, along with strict blood pressure and cholesterol control.

At Memphis Heart Clinic, treating AF takes up more than 50 percent of Kerlan's practice annually. Treatment for atrial fibrillation covers two categories – rhythm control and rate control. All patients receive tailored therapy, said Kerlan, but the mainstay is to uphold the sinus rhythm with blood thinners. Most patients under 65 are managed with aspirin. After 65, the big decision involves the stroke risk, he added, which means determining which patients should stay on aspirin and which ones need Coumadin.

If a patient needs more aggressive therapy to restore rhythm, he may receive other medications—or an electric cardioversion, a temporary fix. Overall, rhythm control methods do not cure the disorder but offer patients relief from the symptoms.

"One of the biggest issues is how aggressively we try to get them back to a normal rhythm and how much they want to get back," Kerlan stated.

When AF cannot be restored to a normal rhythm, the goal then becomes to slow the heart rate, which includes additional medications, or if that doesn't work, an ablation procedure.

As an electrophysiologist, Kerlan performs many ablation procedures, the most common of which is AV node ablation. AV node uses radiofrequency energy to eliminate the electrical connection between the atria and ventricles. A pacemaker must be installed to control the rhythm and because the atria still quiver, anticoagulant medication must be continued to reduce the risk of stroke.

A more novel therapy that is relatively new on the scene is pulmonary vein ablation, which is designed to restore the sinus rhythm without being dependent on medication. This treatment was developed from research that suggests almost all atrial fibrillation signals come from the four pulmonary veins. It is thought, Kerlan explained, that sleeves of electrical tissues may trigger the development of an abnormal signal and initiate AF. Pulmonary vein ablation, or pulmonary vein antrum isolation, isolates those triggers from precipitating AF.

"This takes ablation to a whole new level," said Kerlan, who added it's not a common procedure found in every cardiology office.

The procedure is more complex, with catheterization initiating on the left side of the heart. A special machine delivers energy to the atria that connects to the pulmonary vein. The ablation produces a circular scar that blocks any impulses firing within the pulmonary vein, thereby disconnecting the pathway of the abnormal rhythm. Success rates for paroxysmal patients are 80 to 85 percent with the first ablation. Those who return for further ablation have a success rate of 95 percent. The success rate goes down for people who have had chronic AF for long periods.

Currently, the procedure is not generally used on elderly patients, Kerlan explained, but as physicians have gained experience and greater knowledge of risks, the patient parameters have expanded. Typically, the procedure is performed on middle-aged patients, but can range from age 40 to 70, and in some cases, up to the eighties.

Kerlan performs 75 pulmonary vein ablations a year at Memphis Heart Clinic.

Cardiologists see the evidence of the aging population in their offices everyday, and AF is a disorder that requires vigilance to diagnose and keep under control.

"The numbers of atrial fibrillation are not going down," concluded Kerlan. "It's expected as patients are living longer, this is going to be an increased issue."

Tags:

None

Login and voice your opinion!