Atrial Fibrillation or A-Fib

A-Fib is the most common heart arrhythmia, affecting one in nine people over the age of 65 or somewhere between four and six million Americans. Men are more commonly affected up to age 65, and then the incidence in women dominates because they outlive men by about four to five years and have a longer number of years at risk. African-Americans are less at risk than Caucasians of European extraction.

For just a short review of heart function, a small node in the right atrium of the heart named the sinoatrial node generates and transmits an electrical impulse to the left atrium and to the atrioventricular (AV) node.

In the case of A-Fib, there are more sites in the left atrium that are electrical sources, and these may fire off enough to override the AV node and cause irregular heartbeats in the atrium and ventricle. Also, there is a small cavernous appendage coming off of the atrial wall, and this is about as large as the third segment of the fifth (small) finger.

When A-Fib occurs, clots may form in the appendage and are the source of blood clots for stroke or embolism to the arteries of the extremities, kidneys, or intestines. All of these are serious medical problems, so it is important to get rid of the A-Fib or identify high-risk individuals and prescribe blood thinners when necessary.

Effective ways for getting rid of the A-Fib include medications, radio frequency, ablation of the extra electrical sites in the left atrium, or procedures called MAZE III or mini-MAZE, in which the electrical sites near some of the pulmonary veins are excised or cut away. It is also possible to excise or close off the atrial appendage which eliminates the source of clots but does not eliminate A-Fib.

Prior to any of these options, a procedure called cardioversion (an electric shock to the heart) can sometimes be effective in eliminating the irregular heartbeat and can be followed up with medication which helps sustain a regular heartbeat. It should be mentioned that paroxysmal A-Fib can come on and then go away spontaneously, sometimes not needing any follow-up treatment unless it becomes frequent.

On a personal note, because of arthritis in one knee joint due to a football injury in high school, I was examined and told that knee joint replacement would help me overcome this moderately disabling problem and make me more mobile and pain-free. After the surgery date was selected, I found out by accident that there was a new procedure called the Sentara-WATCHMAN and this enabled obliteration of the atrial appendage with a small prosthesis placed in a vein in the leg. Although about 10,000 of these have been done around the world, Dr. Paul Mahoney at the Sentara Heart Hospital has done 30+ of these with good results.

The procedure takes about 1-1/2 hours, and is preceded by ultrasound delineation of the appendage and followed up six weeks after surgery to ensure proper placement of the small implant obliterating or filling this appendage. Six weeks after the surgery, I came off of Coumadin and have done well with the arthritis by taking NSAIDs which I have not been able to take for over five years. Now that I can take NSAIDs, my knee is so much better that the knee surgery has been cancelled and I hope that it will not be needed ever.

The procedure is available to those with A-Fib, and for me was easy and effective. The reason for telling you about it is that none of the physicians with whom I have discussed this even knew about it, and so I assumed that the general public did not either.

In summary, if you develop A-Fib as determined by pulse rate or EKG, you should discuss your options for treatment of this with a cardiologist and be sure to ask about the WATCHMAN procedure which is easy to go through and also effective. Go to and watch the WATCHMAN procedure for more clarity and understanding of the minimally invasive procedure.

Dr. James Carraway is a plastic surgeon at the Cosmetic & Plastic Surgery Center of EVMS. Call 757-557-0300.

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James H. Carraway, M.D.

Dr. James Carraway is a full-time academic and practicing clinical plastic surgeon.  He is Director of the Cosmetic & Plastic Surgery Center of EVMS, is board certified in surgery and plastic surgery, and is a fellow of the American College of Surgeons.  Dr. Carraway has been teaching and practicing for 30+ years and has been director and chairman of residency training programs and fellowship programs in plastic surgery.
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