FEATURE | Posted Sept. 4, 2015

When to worry about AFib

UC Davis cardiologist sheds light on a common cause of stroke and heart failure

Photograph of Dr. Uma Srivatsa, UC Davis cardiologist and AFib specialist © UC Regents
UC Davis heart specialist Uma Srivatsa has spent her career treating arrhythmia. For Atrial Fibrillation Awareness Month, she discusses the symptoms, causes and treatments for a common type of arrhythmia known as AFib.

Atrial fibrillation (also known as AFib or AF) is a type of irregular heart beat — or arrhythmia — linked with heart failure and stroke. It affects millions of Americans but, because symptoms can be hard to detect, many don’t know they have the condition.

To encourage understanding of AFib, Uma Srivatsa, a UC Davis specialist in arrhythmia treatment, answers questions about the disease for Atrial Fibrillation Awareness Month (September).

What is atrial fibrillation?

Srivatsa: AFib occurs when electrical activity in the heart goes haywire, causing the two upper chambers, or atria, to beat out-of-sync. Without a regular rhythm, the heart can’t efficiently pump blood throughout the body.

Why is this a problem?

Srivatsa: AFib is a common reason for emergency department visits and hospitalizations. It’s also a significant cause of heart failure and disabling strokes that occur when blood clots form in pooled blood in the left atrium and travel to the head.

Graphic of human heart showing where AFib occurs
AFib occurs when the right and left atria beat out-of-sync, reducing the heart’s ability to pump efficiently.

What are the causes?

Srivatsa: The reasons for the disease are not known, however basic scientists, including a remarkable team led by Nipavan Chiamvimonvat at UC Davis, are identifying the cell-signaling systems that lead to AFib. It is currently understood that aging, persistent high blood pressure, coronary artery disease, heart failure, diabetes, obesity, sleep apnea or emphysema can eventually damage the heart’s electrical system and lead to arrhythmias, making it important to treat these conditions early and aggressively.

Who gets AFib?

Srivatsa: It is most common among Caucasian men over the age of 65. However, I am seeing more women and patients of all ages, races and ethnicities with AFib, so no one is truly “in the clear.” People with diabetes or who are obese are also more likely than others to get AFib.

What are the symptoms?

AFib treatment at UC Davis

The UC Davis Division of Cardiovascular Medicine offers a robust AFib diagnosis and management program aimed at controlling symptoms, reducing hospitalizations, preventing stroke and improving survival, including:

  • An anticoagulation clinic led by Richard White that focuses on blood clot and stroke prevention 
  • State-of-the-art electrophysiology technology, including a magnetic heart-mapping system that minimizes radiation and complications, and the excellent ablation team of Uma Srivatsa, Nayereh Pezeshkian and Yingbo Yang
  • Highly skilled cardiothoracic surgeons like Broadus Atkins, who perform novel thoracoscopic (minimally invasive) procedures and traditional open surgeries for AFib
  • An innovative structural heart disease team, led by Reginald Low and Jason Rogers, that uses catheters to implant stroke-prevention devices
  • The region’s only board-certified pediatric cardiac electrophysiologist — Jeanny Park — who treats heart rhythm problems in children

To request an appointment or a referral to a UC Davis cardiac specialist, call 1-800-2UCDAVIS (1-800-282-3284).

Srivatsa: A common symptom is heart palpitations or the sense that the heart is beating out of control. AFib can cause extreme fatigue or exercise intolerance, which is what drives most patients to seek treatment. Some people unfortunately do not have noticeable symptoms until they have a stroke.

What do you do as a cardiac electrophysiologist?

Srivatsa: I conduct catheter-based electrophysiology studies that offer real-time maps of the heart in action and that can identify arrhythmias along with their specific sources. During those exams, I can apply  targeted energy to affected tissue, often permanently restoring normal heart rhythm and reducing the need for medications. This treatment is useful for simple and complex arrhythmias like AFib and ventricular tachycardia; the latter often causes cardiac arrest.

What changes have you seen in AFib treatment during your career?

Srivatsa: Treating AFib has undergone tremendous improvements in the past two decades. Medications, catheter-based interventions or heart surgery can restore normal heart rhythm. Advances have been made in leaps and bounds to mapping and ablation techniques of the heart to enhance precision of our work. Newer stroke-prevention measures, including drugs that require less monitoring and devices that trap blood clots, have greatly reduced strokes.

What is the best way to prevent AFib?

Photograph of doctor checking heart of patient for AFib © iStockphoto
Changes in heart rate, energy level or ability to exercise are symptoms to discuss with a physician.

Srivatsa: Living a healthy lifestyle is important in reducing all cardiovascular disease. Everyone should also receive heart rhythm evaluations during routine physical exams and check his or her own pulse regularly. A noticeable rapid or slow heartbeat, worse-than-normal tiredness or an inability to complete a regular exercise routine should lead to a referral to a cardiac specialist and treatment if AFib is diagnosed. Managing AFib is a journey, and no single approach works for everyone. But the condition definitely needs to be monitored and controlled and stroke prevention absolutely needs to be addressed. You need to be aware of your symptoms, discuss with your doctor the criteria for an emergency room visit and what you should do if your heart suddenly becomes irregular, and stick with your treatment plan.