At Norton Heart & Vascular Institute, our specialists typically start treating atrial fibrillation (A-fib) with medication. If medication isn’t effective or if side effects are impacting quality of life, there are other options.
Often, a combination of medical therapy, monitoring and minimally invasive surgical intervention can help improve A-ﬁb symptoms or even correct the arrythmia. Our team offers the latest in monitoring; radiofrequency ablation; cryo-ablation; and hybrid procedures such as maze, a combination of ablations; and convergent, a hybrid ablation and surgical procedure.
At Norton Heart & Vascular Institute Heart Rhythm Center we can work with you on new ways to monitor your A-fib and discuss new treatments that our specialists provide.
Nonsurgical management of A-fib
A diagnosis of atrial fibrillation often comes with a prescription for medication to prevent and treat blood clots that may be caused by the arrhythmia. Left untreated, blood clots can lead to a stroke. Additional medications may be prescribed to control heart rate and rhythm. For many patients, these can be the first and most helpful form of treatment.
Answers to your top questions about atrial fibrillation medications
If you’re eager to monitor your own heart rhythm, you can use a device that connects to a smartphone app.
In 30 seconds, you can record an electrocardiogram (EKG) on your smartphone using the Kardia app from AliveCor. Touch the record button and then place two fingers from each hand on small sensors near the phone. If the app detects possible A-fib, it signals an alert.
You can email the EKG reading to your physician for review. A watchband monitor works with the Apple Watch.
As a diagnostic tool, the app is not as accurate as a medical grade device but has benefits, said Kent E. Morris, M.D.
“It does empower patients to take ownership and be more involved in their own health care,” he said.
iRhythm offers an FDA-approved, medical-grade patch monitor called Zio, available by prescription. Zio, which can be worn for 14 days, resembles an oversized adhesive bandage with a rectangular button in the middle. It sticks to the skin just below the left collarbone.
When you experience an unusual heart rhythm, you press the button on the patch and log a note about your symptoms and activities.
“Patients really love the Zio monitor because of the convenience of having just the patch and the lack of obtrusive cables attached to it,” said Robert A. Schwartz, M.D., electrophysiologist, Norton Heart & Vascular Institute Heart Rhythm Center.
Surgical A-fib treatment options
LINQ is a surgically inserted cardiac monitor for patients with infrequent palpitations or syncope, or those diagnosed cryptogenic stroke. The implantable device is the size of a paper clip and lasts up to three years.
“This long-term monitor improves our ability to diagnose their palpitations, cause for syncope or diagnose cryptogenic stroke associated with atrial fibrillation,” said
Tara U. Mudd, APRN, Norton Heart & Vascular Center Heart Rhythm Center.
In some circumstances, it is necessary for us to implant a pacemaker to allow us to use medications more effectively to treat your atrial fibrillation. While a pacemaker itself does not treat A-fib, it does allow us to use medications or certain ablation procedures to help treat your symptoms.
An electrophysiologist performs ablation by inserting a catheter into a blood vessel in the groin and guiding it to the heart. The specialist then carefully destroys malfunctioning tissue using radiofrequency (heat) or cryotherapy (cold). Each scars the problematic areas, so they can no longer transmit abnormal signals.
There are hybrid procedures that combine types of catheter ablations and those that combine ablation with surgical intervention.
Norton Heart & Vascular Institute offers a convergent procedure for A-fib patients with persistent symptoms. If conventional ablation isn’t right for your condition or you’ve had ablation in the past and it didn’t work, our specialists may recommend a convergent procedure.
The procedure is performed in two stages. First, Steven M. Peterson, M.D., cardiothoracic surgeon, Norton Cardiothoracic Surgery, performs an ablation on the outside of the heart where tissue is causing the A-fib. Then, approximately six weeks later, a cardiac electrophysiologist performs an ablation on troublesome tissue from inside the heart.
If you have more persistent A-fib and continue to be symptomatic, you may be a good candidate for the convergent procedure.
Coming at the potential A-fib triggers from inside and outside the heart improves the chances for success, Dr. Peterson said.
The surgery to address the outside of the heart is done through an incision of about an inch under the rib cage. For the ablation inside the heart, an electrophysiologist inserts a catheter in the groin and threads it to the troublesome area inside the heart.
In most patients, the cardiothoracic surgeon also can close off the left atrial appendage — the source of about 90 percent of A-fib-related strokes.
You can expect to be in the hospital for three to four days following the initial surgical portion of the procedure. Typically you’ll have to spend one night in the hospital following the second ablation procedure.
A-fib patients with an existing need for heart surgery can undergo a maze procedure.
During a maze procedure, a surgeon uses both cryotherapy and radiofrequency to create multiple lesions in both the right and left atria to block the erratic signals associated with A-fib. Once the lesion set is completed, patients have a high chance of successfully maintaining a normal heart beat.
The Watchman implant procedure takes place in an electrophysiology lab under general anesthesia and lasts about an hour. The physician places the device into the left atrial appendage to occlude it.
The left atrial appendage is a little pocket of tissue in the heart that is the source of 90 percent of A-fib-related strokes.
“For patients with nonvalvular A-fib who are seeking an alternative to warfarin, the Watchman implant offers a potentially life-changing treatment option that could free them from the challenges of long-term medication therapy,” said Kevin M. Thomas, M.D., electrophysiologist, Norton Heart & Vascular Institute Heart Rhythm Center.
A-fib care for the whole person
We offer classes, events and support groups for patients and families. To register for any activity, call (502) 629-1234.
- Norton Heart & Vascular Institute Resource Center offers education, support and resources for men and women of all ages seeking to improve cardiovascular health, including free classes with topics ranging from tai chi to living a full life with heart failure.
- A-Fib Education Workshops at the Marshall Women’s Health & Education Center discuss the latest in treatment and education offerings. Learn how to live with A-fib at Nortonhealthcare.com/AfibEducation.
- Circle of Hearts: A free education series from Norton Women’s Heart & Vascular Center dedicated to teach women about heart disease
- WomenHeart: Trained heart disease survivors providing recovery plans for women with heart disease
- Pulmonary and cardiac rehabilitation: Medically supervised exercise program and education for patients struggling with respiratory ailments or recovering from a cardiac event
- Communicate with your provider, manage appointments, refill prescriptions and more anytime from a computer or mobile device with a free MyNortonChart account.
About Norton Heart & Vascular Institute
Norton Heart & Vascular Institute specialists treat more cardiovascular patients — about 100,000 every year — than any provider in Louisville and Southern Indiana.
- Our board-certified and fellowship-trained cardiologists, electrophysiologists, cardiothoracic and vascular surgeons have the experience, expertise and easy access you’d expect from Louisville’s leader.
- We have more than 45 board-certified cardiovascular physicians and 30 advanced practice providers. Through training and years of experience, they specialize in areas such as cardiology, interventional cardiology, cardiothoracic surgery, electrophysiology, advanced heart failure and vascular surgery.
- We offer same-day new patient appointments.
- We have 27 locations in Louisville and Southern Indiana. Telecardiology is offered at more than 30 clinical sites in the region.
- We have the experience, expertise and easy access you’d expect from the largest cardiovascular care provider in the state.
- The American College of Cardiology Accreditation Services certifies Norton Healthcare for chest pain and atrial fibrillation care.
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