 Today we'll be talking about atrial fibrillation. This is a very common abnormality that affects the heart and people usually of older age affected more than younger people. This abnormality is electrical issue that affects the top chamber of the heart. Usually the atrium beats regularly. With fibrillation it goes like this without really beating it regularly. This fibrillation in the top chamber causes the bottom chamber to go very fast. When the bottom chamber goes very fast patients feel palpitations, sometimes shown as a breath. If it goes unrecognized it may cause heart failure, where the bottom chamber becomes tired, enlarged and weak. That will drive the patients to the doctor. The risk of atrial fibrillation is mainly due to inducing strokes. What happens with the top chamber when it's not beating regularly and fibrillating like this, the blood doesn't move effectively and the blood becomes stagnant and then it may clot and then a piece of the clot may break loose and go to the brain or in fact any part of the body. This is a very common cause for strokes. About 25% of strokes are caused by atrial fibrillation. When the patient comes to us with this problem, our duty is to find out a few things. Number one, why it happened. For example, a patient had thyroid problem that could provoke atrial fibrillation. Alcohol is a common problem. Hypertension is a common cause of this. There are many other causes like valve or heart disease, leaky valves or blockages and the vessels of the heart. So our evaluation is focused on finding the reason. So we do stress test, we do echo which is ultrasound of the heart to find out if there is a valve problem or weak heart muscle. We also look for any clots that could be already present. The second thing is we need to give them medications to slow the heart rate down because that would make them feel short of breath. So we give them medicine like beta blockers or toprol, calcium champlockers or cardyzam. But most importantly, we give them blood thinner. Now blood thinners are many. We have coumadin which is probably known by most people. It is a right poisoning. However, it's very uncontrollable. It's affected by food, other medications we use, the time we take it, the dose we take. Many things affect the level, and the level rarely stays in a normal range that we want it. And it requires blood testing every week or two to monitor the effect. There are new class of medications called the nuax, or new oral anticoagulants. For example, predaxa, xeralto, alequus, sevesa, those are the four names that are in the market. Dose medications are easy to use. They don't require monitoring of blood level because they are more steady in the blood. In fact, the trials show that they are more effective in decreasing stroke rate compared to coumadin when they compare them head-to-head in randomized trials. Also, the bleeding from them is as low as coumadin or even lower in some instances. So we prefer those medications except when the insurance does not cover them. Finally, when patients have AFib, we would like to get them out of atrial fibrillation. How do we do that? We do what's called cardioversion, or what's known as shock in the heart. We do it under anesthesia in the hospital. It's our patient. It takes a few seconds. The patient is monitored for about an hour after that and they go home. If the AFib capsules are occurring, then we refer them to have oblation. And that's done by electrophysiologists which is subspecialty in cardiology. And what they do, they go inside the vein from the groin up to the heart. They find the problem that is causing the atrial fibrillation, the area, and they burn, put micro burns with radiofrequency energy so they can block those extra channels causing the atrial fibrillation. Finally, if we cannot give the patient blood thinners and they are at risk for having clots, there's a new device called Watchmen. Now, Watchmen devices like umbrella sits in part of the atrium called the appendage and that prevents the formation of clots and prevent strokes. It's available in our practice and available in our hospitals. Please ask your doctor for it if you qualify to have the implantation. Have a good day.