How to self-test for AFib

How to self-test for AFib


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The episodes often struck at night. Robin Plume would awaken breathless, her heart beating rapidly and irregularly. Only a trip to the emergency room would make the haphazard thumping stop.

The fit 63-year-old business owner who does yoga and loves to garden wasn't sure what was triggering her suddenly frenzied and unsteady pulse. Sometimes it seemed like wine, French cheeses, salami or coffee brought it on. Airplane rides were another suspect.

A frequent traveler, she saw the inside of ERs in four different cities in one year. Other times, Plume's heart appeared to start racing out of nowhere.

"They determined I didn't have plumbing problems," Plume said. "My problem was electrical."

During an ER visit, Plume learned she had atrial fibrillation, an abnormal heart rhythm that occurs when confused electrical signals cause the upper chambers, called the atria, to fibrillate or quiver.

The tricky part is that many people don't know they have AFib because they don't have obvious symptoms like the kind Plume experienced.

"About 30% have no major or clear symptoms, so we often don't deal with AFib at the early stages," said Nassir Marrouche, M.D., a cardiologist at University of Utah Health Care and one of country's preeminent AFib experts. "In fact, we see patients with stroke and heart failure as a first indicator of AFib."

When obvious symptoms do occur, they may include everything from chest pain and palpitations to headaches, dizziness, insomnia, even diarrhea, and the list goes on.

"It could be almost anything," said Marrouche of the varied symptoms, noting that another complicating factor is some people attribute their AFib symptoms to a normal part of the aging process.

When it comes to AFib, timing is key. Risk factors are similar to the ones that affect heart disease: high blood pressure, diabetes, thyroid disease, overconsumption of alcohol, smoking and genetics.

If AFib is allowed to continue, the irregular, sped-up rhythms can result in irreparable scarring of the heart, and too much scarring can render the best treatment options ineffective.

Backed by the University of Utah's CARMA Center research, Marrouche has dedicated his career to changing the way the condition is treated. As a champion of early intervention, he has become a sought-after physician by patients from all over the U.S. Plume flew in from the Seattle area to see him.

"I was very interested in the fact that Dr. Marrouche took a very proactive approach," Plume said. "I want to eventually retire and maybe leave the United States on a trip and not be terrified I'm going to have an episode in some small village in France or in Singapore."

The two options for treating AFib are medication or a procedure called catheter ablation in which a doctor cauterizes the areas in the heart that are firing electrical impulses abnormally. When possible and if patient is a candidate, Marrouche advises undergoing the ablation procedure early rather than relying on multiple medications for the rest of a patient's life.

Far from open-heart surgery, ablation is minimally invasive — a catheter is inserted into the groin vein and threaded up to the heart. If successful, a patient's heart will beat uniformly and episodes will cease.

Unfortunately, some people aren't good candidates for ablation because their heart has too much scarring or fibrosis. To evaluate if ablation is likely to work for an individual, Marrouche uses a classification system that he helped develop at the University of Utah's CARMA Center and that was presented in the prestigious Journal of the American Medical Association in 2014.

Prior to ablation, patients at the University first undergo a 3-D MRI that illustrates scarring of the heart muscle. At hospitals worldwide, ablation of all types of AFib is successful in less than 50% of cases.

Implementing the MRI screening and classification protocol at the University, Marrouche and his colleagues are now reporting better procedural success rates because they are able to predict which patients are most likely to benefit from ablation and which are better off using medication.

"Until now, the treatment options for AFib have been one-size-fits-all," said Marrouche of a condition that affects 4-6 million people in the U.S. and 20% of people ages 77 and up. "Now instead of giving a patient a pill from day 1, we have options."

After a 3-D MRI scan of Plume's heart revealed she was an excellent candidate for ablation, she decided to ready her body for the procedure. She made significant lifestyle changes, limiting her favorite salty snacks and cutting out wine and coffee.

"I did everything I could so when I went into it I had as clean a slate as I possibly could," Plume said.

Late last year she had the procedure at University Hospital. She felt no pain; the most uncomfortable part was not being allowed to move for four hours. She had two episodes as her heart worked to heal itself, which is typical, and now she's doing great.

"I take no drugs whatsoever for heart-related issues," Plume said. "My advice to people who have AFib is do not be passive. It doesn't get better. It only gets progressively worse."

Her heart repaired, she recently participated in a Tour de France-themed spinning class. Plume's heart rate reached 150 beats a minute for several minutes at a time as she raced up the virtual mountain.

"I was hooked up to a reader that recorded my heart rate at all times, and it projected on the board for everybody to see," she said, laughing.

It was a big moment for Plume, her pulse on display, ticking steadily as she pedaled.

Check yourself for AFib

The good news is you can screen yourself for AFib, and you don't need a 3-D MRI or any other advanced technology. It's as easy as taking your pulse. Dr. Marrouche recommends monitoring your pulse daily for 30 seconds with two fingers on your wrist artery, noting any off-kilter beats. If it's irregular, see your family doctor or cardiologist.

Would you like to learn more about University of Utah Health Care's AFib treatment options? Clickhereor call 801-587-7676.

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