In the normal heart, an electrical system controls the orderly contraction of the upper chambers (the atria) followed by the contraction of the lower chambers ( the ventricles).

This sequence of contraction results in the efficient emptying of the heart chambers to provide blood flow to the body and lungs.

Almost every heart disorder can effect the electrical system of the heart. These alterations of heart rhythm are called arrhythmias.

Atrial fibrillation is a common arrhythmia of the upper chambers of the heart which starts in the veins from the lungs and causes a “shimmering” of the atria and thereby the loss of atrial contraction.

Atrial fibrillation may be intermittent or persistent. The rapid irregularity of the atrium drives the ventricles at a very fast rate causing symptoms of shortness of breath, palpitation, or light headedness.

Most importantly, atrial fibrillation is one of the major causes of stroke.

When atrial fibrillation occurs, the atria do not contract and blood stagnates and lingers in the LEFT ATRIUM and atrial appendage which arises from the atrial chamber.

The appendage is a small, blind pouch or ear-like structure where clots form during atrial fibrillation. 90% of clots come from the appendage and cause stroke when they dislodge and travel to the brain from the heart.

Clots traveling from the heart usually go to the brain and lodge in the brain arteries stopping blood flow.

When blood flow stops, permanent death of brain cells occurs. ½ of strokes due to atrial fibrillation are disabling strokes.

Atrial fibrillation is usually diagnosed by EKG or rhythm monitoring by 24 hour monitors or event monitors

Echocardiograms from the chest surface (TTE) or esophagus (TEE) are often used to evaluate heart structures which contribute to atrial fibrillation. TEE is a good way to check for clot in the atrial appendage.

The goals of treatment of atrial fibrillation are:

• control of heart rate with medications.
• prevention of atrial fibrillation with medications or ablation therapy.
• Cardioversion (shocking the heart) to normal rhythm.
• prevention of stroke by treatment with coumadin (a strong anticoagulant).

Many patients remain at high risk for stroke despite coumadin treatment.

90% of clots causing stroke come from the appendage.

It makes sense to try and obliterate the appendage.

Appendage closure by suturing is recommended during open heart surgery for valve problems and atrial fibrillation ablation.

Catheter closure of the appendage is now available as a research treatment.

See theinformational video to view the procedure.

Patients at high risk for stroke with atrial fibrillation

Patients able to take coumadin and discontinue coumadin

Patients able to have esophageal echo tests

Many patients with atrial fibrillation do very well with coumadin and rate control medications.

Patients with significant symptoms often do better by maintaining normal rhythm with medications or ablation treatment.

Patients at high risk for stroke or bleeding seem to have lower risk with surgical appendage closure. The PROTECT-AF study with the occlusion of the atrial appendage with the catheter placement of the Watchman® device will help to prove that catheter treatment is effective in preventing stroke and bleeding complications in atrial fibrillation.