Heart Arrhythmias: AFib and Atrial Flutter on the Rise in U.S.

A recently published study in The American Journal of Cardiology shows that the incidence of atrial fibrillation (AFib) and atrial flutter (AFL), two common heart arrhythmias, increased in the United States between 1990 and 2017.

The study points to regional differences in the uptick of AFib and AFL cases, with states in New England having the highest incidence among men, and Ohio, West Virginia, Delaware and Louisiana accounting for the highest number of women with these conditions. Deaths related to these conditions that cause irregular heartbeats also increased across the country, except in Alaska, where death rates decreased among men and women. The study also found the number of cases and deaths among women had risen more rapidly, compared to those of men.   

These findings are not surprising to Juan Viles-Gonzalez, M.D., an electrophysiologist with Baptist Health’s Miami Cardiac & Vascular Institute, and the Institute’s director of cardiac electrophysiology, who has authored numerous studies about atrial fibrillation, atrial flutter and the electrical inner workings of the heart.

‘Most Common Arrhythmia’

“Atrial fibrillation is the most common arrhythmia worldwide,” Dr. Viles-Gonzalez said. “More than 60 million Americans have it, and 30 to 50 percent of those also have atrial flutter.”

Arrhythmias occur when the heart’s electrical system malfunctions and causes the heart to beat too fast, too slow or erratically, according to the American Heart Association. Dr. Viles-Gonzalez says that AFib occurs when the left upper chamber of the heart, or atrium, contracts irregularly and prevents the heart from pumping enough blood to the rest of the body. Similarly, atrial flutter starts in the right atrium and prevents enough blood from being pumped to the lungs for oxygen.

Both conditions cause fatigue, palpitations and can weaken the heart muscle over time, leading to heart failure and a significantly diminished quality of life, Dr. Viles-Gonzalez says. Additionally, these types of arrhythmias elevate the risk of blood clots and stroke.

Risk Factors of Atrial Fibrillation and Atrial Flutter

Dr. Viles-Gonzalez says the number of cases of these conditions that cause irregular heartbeats are increasing because the number of people with risk factors for these conditions is also increasing. He says the most common risk factors are:

• Obesity
• Hypertension, or high blood pressure
• Diabetes
• Obstructive sleep apnea

He adds that often, more than one of these risk factors is present. He also says that the sedentary lifestyles and resulting obesity of many children contribute greatly to the increasing number of people with these types of arrhythmias. In one of his published papers on the growing global incidence of atrial fibrillation, Dr. Viles-Gonzalez and his co-authors cite a potential doubling of cases worldwide by 2030.

Preventing Atrial Fibrillation and Atrial Flutter

Luckily, despite the increasing number of AFib and atrial flutter cases, electrophysiologists have effective treatments to offer their patients.

Mario Pascual, M.D., another cardiac electrophysiologist at Miami Cardiac & Vascular Institute, says the best way to treat AFib and atrial flutter is through prevention by controlling those common risk factors.

“The way to prevent AFib and atrial flutter is by maintaining a healthy weight, eating nutritious foods and moderately exercising 20 to 30 minutes each day,” he said. “As with most heart-related conditions, these prevention strategies greatly reduce the risk of developing these arrhythmias.” 

The Institute offers a multidisciplinary team that includes registered dietitians, exercise physiologists, sleep specialists, diabetes educators, heart failure specialists, cardiologists and electrophysiologists, like Dr. Pascual and Dr. Viles-Gonzalez. This team works together to evaluate patients’ risk factors and to develop the most effective plan for reducing them.    

Diagnosing AFib and Atrial Flutter

Once someone is diagnosed with atrial fibrillation or atrial flutter – most often through an electrocardiogram (EKG) or by a wearable heart monitor, such as a Holter monitor – Dr. Pascual and Dr. Viles-Gonzalez evaluate the heart muscle with an echocardiogram (ECHO) or ultrasound of the heart.

This helps determine if the heart is structurally normal, which points to a different treatment strategy than if there’s an abnormality of the heart muscle, such as tissue damage from a prior infection that has resulted in cardiomyopathy, or a congenital defect that makes the heart look and function differently. They also check for any other underlying heart disease, such as heart failure or coronary artery disease.   

Treating AFib and Atrial Flutter

Both Dr. Pascual and Dr. Viles-Gonzalez recommend rhythm-control strategies that have proved effective. In structurally normal hearts with no symptoms of either arrhythmia, they often start their patients on antiarrhythmic medications, which help suppress electrical signals that cause the erratic beats associated with AFib and atrial flutter. If these medications are well tolerated by the patient and don’t cause problematic side effects that impact quality of life, these often-daily medications may be enough to effectively treat the arrhythmias and prevent stroke or heart failure.

Catheter Ablation

In patients with structural heart defects, with underlying heart disease or who are symptomatic, Drs. Pascual and Viles-Gonzalez encourage them to undergo cardiac ablation, which they both perform at Miami Cardiac & Vascular Institute.   

With cardiac ablation, the doctors find the abnormality in heart tissue that is causing the electrical signals to misfire. Then, through a catheter, or hollow tube, inserted into a vein in the groin, they thread a heating or cooling device to that area of the heart. Heating or cooling the tissue essentially permanently allows the proper conduction of the electrical signals through the heart to keep it beating regularly.

Following the procedure, Dr. Pascual says that patients go home the same day or the next day, are fatigued for two to three days and are restricted from lifting anything heavier than 20 pounds for two weeks. Patients are prescribed anticoagulant medications, some temporarily, to keep their blood thin. They are also referred to the Institute’s multidisciplinary team for follow up to address and manage the risk factors that led to the arrhythmias in the first place.

“It’s important for patients to understand that it’s not simply ablation that we offer,” Dr. Pascual said. “We must also help patients reduce their risk factors to prevent other heart conditions and improve these patients’ overall quality of life.” 

Improved Technology Improves Treatment

Dr. Viles-Gonzalez has extensively studied the effectiveness of catheter ablation on atrial fibrillation and atrial flutter over his career, with his latest paper, published in December 2020, showing a “significant” reduction in hospitalizations due to atrial fibrillation and atrial flutter following catheter ablation.

Dr. Pascual says with research like Dr. Viles-Gonzalez’s and with improved technology that makes the procedure easier to perform and has enhanced its safety, the long-term effects of catheter ablation have greatly improved the quality of life for patients over the last five years.

“While AFib and atrial flutter are not life-threatening conditions themselves, stroke prevention is key, as is preventing long-term heart damage that impairs quality of life,” he said.   

Caption: With AFib and atrial flutter on the rise, Miami Cardiac & Vascular Institute electrophysiologists are using catheter ablation to prevent stroke and other complications from these arrhythmias.