By AMERICAN HEART ASSOCIATION NEWS
Spencer Moseley is not the type of person you’d expect to have a heart problem.
A dedicated runner with 50 marathons under his belt, Moseley kept meticulous track of his pace while logging 45 to 60 miles a week. Usually, he kept a steady 7:30 per-mile pace with a 140 beat-per-minute heart rate. But last year, he noticed that rate was increasing. He thought he might be sick, so he scaled back. Or maybe it was just the stress of recent international travel, a transfer of his military-related job and a recent move. Still, it continued to worsen.
“I was winded on easy runs,” said Moseley, who turns 50 in June. “What was I doing walking on a four-mile run? I was posting heart rates of 220 to 230 heartbeats per minute.”
Moseley was due for an annual physical, and when he mentioned his symptoms, a nurse listened to his heart and gave him an EKG, an electrocardiogram. Then, his doctor told him he had a condition called atrial fibrillation – and that he needed tests at a hospital right away.
Moseley’s condition, a quivering or irregular heartbeat in the upper chambers of the heart, affects about 33.5 million people, including an estimated 2.7 million to 6.1 million people in the United States. Researchers expect the number to double by 2050.
“A lot of people, when you say atrial fibrillation, they say, ‘I think I’ve heard of that,’ or, ‘My grandfather had that.’ But people don’t understand how common it is today,” said Dr. Jonathan Piccini, director of the Center for Atrial Fibrillation at Duke University Medical Center in North Carolina. “If you are older than 40 years old, there’s a one in four chance that in your lifetime you are going to get it. It’s very common.”
But as common as AFib may be, it is not something to take lightly: Untreated, AFib doubles the risk of heart-related death. It increases a person’s chance of having a stroke five-fold.
What causes the quiver?
Basically, each heartbeat is controlled by the heart’s electrical system. An impulse begins at the top of the heart and travels like a wave to the lower chambers, signaling the tissue to contract. In a healthy adult, a node in the top of the heart fires off between 60 and 100 heartbeats per minute. The electrical wave moves through the atria to another node that acts as a kind of gatekeeper for electrical pulses going from the top to the bottom chambers.
But in AFib, that electrical system malfunctions. The top chambers, the atria, don’t produce an effective regular contraction, either beating too fast or unevenly. When that happens, the heart fails to squeeze all the blood from one chamber to the next. That can leave blood to pool in the atria, which can increase the risk of clotting. If a blood clot forms, it can break off and lodge in an artery leading to the brain, blocking off blood supply and causing a stroke.
With weak or irregular contractions, a heart in AFib can allow blood to back up in the pulmonary veins, causing fluid buildup in the lungs, which causes fatigue and shortness of breath. And when oxygen-rich blood doesn’t get delivered to the body and brain, physical and mental fatigue can set in. Fluid also can build up in the feet, ankles and legs, causing heart failure-related weight gain.
The many facets of AFib
People who experience AFib describe it in a wide range of ways – a painful thumping in the chest, a racing heart that leaves them gasping for air, a fluttering in the chest. Some feel dizzy or nauseated. But many people aren’t even aware of their symptoms.
Overall, most of the risks, symptoms and consequences of AFib are related to how fast the heart is beating and how often rhythm disturbances occur. AFib may be brief, with symptoms that come and go. It is possible to have an atrial fibrillation episode that resolves on its own. Or, the condition may be persistent and require treatment. Sometimes AFib is permanent, and medicines or other treatments can’t restore a normal heart rhythm.
The risk for AFib increases with various stressors on the heart, including high blood pressure, heavy drinking, obesity and sleep apnea. It can be influenced by heredity and genetics and is more common with age.
But “for reasons we don’t quite understand,” Piccini said, some high-endurance athletes also have a higher risk of developing atrial fibrillation. “It’s not uncommon to see ultrarunners and long-distance cyclists with atrial fibrillation.”
After diagnosis, Piccini said he discusses three goals with his patients – preventing stroke, making sure the heart isn’t racing and controlling symptoms. The treatment might include medicines such as blood thinners, lifestyle changes and surgical procedures.
A world upended
On Oct. 3, three days after he and his wife closed on their new house in Virginia, Moseley had an ablation surgery on his right atrium, an upper heart chamber. In cardiac ablations, doctors typically use a catheter, threaded through the large veins, to help scar or destroy the exact tissue in the heart that’s causing the incorrect electrical signals.
While “destroying heart tissue” doesn’t sound like a good thing, this common procedure saves lives each year. Catheter ablation is considered a procedure, not surgery, and typically takes three to six hours. Sometimes, the procedure has to be repeated.
Since October, Moseley has had a second ablation and six cardioversions, in which doctors shock the heart to try to place it back into normal rhythm. He is scheduled for a third ablation in March.
It’s been tough for him, and for his wife, to get used to a new normal, with its slower pace, medicine and procedures.
“Everything outside my professional life was based on this running, being fit and being outside,” he said. “We scheduled vacations around it. I might run again, but never like I used to. That side of my life is now gone, and I have to go through a grieving process. I need to find something else. … I’m still waiting for that sunrise.”
Waiting for the sunrise. It’s become his mantra of sorts, to get him through darker times and the lonely overnight hours when his AFib symptoms keep him awake. He’s been sharing his experiences, and his sharp sense of humor, on an online community board hosted by the American Heart Association and StopAfib.org, called My AFib Experience.
It’s not a sprint
Piccini, who sees patients at Duke as a cardiac electrophysiologist and studies AFib as a researcher, acknowledges the condition and all its unknowns can be scary. But “people with atrial fibrillation can have complete, happy and productive lives.”
While in some cases AFib can be cured, it’s most likely going to “be a lifelong traveling companion” that needs to be managed, Piccini said. And a growing number of treatment options and new research means there are plenty of reasons for optimism.
“What I tell my patients is sometimes you have to go through several treatments before you find the one that works for you,” he said. “Sometimes it’s a cumulative effect of several treatments. You have to have patience. You have to have faith, and you have to keep fighting. It’s going to take some time, and it’s not a sprint. It’s a marathon.”
That’s something Moseley knows quite a lot about.
For more information:
–A quick primer on atrial fibrillation
–View an AFib animation
—Resources for the newly diagnosed
AFib terms and what they mean
Ablation – A thin, flexible tube called a catheter is inserted into blood vessels and guided to the heart. Doctors use it to deliver radiofrequency, laser or cryotherapy to scar the areas sending abnormal electrical signals.
Arrhythmia – an abnormal heartbeat
Cardioversion – restoring the regular rhythm of the heart with medicines or with an electric shock outside the chest and while under mild anesthesia
Electrophysiologist/electrophysiology – conducts tests to study the electrical activity of the heart to find where an abnormal heartbeat is coming from
ECG or EKG – electrocardiography, a painless, non-invasive procedure that records the heart’s electrical activity and can help diagnose arrhythmias
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