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GLOSSARY
- A-Fib:
- Abbreviation for Atrial Fibrillation
- Ablation:
- The elimination of heart tissue which causes A-Fib.
This tissue is physically destroyed by applications of RF, Cryo (freezing), laser, or ultrasound
energy.
- ACT:
- Abbreviation of "Activated Coagulation Time."
Used to measure the effect of high dose heparin before, during and shortly
after surgeries which requires intense anticoagulation. ACT is measured at
intervals during a Pulmonary Vein Ablation procedure to achieve and maintain
a steady level of heparin anticoagulation. ACT is measured in seconds. The
higher it is, the higher the degree of clotting inhibition.
-
Action Potential:
- When a heart cell goes from a negative resting value to a positive
value. See
http://library.thinkquest.org/C003758/Function/The Cardiac Action
Potential.htm
- Adrenergic A-Fib:
- See Vagal & Adrenergic A-Fib.
- AF:
- Abbreviation for Atrial Fibrillation
- AFib:
- Abbreviation for Atrial Fibrillation
- Amiodarone:
- Brand name Cordarone. An antiarrhythmic drug
(Class 3). See Medications.
- Anatomically-Based
Circumferential Ablation:
- A type or method of Pulmonary Vein Ablation
(Isolation) developed by Dr. Carlo Pappone. Also called "Left Atrial
Ablation." It creates
blocking lesions in the left atrium similar to "Circumferential" ablation. But instead of trying to make continuous, perfect linear lesions
around the Pulmonary Veins, a
large diameter catheter at a high wattage is dropped and dragged to make the
circular linear lesions. There may be gaps left in these lesions which may
result in Atrial Flutter. But over time scar tissue usually closes these gaps
(see Morady and
Pappone).
(Please be advised that the "Anatomically
Based Circumferential Ablation" procedure may be responsible for isolated
cases of Atrial Esophageal Fistula in which a hole forms between the atrium and the
esophagus, often resulting in death. It is presumably caused by the use of
high wattage catheters during catheter ablation procedures to fix A-Fib. If your doctor uses this
procedure, ask him what steps he/she takes to prevent causing a hole to form in the
esophagus.)
- Aneurysm:
- A ballooning out of a blood vessel or of a portion of the heart muscle. If
the aneurysm ruptures, it can be deadly.
- Angina Pectoris:
- Chest pain caused by reduced blood flow to the heart.
- Antiarrhythmic Medications:
- Drug therapy that attempts to stop A-Fib and
make the heart beat normally. See Medications.
- Anticoagulants:
- Medications such as warfarin (Coumadin) which
help prevent blood clots and stroke.
An anticoagulant works by slowing the production of blood clotting
proteins made in the liver. (Oral
anticoagulants like warfarin are also called "vitamin K antagonists," since
they work by counteracting the coagulation vitamin K.)
-
Antiplatelets:
- Medications such as Aspirin, Plavix, Ticlid which help prevent blood clots and stroke. An antiplatelet works by decreasing the
stickiness of circulating platelets (small blood cells that start the normal
clotting process), so that they adhere to each other less and are less
likely to form blood clots. (Plavix and Ticlid are
antiplatelet drugs like aspirin but they are not the same or interchangeable
with aspirin. If your doctor prescribes Plavix or Ticlid, you should not
substitute aspirin for them.)
- Aortic
Valve:
- The heart valve between the Left Ventricle and
the Aorta. The Left Ventricle pumps oxygenated blood through the tricuspid
(three flapped) Aortic Valve into the Aorta which carries it to the rest of
the body. When pressure in the Left Ventricle drops, the pressure of blood
in the Aorta will push the Aortic Valve closed. To see an excellent video of
how this valve works, go to
http://www.youtube.com/watch?v=WXwYYsi6z7Q&feature=player_embedded
- Arrhythmia:
- An abnormal heart rhythm.
- Arrhythmic:
- Having an abnormal heart beat: too fast is
called Tachycardia, too slow is called Bradycardia, or irregular is called
Fibrillation.
-
ATP (Adenosine Triphosphate):
- A chemical used by cells as an energy carrier. It transports chemical
energy within cells for metabolism. See
http://en.wikipedia.org/wiki/Adenosine_triphosphatehttp://en.wikipedia.org/wiki/
-
Adenosine_triphosphate
-
Atrial-Esophageal Fistula:
- A hole that forms between the atrium and the esophagus, often resulting in
death. It is presumably caused by the use of high wattage catheters during
catheter ablation procedures to cure A-Fib.
- Atrial Fibrillation (A-Fib):
- A heart rhythm disorder in which the upper
chambers of the heart (the atria) contract (quiver) very rapidly and
irregularly as many as 300-600 times a minute, due to chaotic, uncoordinated
electrical activity; it usually originates in the left atrium.
- Atrial Flutter
(A-Flutter):
- A heart rhythm disorder in which the upper
chambers of the heart (the atria) contract faster than the lower chambers (the
ventricles) in an organized, predictable pattern. (In Atrial Fibrillation the
atria beat chaotically and irregularly.)
You can consider Atrial Flutter as a more regular variety of A-Fib.
A-Flutter often, though not always, originates in the right atrium, whereas
A-Fib usually comes from the left atrium.
Here is an EKG of Atrial Flutter:
ECG 3 - atrial flutter

This ECG illustrated a heart
in atrial flutter. This has very distinct appearance. The "flutter waves"
that we expect to see in atrial flutter are noticeable throughout the ECG,
but are very easy to see in the rhythm strip. The rhythm is still regular,
although this is not always the case in AFL
130 (from
wolfminimaze.com)
-
Atrial Natriuretic Peptide (ANP):
- A powerful vasodilator and a hormone secreted by heart muscle cells in
the upper chambers (atria) of the heart. It reduces the water and sodium
loads on the circulatory system. It is released in response to atrial
stretch and other signals such as atrial fibrillation.
http://en.wikipedia.org/wiki/Atrial_natriuretic_peptide
-
Atrial Tachycardia:
- A rhythm disturbance in the atria of the heart. An electrical impulse
comes from somewhere in the atria other than from the
SA Node which is the normal pacemaker of the heart.
In A-Fib Ablation, Atrial Tachycardia can be considered a
milder form of Atrial Flutter. During an
ablation procedure, first A-Fib signals disappear, second A-Flutter signals,
then Atrial Tachycardia.
-
Atrioventricular (AV) Node:
- The AV Node is specialized conducting tissue
that acts as an electrical road or gate connecting the atria to the
ventricles. Normally the AV Node is the only electrical connection between
these heart chambers. See Overview.
-
Atrioventricular (AV) Nodal Reentry Tachycardia (AVNRT):
- The AV Node develops two pathways instead of one, allowing a signal to go
down one pathway, then back up the other pathway to the atrium (reentrant
circuit) resulting in
Supraventricular Tachycardia (speeding up the heart beat).
- Atrium (plural Atria):
- Either one of the two upper chambers of the
heart in which blood collects before being pumped into the lower chambers
(ventricles). See Overview.
- AV Node:
- See
Atrioventricular Node.
- AVNRT:
- See Atrioventricular (AV) Nodal Reentry
Tachycardia.
- Beta Blocker:
- A medication that slows down conduction through
the heart and makes the AV Node less sensitive to A-Fib impulses. See
Medications.
- Betapace:
- See Sotalol.
-
Bicuspid Valve:
- See Mitral Valve.
-
Bidirectional Block:
- Refers to both Exit Block
and Entrance Block, goals of a successful A-Fib
ablation. Signals from both inside and outside the Pulmonary Vein can not
cross the ablation lesions.
- Blood
Thinners:
- Antithrombotic medications which don't actually thin the blood. Rather
they inhibit the ability of substances in blood to form clots.
- BMBS
(MBCHB, MBBS):
- Bachelor of Medicine, Bachelor of Science. Awarded on graduation from
medical school in various countries which follow the tradition of the United
Kingdom. (Like an MD.)
- Bradycardia:
- A heart rhythm problem in which the heart beats
slower than normal. Bradycardia may be caused by the SA Node not working
properly or by the electrical pathway in the heart being blocked (heart
block).
- Calcium Channel Blocker:
- A medication that prevents or slows the flow of
calcium ions into smooth muscle cells such as the heart. This impedes muscle
cell contraction, thereby allowing blood vessels to expand and carry more
blood and oxygen to tissues. See Medications.
- Cardiac Arrest:
- When the heart quits pumping effectively.
- Cardiologist:
- A doctor who specializes in the diagnosis and
treatment of heart disease and blood vessel problems; often referred to as the
"plumber" of the heart.
- Cardiomyopathy:
- A heart condition or disease in which the heart muscle is weakened and the
heart's ability to pump blood is impaired. For example, fibrous tissue may
partially replace the heart muscle, disabling the heart so that it no longer
functions properly, and blood no longer moves efficiently. Cardiomyopathy is often accompanied by atrial
fibrillation.
- Dilated Cardiomyopathy: The lower chambers of the heart
become enlarged and cannot pump efficiently.
- Hypertrophic Cardiomyopathy: The walls of the heart become
thickened and stiff, and are unable to properly fill and pump blood
efficiently. This disorder often runs in families.
- Restrictive Cardiomyopathy: The heart chambers are unable
to expand and fill with blood between contractions.
(See
http://www.hrspatients.org/patients/the_normal_heart/
structural_defects.asp)
(The World Health Organization recognizes Cardiomyopathy
as a "selenium deficiency.")134
-
Cardiopulmonary Bypass:
- A technique that temporarily takes over the
functions of the heart and lungs during heart surgery, maintaining the
circulation of blood and the oxygen content of the body; commonly referred
to as a heart-lung machine.
- Cardioversion:
- Converting the heart from A-Fib to normal rhythm by using medications
and/or electrical shock.
-
Carotid Sinus Stimulus (Massage):
- Doctors partially block or slow down the flow of
blood through the carotid sinus. It is used to tell the difference
between different types of arrhythmias, and "rarely, may also terminate the
arrhythmias and reestablish sinus rhythm."212
- CARTO Mapping:
- An A-Fib mapping system that uses a special catheter to generate 3-D maps
of the heart.
- Catheter:
- A soft, thin, flexible tube with an electrode at
the tip.
- Catheter Ablation:
- A procedure in which a catheter (a soft, thin,
flexible tube with an electrode at the end) is inserted through a vein or
artery in the groin or neck and moved into the heart. Through the electrode,
RF, laser, Cryo (freezing) or ultrasound energy is applied to eliminate or physically destroy
specific heart tissue.
- CAT Scan:
- Short for Computed Axial Tomography---a method of producing 3-D images by
recording the passage of waves of energy through structures.
- Caviotricuspid Isthmus:
- In the Right Atrium this is the space between the Inferior Vena Cava and
the Tricuspid Valve. In ablation for Right Atrial Flutter, a Caviotricuspid
Isthmus ablation line is often made to prevent Atrial Flutter.
- CCDS:
- Certified Cardiac
Device Specialist. Designates an EP who has passed an exam for cardiac
devices such as pacemakers. The exam is given by the International Board of
Heart Rhythm Examiners (IBHRE) affiliated with the Heart Rhythm Society. This
credential may not be totally relevant to A-Fib ablation.
- CFAE:
- Complex Fractionated Atrial Electrograms (an
electrogram is a picture of the electrical activity of the heart as sensed
by a pacemaker or catheter in the heart). Discovered by Dr. Koonlawee
Nademanee of the Pacific Rim EP Research Institute in Inglewood, CA, they
are low voltage electrical signals with very short cycle lengths used to
identify areas in the heart that need to be ablated. See
Complex Fractionated Atrial Electograms.

- CHADS2:
- CHADS2 refers to risk factors for stroke. If you have one of the risk
factors, you have a risk score of 1. However, if you’ve had a stroke
already, that counts as a risk score of 2 ("S2"):
- "C" Congestive Heart Failure Score = 1
- "H" Hypertension
Score = 1
- "A" Age 75 or over Score = 1
- "D" Diabetes
Score = 1
- "S2" Previous Stroke or TIA Score = 2
For example, someone with a risk factor of 1 not receiving
any anticoagulant therapy would have 1.9%-2.8% chance of having a stroke within
a year, whereas someone with a score of 6 would have an 18.2% chance of having a
stroke.
- CHA2DS2-VASc:
- A European refinement of the
CHADS2 identifying more risk factors for stroke.
• "C" Congestive Heart Failure/ Score
= 1
LV Dysfunction
• "H" Hypertension
Score = 1
• "A2" Age 75 or over
Score = 2
• "S2" Stroke/TIA
Score = 2
• "V" Vascular Disease (prior
heart attack, peripheral
artery disease, aortic plaque)
Score = 1
• "A" Age 65-74
Score = 1
• "Sc" Sex category (female)
Score = 1
People with a score of 1 can be treated with aspirin or oral
anticoagulant, but preferably oral anticoagulant. People with a score of 2
or above should be treated with oral anticoagulant. Low risk people with a
score of 0 don't need blood thinners.
This risk factor model recognizes that women have a
significant risk of stroke. Any woman 65 or over should be on
anticoagulants.
-
-
Chronic Atrial Fibrillation:
- In chronic A-Fib the heart remains in A-Fib all
the time, as contrasted with "paroxysmal" A-Fib where the heart has occasional
attacks of A-Fib.
-
Circumferential Catheter Ablation:
- A Catheter Ablation technique that utilizes a catheter to make
circular lesions around the Pulmonary Vein openings, thereby isolating the
Pulmonary Veins from the rest of the heart. This prevents A-Fib pulses
produced in the Pulmonary Veins from spreading through the rest of the heart.
A type of Pulmonary Vein Ablation.
- Class 1 Medications:
- Sodium Channel Blocker medications which
decrease the speed of electrical conduction in the heart muscle. See
Medications.
- Class 2 Medications:
- Beta-Adrenergic or Beta-Blocker medications
which slow down conduction through the heart and make the AV Node less
sensitive to A-Fib impulses. See Medications.
- Class 3 Medications:
- Potassium Channel Blockers which slow nerve
impulses in the heart. See Medications.
- Class 4 Medications:
- Calcium Channel Blockers which prevent or slow
the flow of calcium ions into smooth muscle cells such as the heart. This
calcium blocking impedes muscle cell contraction, thereby allowing blood
vessels to expand and carry more blood and oxygen to tissues. See
Medications.
-
Complex Fractionated Atrial Electrograms (CFAEs):
- A low voltage A-Fib signal with many deflections and irregular spiking and
often with a very short cycle length. Discovered by
Dr. Nademanee, they are used to identify sources of A-Fib in the heart.
See CFAEs.
- Congestive Heart Failure:
- The heart is unable to pump adequate amounts of blood, often as a result
of a heart attack.
- Cordarone:
- See Amiodarone.
Coronary Artery Disease (CAD):
Plaque accumulates in the coronary arteries limiting the flow
of blood to the heart.
CAD sometimes results in a blood clot that causes a
heart attack.
Coumadin:
An anticoagulant whose generic name is
"Warfarin." See Medications.
C-Reactive Protein (CRP):
A marker or sign of inflammation, often found in patients with A-Fib.82
Cryoablation:
An ablation technique that freezes the focal sources of A-Fib rather than
ablating them with RF energy.
Dabigatran (brand name Pradaxa):
Dabigatran is a direct thrombin inhibitor, a newer type of blood thinner medication.
Thrombin is an enzyme that converts soluble fibrinogen into insoluble
fibrin. Fibrin is a fibrous protein involved in the clotting of blood. It
forms a mesh or clot over a wound. Dabigatran does not require close
monitoring and has less bad side effects than warfarin. It is expected to
replace warfarin as the blood thinner of choice for A-Fib.
Defibrillator:
An electrical device that delivers a shock in
order to restore the heart to normal rhythm. It is used primarily in life
threatening conditions to stop very rapid and irregular heart beats.
DHA:
Docosahexaenoic Acid, a fish oil/omega-3 fatty acid that plays a crucial
role in brain function, as well as in normal growth and development.
Diastolic
Blood Pressure:
The optimal blood pressure reading currently is 115/75.59
The "75", the second number, is the Diastolic Blood Pressure---the amount of
pressure in your arteries when your heart is at rest between beats. See
Systolic Blood Pressure.
Digoxin:
A rate-control medication that is a Digitalis
compound, brand name Lanoxin. Digoxin slows down and controls the heart rate
by blocking the electrical conduction between the atria and ventricles. See
Medications.
Ditiazem:
A rate-control calcium-channel blocker
medication. See Medications.
Disopyramide:
Brand name Norpace. An antiarrhythmic drug
(Class 1A). See Medications.
DO:
Doctor of Osteopathic Medicine
Dofetilide:
Brand name Tikosyn. An antiarrhythmic drug
(Class 3). See Medications.
Top of Page
ECG:
See Electrocardiogram.
Echocardiography (Cardiac
Ultrasound):
An imaging technology in which special sound
waves are bounced off of the structures of the heart. A computer converts
these images into moving pictures.
Ectopic Beats:
Beats that come from any region of the heart
that ordinarily should not produce heart beat signals. Normal heart beats come
from the Sinus Node, not from areas like the Pulmonary Vein openings where
most A-Fib signals originate. See Overview.
Effective Refractory Period (ERP):
Effective Refractory Period (ERP) refers to the period
of time a cell can not be activated by a new action potential. The ERP acts as
a protective mechanism in the heart by preventing multiple, compounded action
potentials from occurring (i.e., it limits the frequency of depolarization and
therefore heart rate). This is important because at very high heart rates, the
heart would be unable to adequately fill with blood and therefore ventricular
ejection would be reduced.
Many antiarrhythmic drugs alter the ERP, thereby altering
cellular excitability. For example, drugs that block potassium channels (e.g.,
amiodarone, a Class III antiarrhythmic) delay phase 3 repolarization and
increases the ERP. Drugs that increase the ERP can be particularly effective
in abolishing reentry currents that lead to arrhythmias. [Based on
"Cardiovascular Physiology Concepts by Richard E. Klabunde.]103
Ejection Fraction:
The ratio of the volume of blood the heart pumps out during contraction to
the volume of blood in the heart when it fills up with blood. It is expressed
as a percentage normally between 56 and 78 percent.
EKG:
See Electrocardiogram.
Electrical Cardioversion:
Delivering an electrical shock to the heart in
order to convert it from A-Fib to normal rhythm.
Electrogram (EGM):
A picture of the electrical activity of the heart as sensed by an ICD or
pacemaker implanted in the heart, or produced by catheter mapping devices
inside the heart. (This is different from an Electrocardiogram
which senses the heart's electrical activity from the surface of the skin.)
Electrocardiogram (ECG or EKG):
A graphical representation of the electrical
activity of the heart. 12 sensors placed on different parts of the body record
electrical activity from 12 different areas of the heart. These signals are
listed as I, II III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6. An
Electrocardiogram is used as an examination tool to determine if you have
A-Fib, and can sometimes show a doctor where in your heart an arrhythmia signal is
coming from. It is also used during an ablation procedure to determine if an
A-Fib signal source has been ablated/isolated.
Electrophysiologist:
A Cardiologist who specializes in the electrical
activity of the heart and in the diagnosis and treatment of heart rhythm
disorders; the "electrician" of the heart. (An Electrophysiologist performs Pulmonary Vein
Ablations.)
Electrophysiology Study (EP)
(EPS):
A test which uses a catheter inserted through
the veins into the heart to determine which areas in the atria give rise to
Atrial Fibrillation or Flutter.
Entrance Block:
When a signal can not enter a pulmonary vein
isolated by catheter ablation lesions. This is a goal of a successful A-Fib
ablation, along with Exit Block. Entrance and Exit
Block are called Bidirectional Block.
EPA:
Eicosapentaenoic Acid, a fish oil/omega 3 essential fatty acid
Esmolol:
A rate control beta-blocker medication. See
Medications.
Esophageal Fistula
A hole that forms in the esophagus. See
Atrio-Esophageal Fistula.
Event (Loop) Recorder:
A portable type of
EKG that is patient-triggered. When you feel an episode of A-Fib,
you press a button to record several minutes of the A-Fib episode. (It's
actually recording all the time. When you press the button, it captures some
minutes before you press the button and for some time after.) It's called a
Transtelephonic Monitor if you call in to transmit the signals you recorded.
Some Event (Loop) monitors start automatically when they
sense abnormal heart rhythms. You don't need to press a button when you feel
an A-Fib episode.
Exit Block:
An A-Fib signal is blocked by ablation lesions
from leaving the pulmonary veins and affecting the rest of the left atrium.
This is a goal of a successful A-Fib ablation, along with
Entrance Block. Entrance and Exit Block are
called Bidirectional Block.
FACC:
Fellow of the American College of Cardiology. Designates a
Cardiologist who has
completed a minimum of ten years of clinical and educational preparation and
passed a rigorous two-day exam given by the American Board of Internal Medicine.
It's not an absolute requirement for an EP, but most EPs have passed this
Cardiology Board exam.
FDA:
See Food and Drug Administration.
FHRS:
Fellow
of the Heart Rhythm Society. Not an academic title and not limited to
physicians. Membership is based on peer review. Designates heart rhythm
professionals working in the field of electrophysiology and/or pacing, provided
that the majority of their time is not devoted to marketing and/or sales. Most
EPs in the US with FHRS credentials have also achieved FACC. Internationally
this may not be the case.
Fibrillation:
Rapid, uncoordinated contractions of individual
heart muscle fibers.
Fibrosis:
Hardened tissue in the atrium. A condition occurring in A-Fib where the heart develops fiber-like
characteristics
in place of the normal smooth walls of the heart. Fibrosis
seems to be linked to A-Fib.
First-line Therapy:
Based on medical guidelines of protocols, the
doctor's typical first choice of treatment.
Flecainide:
Brand name Tambocor. An antiarrhythmic drug
(Class 1C). See Medications.
Fluoroscopy:
A special type of x-ray that allows the heart to
be visualized and mapped to identify A-Fib signals sources.
Flutter:
Rapid contractions of individual heart muscle
fibers.
Focal
Circuit:
A-Fib coming from a particular spot in the heart. (See also
Reentrant Circuit.)
Focal Point Catheter Ablation:
A procedure in which a catheter (a soft, thin,
flexible tube with an electrode at the tip) is inserted through a vein or
artery in the groin or neck and moved into the heart. This catheter is
directed to the exact point(s) in the heart that are producing the A-Fib.
These points are burned off or isolated from the heart. See
Focal Point Catheter Ablation.
Food and Drug Administration:
U.S. government agency that regulates
pharmaceutical drugs and medical devices.
Fresh Frozen Plasma (FFP):
The liquid portion of human blood that has
been frozen and preserved quickly after a blood donation. In cases where
someone with A-Fib is taking a blood thinner like Coumadin and is in a
serious accident with extensive bleeding, FFP is administered which has
clotting factors to stop the bleeding.
GLA:
Gamma-Linolenic Acid, an omega-6 fatty acid
Heart
Attack (Myocardial Infarction):
A total blockage of blood flow and oxygen to a portion of the heart. This
damages the heart's muscle cells.
Heart
Block:
The heart beats too slow (bradycardia) because
something causes the AV Node to delay or prevent the electrical signal from
traveling from the atria to the ventricles.
Heart-lung Machine:
See
Cardiopulmonary Bypass.
Hemorrhagic Stroke:
A stroke caused by bleeding.
Holiday Heart:
Term used to describe A-Fib admissions over
weekends and holidays when more alcohol is consumed.
Holter Monitor:
A small, portable monitor that continually
records the heart's rhythm for 24-72 hours.
Hypertension:
High blood pressure.
Hypertrophic Cardiomyopathy:
See Cardiomyopathy.
Ibutilide:
An antiarrhythmic drug (Class 3). See
Medications.
ICD:
Abbreviation for Implantable (Cardioverter) Defibrillator
ICE:
Short for Intracardiac Ultrasound (Echo) which uses Ultrasound to image
within the heart in real time.
Implantable (Cardioverter)
Defibrillator [ICD]:
An implanted electronic device which delivers a
shock to the heart any time it senses the heart going into A-Fib. It is also
used in patients who have V-Tach (Ventricular Tachycardia).
ABLATION FOR V-TACH (VENTRICULAR
TACHYCARDIA) AT MASS. GENERAL BY DR. VIVEK REDDY
See
Implanted Defibrillator.
INR (International Normalized
Ratio):
A measurement of the amount of blood thinner in
the blood stream.
To be effective warfarin must be maintained at a certain level in the blood (INR---International Normalized Ratio between 2.0 and 3.0).
Above 4.0 you run the risk of having a hemorrhagic (bleeding) stroke. Below
2.0 you are more in danger of having an ischemic (clotting) stroke, the kind
that most often occurs in A-Fib.
Intracardiac Ultrasound (Echo) (ICE):
Using Ultrasound to image within the heart in real time.
Top of Page
Ischemic Stroke:
A stroke that comes from a clot, the kind that most often occurs in
A-Fib.
Isolation:
A catheter ablation technique that creates
lesions (cuts or scars) around a source of A-Fib to keep it from transmitting
A-Fib signals into the rest of the heart. If a source of A-Fib area is
"isolated," it is still producing A-Fib signals, but they aren't spreading to
the rest of the heart. See Focal Point
Catheter Ablation.
Isoproterenol:
A drug used to stimulate the heart into A-Fib during a Pulmonary Vein
Ablation procedure.
Left Atrial Appendage:
Most strokes come from the Left Atrial Appendage (91%)87
which is located at the top of the Left Atrium. It is a very complicated structure with often more than
one lobe. In A-Fib
the flow of blood from the Left Atrial Appendage is particularly poor. Clots
can easily form. Then when the heart beats, these clots can dislodge and cause
stroke.
Left Atrioventricular Valve:
See Mitral Valve.
Lesions:
In Catheter Ablation of A-Fib,
lesions are electronically created cuts or scars. In surgery they are cuts
made with a scalpel (i.e., traditional Maze operation).
Ligament of Marshall:
A vestige of a vein that was required during fetal development, but is no
longer needed.
Long-standing Persistent
Atrial Fibrillation:
When the heart remains in A-Fib all the time,
as contrasted with Paroxysmal A-Fib
where the heart has occasional attacks of A-Fib, or
Persistent A-Fib where A-Fib
attacks last longer than a week (formerly referred to as Permanent or
Chronic A-Fib).
Lone (Idiopathic) Atrial
Fibrillation:
A-Fib without any accompanying or triggering
heart disease or other illness.
Loop (Event) Recorder:
A patient-triggered monitor/recorder. When you feel an episode of A-Fib,
you press a button to record several minutes of an A-Fib episode.
MAS:
Master of Applied Science
Maze Surgical Operation:
An open heart operation in which the surgeon
makes numerous incisions in the atria. This "maze" of incisions divides the
atria into electronically isolated segments, thereby blocking the electrical
impulses that cause A-Fib from spreading throughout the heart. The atria
continue to be activated by a regular signal from the Sinus Node. See
Maze Surgical Operation.
Metoprolol:
A rate control beta-blocker medication. See
Medications.
Millisievert (mSv):
A measurement of radiation dose used for measuring the effects of
various types or radiation. 1 Sievert equals 1.0 joule/killogram or 100 rem.
A Sievert is defined as producing the same biological effect in a specific
tissue as 1 gray of high-energy x-rays.
Mitochondria:
The part of a cell responsible for the production of energy in the form
of ATP.
Mitral
(Bicuspid, Left Atrioventricular) Valve:
The heart valve between the Left Atrium and
the Left Ventricle. Oxygenated blood from the four Pulmonary Veins flows
into the Left Atrium and through the Mitral Valve into the Left Ventricle.
When the Left Ventricle pumps this blood into the Aorta and the rest of the
body, the pressure of this blood pushes against the two folds or cusps of
the Mitral Valve to close it. For an excellent video of how this valve
works, go to
http://www.youtube.com/watch?v=WXwYYsi6z7Q&feature=player_embedded
MBBS (MBCHB, BMBS):
Bachelor of Medicine, Bachelor of Science. Awarded on graduation from
medical school in various countries which follow the tradition of the United
Kingdom. (Like an MD.)
MPH:
Master of Public Health
MSc:
Master of Science
mSv:
See Millisievert.
Myocardial Infarction:
The medical term for a Heart Attack. See Heart
Attack.
Normal Heart Rhythm (also called
"Sinus Rhythm"):
The normal beating of the heart (60-80 beats per
minute). See Overview.
Norpace:
See Disopyramide.
Off-Label:
Outside of
licensed indication---the clinical application of prescribed drugs for
indications other than those approved by the FDA. Off-label uses are legal
and may be in the best interests of patients. But they have not received the
same degree of independent scrutiny through randomized clinical trials as
have approved indications. One can not advertise or market a drug for
something other than what has been approved by the FDA.
Operating Room (O.R.) Report:
A very technical, detailed
report by your ablation doctor describing step by step the procedures and
results of an particular ablation. (Because it is very technical and
difficult for patients to read, it isn't normally given to patients unless
they ask for it.)
Ostium (plural Ostia):
The opening from a pulmonary vein into the left
atrium.
PAC:
Abbreviation for Premature Atrial Contraction. A common and generally
benign arrhythmia that occurs even in people with normal heart rhythm. A PAC
is a heartbeat that comes from some other area than the sinus node. It feels
like a skipped or extra heart beat.
Pacemaker:
A small, implantable device that provides an
electrical stimulus to the heart when the natural electrical signal is absent
or too slow to provide sufficient pumping action.
Parasympathetic Nervous System:
The Parasympathetic Nervous system
controls the heart, smooth muscles and glands of the head and neck, and
thoracic, abdominal, and pelvic viscera. It's in control during periods of
digestion and rest. Some research indicates a raised parasympathetic tone
can lead to arrhythmias.
http://www.normanallan.com/Sci/ANS.html
The Sympathetic Nervous System enables the body to rise to
emergency demands encountered in flight, combat, pursuit, and pain. It
enervates and stimulates the body.
Paroxysmal Atrial Fibrillation:
Occasional attacks of A-Fib that return to
normal heart rhythm (sinus rhythm) on their own, as contrasted with
Persistent A-Fib or
Long-standing
Persistent A-Fib.
Percutaneous:
Through the skin.
Persistent Atrial Fibrillation:
A-Fib that lasts more than a week, or that
lasts less than a week but requires cardioversion to return to normal sinus
rhythm.
"Pill-in-the-Pocket"
Treatment:
For Paroxysmal A-Fib patients. When an A-Fib
attack occurs, the patient takes an antiarrhythmic med (flecainide,
propafenone) to return to normal sinus rhythm. A variation of
the Pill-In-The-Pocket treatment is to take an antiarrhythmic med on a
regular basis, then take a higher dose at the time of an A-Fib attack.
(There is some disagreement about this strategy. Some say it
might be better to keep patients out of A-Fib by taking antiarrhythmic meds
daily [keeping a fire from starting], rather than waiting for an A-Fib
attack to start [having to put the fire out once it starts]. See
Two Different "Pill-in-the-Pocket" Approaches
Pericarditis:
Inflammation of the pericardium, the sac that surrounds your heart.
Persistent Atrial Fibrillation:
A-Fib that lasts over 24 hours but that is
amenable to cardioversion.
Polar Heart Rate Monitor:
A device for monitoring your heart rate in
A-Fib. Designed primarily for runners it consists of a band around your chest
which transmits a signal to a wrist watch. You can set the wrist watch to set
off an alarm if your pulse rate goes too high. Available in sporting goods
stores.
Post-Operative A-Fib:
Atrial Fibrillation which arises during or
soon after cardiac surgery.
Pradaxa:
Brand name for dabigatran.
Dabigatran is a direct thrombin inhibitor, a newer type of medication.
Thrombin is an enzyme that converts soluble fibrinogen into insoluble
fibrin. Fibrin is a fibrous protein involved in the clotting of blood. It
forms a mesh or clot over a wound.
Dabigatran does not require close monitoring and has less bad side effects
than warfarin. It is expected to replace warfarin as the blood thinner of
choice for A-Fib.
Premature Atrial Contraction
(PAC):
A common and generally benign arrhythmia that occurs even in people with
normal heart rhythm. A PAC is a heartbeat that comes from some other area than
the sinus node. It feels like a skipped or extra heart beat.
Proarrhythmic:
A medication is "proarrhythmic" if it worsens
your heart rhythm rather than making it more regular.
Procainamide:
Brand names Procan SR, Promine, Pronestyl,
Procanbid. An Antiarrhythmic drug (Class 1C). See
Medications.
Procan SR:
See Procainamide.
Procanbid:
See Procainamide.
Promine:
See Procainamide.
Pronestyl:
See Procainamide.
Top of Page
Propafenone:
Brand name Rythmol. An antiarrhythmic drug
(Class 1C). See Medications.
Propranolol:
A rate control beta-blocker medication. See
Medications.
Pulmonary Valve:
The heart valve between the Right Ventricle
and the Pulmonary Artery. The Pulmonary Valve opens as deoxygenated blood is
pumped out of the right ventricle into the Pulmonary Artery to flow into the
lungs to be oxygenated. When pressure in the Right Ventricle drops, the
pressure of blood in the Pulmonary Artery will push the Pulmonary Valve
closed. To see an excellent video of how this valve works, go to
http://www.youtube.com/watch?v=WXwYYsi6z7Q&feature=player_embedded
Pulmonary Vein:
The four Pulmonary Veins bring oxygenated blood
from the lungs into the left atrium. (The openings from these Pulmonary Veins
into the left atrium are the source of most Focal Point A-Fib).
Pulmonary Vein Ablation (PVA):
Catheter Ablation procedure to isolate A-Fib
signals by ablating the openings around the pulmonary veins. Also called
Pulmonary Vein Isolation (PVI).
Pulmonary Vein Antrum Isolation:
A type or method of Pulmonary Vein Ablation.
Instead of making encircling lesions around each of the pulmonary veins,
wider ablations encircle each of the two left and two right pulmonary veins
in the Antrum area around the veins.
Pulmonary Vein Isolation
(PVI):
Catheter ablation procedure to isolate A-Fib
signals by ablating the openings around the pulmonary veins. Also called
Pulmonary Vein Ablation (PVA).
Pulmonary Vein (PV) Potentials:
An electrical charge or energy (potential) in
the Pulmonary Veins that can cause A-Fib. A PV Potential can be measured and
pinpointed even if the patient isn't in A-Fib at the time. See
Focal Point Catheter Ablation.
PVC:
Premature Ventricular Contraction. A type of irregular heart beat in which
the ventricle contracts prematurely. also known as VPB (Ventricular
Premature Beat,) extrasystole, "skipped beat," or palpitations.
PV Stenosis:
Swelling of the Pulmonary Vein opening that may
occur after Catheter Ablation. This swelling can restrict blood flow from the
lungs into the heart. See Questions For Doctors.
Quinaglute:
See Quinidine.
Quinidex:
See Quinidine.
Quinidine:
Brand names Quiniglute, Quinidex, Quinidine
Glaconate. An antiarrhythmic (Class 1A) drug. See
Medications.
Quinidine Glaconate:
See Quinidine.
The QT Interval:
In an EKG signal the QT interval represents the time the ventricles are
pumping and at rest. See The EKG Signal.
The QTc Interval:
In an EKG signal the QTc Interval represents the time the ventricles are
pumping and at rest corrected or adjusted for movement of the heart when
beating. See The EKG Signal.
Radio Frequency (RF):
High frequency electrical energy used to form
lesions or scar tissue in catheter and surgical ablations.
Radial Maze Surgical Ablation:
The newest refinement of the classic Maze
surgery, sometimes called the Cox Maze IV. It replaces the surgeon's scalpel
and "cut and sew" incisions with linear lesions (scars) created either with
radiofrequency energy (heat) or cryo energy (freezing).
Rate Control Medications:
Drug therapy that attempts to control your heart
rate (ventricular beats), but leave the upper chambers (atria) of your heart
in A-Fib. See Medications.
Recent-onset Atrial
Fibrillation:
A term used to describe A-Fib during the first
48-72 hours of occurrence.
Reentrant
Circuit (Macro Reentrant Circuit):
Circular, random electrical patterns or wavelets found in the Atria of
patients with A-Fib and A-Flutter.
Remodeling:
In A-Fib over a period of time, the fast,
abnormal heart rhythm in the atria causes electrical changes and enlarges the
atria.
Rythmol:
See Propafenone.
Rhythm Control Medications:
Drug therapy that uses rhythm control drugs,
called antiarrhythmics, to try to stop A-Fib and make the heart beat
normally.
RVT:
Registered
Vascular Technologist.
Must pass two exams given by the American Registry for Diagnostic Medical
Sonography.
Segmental Catheter Ablation:
A Catheter Ablation technique that uses Pulmonary Vein Potentials to
identify and ablate (destroy) focal points or areas of the heart producing
A-Fib signals. A type of Pulmonary Vein Ablation.
Silent
A-Fib:
Atrial Fibrillation in which the patient feels
no or very few symptoms; often discovered only during a routine medical
exam.
Sinoatrial (SA) Node:
See Sinus Node.
Sinus Node:
(Also called "Sinoatrial [SA] Node.") The Sinus
Node is a specialized group of cells in the heart which generates an
electrical signal that travels down a single electrical road (the AV Node)
connecting the atria to the ventricles. The Sinus Node is called the heart's
"natural pacemaker," because it maintains a regular heart beat and makes
adjustments to increase the heart rate during exercise and to slow it during
rest. See Overview.
Sinus Rhythm:
The normal beating of the heart (60-80 beats per
minute). Also called "Normal Heart Rhythm." See
Overview.
Top of Page
Sotalol:
Brand name Betapace. A rate control beta-blocker
medication. (Class 3 drug.) See Medications.
Spline:
A spline has a series of
projections on a shaft that fit into slots on a corresponding shaft. A spline
is used on a catheter to insert the Watchman device.
Stenosis:
A swelling, constriction or narrowing of a duct or passage. See
PV
Stenosis.
Structural Heart Disease:
This term can refer to several different structural defects in the heart:
1. Heart muscle disease (Cardiomyopathy)
2. Heart valve disease
3. Congenital heart disease (patients born with abnormalities
of the heart valves or chambers)
4. Heart damage caused by infection, such as Paricarditis
Sudden Cardiac Death:
Also called "cardiac arrest." Occurs when the electrical
impulses in the heart become rapid (ventricular tachycardia) or chaotic
(ventricular fibrillation) or both. This irregular heart rhythm causes the
heart to suddenly stop beating. (This heart problem has received much less
publicity than a Heart Attack.)
Supraventricular Tachycardia (SVT):
An arrhythmia similar to A-Fib in which the heart beats fast (100 to 240
beats per minute). SVT usually begins and ends suddenly. SVT often begins in
childhood or adolescence. It is commonly caused by a variation in the
electrical system of the heart. It is usually not dangerous, but can cause a
drop in blood pressure and lightheadedness.
"Supraventricular Tachycardia" in clinical practice commonly
refers to atrial tachycardia, atrioventricular nodal reentrant tachycardia
(AVNRT), and atrioventricular reciprocating tachycardia (AVRT), an entity
that includes Wolff-Parkinson-White syndrome. While Atrial Fibrillation is a
distinct entity classified separately.
The term "Supraventricular Arrhythmia" most often is used to
refer to Supraventricular Tachycardias and Atrial Flutter.
In practice, Supraventricular Tachycardia is often used to
include all arrhythmias in the Atria, including A-Fib.
SVT:
See Supraventricular
Tachycardia.
Sympathetic Nervous System:
The Sympathetic Nervous System
enables the body to rise to emergency demands encountered in flight, combat,
pursuit, and pain. It enervates and stimulates the body.
The Parasympathetic Nervous system controls the heart, smooth
muscles and glands of the head and neck, and thoracic, abdominal, and pelvic
viscera. It's in control during periods of digestion and rest.
Symptomatic Atrial
Fibrillation:
Atrial Fibrillation with noticeable symptoms
(versus asymptomatic or Silent A-Fib)
Systolic Blood
Pressure:
The optimal blood pressure reading currently is 115/75.59
The "115", the first number, is the Systolic Blood Pressure---the pressure
your heart generates when pumping blood through your arteries. See
Diastolic Blood Pressure.
Tachycardia:
A heart rhythm problem in which the heart beats
faster than normal.
Tambocor:
See Flecainide.
Tamponade:
Blood or fluid collects in the pericardium, the sac around the heart.
This pressure can prevent the heart from beating and feel like one is being
strangled. Doctors need to drain this fluid or blood from the pericardium.
TEE:
See Transesophageal Echocardiogram
Tikosyn:
See Dofetilide.
TIA:
Transient Ischemic Attack, a temporary "mini-stroke"
Tilt Table Test:
This test is typically performed to help
diagnose the cause of dizziness and fainting. The individual is placed on a
table that tilts upward, and the table is then placed at an approximately
upright position so the individual is standing. Heart rate and blood
pressure are monitored during the test. If no symptoms occur, a medication
may be given to increase the heart rate in an attempt to reproduce the
symptoms.
Toprol-XL:
A rate control beta-blocker medication.
See Medications.
Transmurality:
Passing through the wall of the heart or involving the whole thickness of
the heart wall.
Transesophageal Echocardiogram:
In this procedure used to test for the presence of blood clots in the
heart, a tube is run down your Esophagus next to your heart. The
Echocardiogram uses high-frequency ultrasonic waves to visualize structural and functional
abnormalities of the heart from behind it within the esophagus.
Tricuspid Valve:
The heart valve between the right atrium and
the right ventricle. The right atrium receives deoxygenated blood, then
pumps it into the right ventricle through the Tricuspid Valve. This valve
then closes as the right ventricle pumps this deoxygenated blood into the
Pulmonary Artery. The pressure of the blood being pumped out of the right
ventricle closes the three curved flaps or cusps of the Tricuspid Valve. For
an excellent video of how this valve works, go to
http://www.youtube.com/watch?v=WXwYYsi6z7Q&feature=player_embedded
Ultrasound:
High-frequency sound vibrations used in some
types of Catheter Ablation to produce images of the heart and vessel structure.
Vagal
& Adrenergic A-Fib:
The Adrenal (Adrenergic) Glands sit above the kidneys and produce the
hormone epinephrine (adrenaline) in response to stress, which causes an
increase in heart rate and blood pressure. This adrenaline stimulates what is
called the Sympathetic Nervous System to speed up the heart and constrict the
blood vessels. The Vagus Nerve, in contrast, controls the abdomen and is part
of the Parasympathetic Nervous System that tends to slow the heart and dilate
blood vessels.
Adrenergic and Vagotonic forms of paroxysmal A-Fib are
uncommon.43
"The majority of patients with paroxysmal A-Fib do not have a clear autonomic
pattern."110
However, if your A-Fib is normally triggered by exercise, stress, stimulants,
exertion, etc., then you may have "Adrenergically-Mediated" A-Fib. People with
structural heart disease seem more prone to Adrenergic A-Fib44.
But if your A-Fib occurs at night, after a meal, when resting after
exercising, or when you have digestive problems, then you may have
"Vagally-Mediated" A-Fib. People with Lone A-Fib seem more prone to Vagal A-Fib44. (Many people have a mix of both Adrenergic and Vagal A-Fib.)
(Perhaps A-Fib begins as a nervous system problem, then becomes a heart
problem after the arrhythmia is established.) It might
be helpful to determine if you have one or the other so
that you can better identify what triggers your A-Fib, and because the
treatments are often different for each. For example, beta-blockers usually
don't work well with Vagal A-Fib.86
Of the antiarrhythmic 1c meds, flecainide seems to work better for Vagal A-Fib
than propafenone.111 (Though it's difficult to generalize
about A-Fib treatments, because each person reacts so individually.) For a
more in depth look at Vagal A-Fib, go to
VagalA-Fib .
See also in the FAQs section
"What is the difference between
"Adrenergic" and "Vagal" Atrial Fibrillation. How can I tell which one I have?
Does it really matter? Does Pulmonary Vein Ablation (Isolation)
work for Adrenergic and/or Vagal A-Fib?"
Vagal
Tone:
Impulses from the Vagus nerve inhibit and slow
the heartbeat.
Ventricles:
The lower chambers of the heart. See
Overview.
Ventricular Tachycardia:
A fast heart rhythm that originates in one of the ventricles. It is a
potentially life-threatening arrhythmia, because it may lead to Ventricular
Fibrillation---very rapid uncoordinated fluttering contractions of the
ventricles resulting in loss of synchronization between heartbeat and pulse
beat. Unlike A-Fib, it can be very dangerous and result in sudden death.
Verapamil:
A rate control calcium-channel blocker
medication. See Medications.
Vitamin K Antagonist (VKA):
A technical description of how VKAs work is the following: "they prevent
the y-carboxylation of the vitamin K-dependent coagulation factor prothrombin
and Factors VII, IX, and X."115
In layman’s terms warfarin works by affecting several steps in the
anticoagulation pathway to prevent clotting.
VKA:
See Vitamin K Antagonist
V-Tach (VT):
Short for Ventricular Tachycardia. A fast heart rhythm that
originates in one of the ventricles. It is a potentially life-threatening
arrhythmia, because it may lead to Ventricular Fibrillation---very rapid
uncoordinated fluttering contractions of the ventricles resulting in loss of
synchronization between heartbeat and pulse beat. Unlike A-Fib, it can be very
dangerous and result in sudden death.
Warfarin:
The generic name of an anticoagulant whose
product name is "Coumadin." See Medications.
Watchman Device:
The theory behind the Watchman Device is most
A-Fib clots originate in the Left Atrial Appendage (LAA). The Watchman
Device closes off the LAA where 90-95% of A-fib strokes come from. It's a
very low risk procedure that takes only a short time to install. Then you
would usually not need to be on blood thinners.
Here's how it works:
Once a patient's Left Atrial Appendage is measured, a wide-sheathed catheter
with a
spline is used to insert the Watchman device
which has a self-expanding Nitinol (a special metal) open-ended circular frame.
The atrial surface of this frame is covered with a thin, permeable 160 μm (micron)
pore filter made of polyester material (Polyethylene Terephthalate known as
Dacron or PET). This filter allows blood to pass
through while stopping clots. Little hooks or anchors called fixation barbs at
the middle of the device make sure it is attached firmly to the
LAA wall. The Watchman device comes in multiple sizes from 21mm to 33mm to
accommodate the different sizes of LAAs.
Before the catheter is removed (which fixes the Watchman
device in place), contrast agents are used to
make sure the Watchman device is stable and entirely closes off the LAA opening. Over time heart tissue
grows over the polyester (PET) material so that it
completely closes off the LAA with smooth heart tissue similar to other heart
surfaces. In this Occlusion slide, heart tissue has completely covered the
Watchman device after only nine months.
Some doctors are inserting the Watchman device in as little
as 20 minutes. It is a low risk procedure with no surgery or
ablation involved.
Patients on Coumadin continue to take it for six weeks after
the Watchman device is inserted. They are then examined using a
TEE (Transesophageal Echocardiogram) to
make sure there is complete closure of the LAA. At that time they are
taken off of Coumadin. You can see a video of how the Watchman device is deployed
at
http://www.atritech.net/media/deviceanimation.aspx
Think of the Watchman device as a replacement for Coumadin or
other blood thinners. Coumadin reduces but does not totally eliminate the
risk of stroke. Even with the proper INR levels of Coumadin, a small number
of people with A-Fib have had strokes. The Watchman device also reduces but
does not totally eliminate the risk of stroke. Like Coumadin, the Watchman
is not an absolute guarantee one will never have a stroke. It basically
reduces the risk of stroke similar to that of a person with a normal heart.
If you hate having to take Coumadin or blood thinners or are
allergic to them, you will be able to go in for a very low risk procedure
that takes as little as 20 minutes, and replace Coumadin and blood thinners
with the Watchman.
Even while you are waiting for or trying to decide on having a Pulmonary
Vein Ablation, you can have the Watchman inserted and reduce your risk of
stroke similar to that of a person with a normal heart.
The Watchman device may become part of most catheter ablation
procedures. If the catheter ablation procedure were unsuccessful or in case
of silent A-Fib attacks after ablation, patients would still be protected
from an A-Fib stroke by the closing off of the Left Atrial Appendage.
The Watchman Device will probably become standard therapy not just for
people with A-Fib, but also for anyone at risk of a stroke.
Though still in clinical trials, the Watchman Device is
available for most people. For a list of US doctors installing the Watchman
Device, go to
Doctors Installing the Watchman Device.
Wolf Mini-Maze:
A version of the Mini-Maze surgery for A-Fib
developed by Dr. Randall Wolf, MD.
Wolff-Parkinson-White syndrome
(WPW):
A form of Supraventricular Tachycardia, WPW occurs when electrical signals fail to
pause in the AV Node because an extra pathway allows the impulse to "bypass"
the normal pathway. Patients with WPW may develop A-Fib and are at increased
risk of developing a dangerous ventricular arrhythmia.
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Disclaimer: the
authors of this Web site are not medical doctors and are not affiliated with any
medical school or organization. The information on this site is not intended nor
implied to be a substitute for professional medical advice. Always seek the
advice of your physician or other qualified health professional prior to
starting any new treatment or with any questions you may have regarding a
medical condition. Nothing contained in this service is intended to be for
medical diagnosis or treatment.
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