Matters of the Heart
Many years later, she was diagnosed with premature ventricular contractions and was prescribed medication that helped manage her condition. Fast forward nearly a decade and Benson, 63, who is married to an Imperial Valley farmer and is mother to two young adult women, found herself fighting a persistent gallbladder infection.
During treatment at the hospital, Benson went into atrial fibrillation, known as AFib, in which the heart beats irregularly and rapidly. The attending physician called Eisenhower Desert Cardiology Center’s Evangelos “Evan” Diamantakos, DO, Board Certified in Cardiology, Cardiac Electrophysiology and Internal Medicine, who came to see her at the hospital.
Benson describes the sensation of AFib as “a very uncomfortable experience ... kind of like you want to crawl out of your skin,” as the heart rate skyrockets, sometimes for hours. “It’s scary,” she says. “Really scary.”
Dr. Diamantakos defines AFib as an irregular heartbeat that originates from the left atrium, leading to symptoms that include, but are not limited to, palpitations, fatigue, weakness and decreased exercise tolerance.
“It can sometimes be identified as an irregular heartbeat, a palpitation or fluttering,” he says. “Some patients describe it as a fish flopping in the heart.” The main concern for AFib, he adds,is that the heart rhythm predisposes patients to a stroke.
Atrial fibrillation falls into four categories: paroxysmal, which
is intermittent and terminates within less than seven days of onset; persistent AFib, sustained for greater than seven days and requires intervention; longstanding persistent AFib, continuous for greater than 12 months in duration; and permanent AFib, a term that is used when the patient and clinician make a joint decision to stop further attempts to restore and/or maintain sinus rhythm.
In general, part of the treatment involves assessing modifiable risk factors. Refraining from alcohol will reduce AFib occurrence/recurrence as well as improve overall cardiovascular health.
“Obesity is linked to AFib, so weight loss and diet are important,” Dr. Diamantakos says. “Managing risk factors of diabetes and blood pressure to ensure those are regulated and within normal range will help reduce the incidence of AFib.”
“Rhythm control can be done in one of three ways. Sometimes, patients need a cardioversion, an electrical shock to get them back to normal rhythm,” he notes. “Some patients are placed on antiarrhythmic drugs that help maintain them in sinus rhythm or normal rhythm versus AFib. Lastly, there is ablation in which multiple energy sources (heating, freezing or pulsed field ablation) can be used to affect the atrial tissue and eliminate the atrial activity that can cause atrial fibrillation.”
The decision to perform an ablation is primarily driven by the patient’s symptoms and/or recurrence of arrhythmia that can occur with the use of medications. Benson’s AFib fell into the paroxysmal category, which made her eligible for a cardiac ablation.
“If patients have failed medical therapy and are symptomatic or wish not to be on medications long-term, there are reasons to have
an ablation,” Dr. Diamantakos says. Long term, ablation has better statistics in maintaining normal rhythm than medication. “For
Mary-Alice, the decision was primarily symptom-driven. She was trialed on some medicines that initially were used to treat her AFib and keep her from having recurrent episodes. Over time, the medicines stopped working.”
Benson underwent pulsed field ablation, a newer technology
in which brief, high-energy (non-thermal) electrical pulses are administered to selectively destroy heart tissue causing abnormal rhythm. This excludes collateral damage to surrounding structures such as the esophagus, lung tissue or phrenic nerve (vital nerve in the neck).
The most common denominator for AFib is age, Dr. Diamantakos notes. “The older we get, AFib becomes more apparent. As we age externally, the inside of the heart ages as well.”
That aging is usually reflected by scarring, or fibrosis, in the heart, “which leads to abnormal electricity,” he says. “For some patients, the AFib itself can create heart failure. Like in a house, where there’s
electricity and plumbing, if the electricity is off, the house won’t work well. Similarly with the heart, if the electricity is not correct, meaning a patient is in AFib, then the pump or squeeze strength of the heart can be significantly affected.”
Atrial fibrillation is usually seen, on average, in patients about 60 years of age and then increasing as years pass. It is most commonly found in those aged 80 years and older. Risk factors for AFib include age and gender, as well as high blood pressure, diabetes, coronary disease, a previous history of stroke, and patients who have heart failure. Women are more often diagnosed with AFib than men.
For Benson, the ablation has allowed her medical team to decrease her medication with a plan to eventually end her need for the beta blocker.
Benson is grateful for her medical care and to Dr. Diamantakos, whom she calls “Dr. D,” saying, “Dr. D is the best. His bedside manner is so kind, so patient, so reassuring, and he has a great sense of humor. I felt very safe in his hands.”
To learn more about the services at Eisenhower Desert Cardiology Center,
visit EisenhowerHealth.org/DesertCard.
