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Atrial Fibrillation: Understanding the Electrical Disorder of the Heart


Dr. John Johnkoski, cardiothoracic surgeon at Aspirus Heart & Lung Surgery

Every year, the month of September is dedicated to raising awareness about atrial fibrillation, or AFib, a common but often misunderstood heart rhythm disorder. To shed light on this condition, John Johnkoski, MD, cardiothoracic surgeon at Aspirus Heart & Lung Surgery, provided valuable insights into the complexities of AFib and its management.


The Dance of the Heart

According to the American Heart Association (AHA), AFib is a quivering or irregular heartbeat, or arrhythmia. Unlike normal sinus rhythm, where the heart's rhythm is orchestrated with precision, AFib disrupts this harmony. Dr. Johnkoski explains, “normal sinus rhythm is named that way because there's a conductor in your heart called the 'sinus node.' This conductor signals the upper chambers of your heart (the atria) to start beating, and then, like clockwork, the lower chambers (the ventricles) follow suit. It's like a well-choreographed dance where everyone moves together smoothly."


AFib's Fearsome Companions

While AFib itself is a significant concern, it often brings two more daunting companions: stroke and congestive heart failure.


In AFib, the left atrial appendage, a small pouch-like structure in the heart, fails to contract effectively. Dr. Johnkoski likens it to a windsock that can trap blood, forming clots. These clots can then travel to the brain, causing a stroke. “The risk of stroke increases about five-fold in individuals with AFib compared to those in normal sinus rhythm,” says Dr. Johnkoski.

He also relates the risk of heart failure to an overexerted car engine. “When your heart goes above its normal rhythm it’s kind of like just putting the gas all the way down in your car and just running it for hours. Your car might last a few hours, but it’s going to be hard on the engine. Our heart isn’t nearly as durable.” Dr. Johnkoski elaborates, "When your heart goes above its normal rhythm for even a few weeks, your heart function can go from normal to very seriously impaired."


Patients have nearly three times higher risk of hospitalization and are twice as likely to die of sudden cardiac death, according to AHA and National Institutes of Health (NIH). This is why prompt diagnosis and management are crucial.


Diagnosis: Catching AFib in Action

Diagnosing AFib can be challenging, especially when symptoms are intermittent. Dr. Johnkoski recommends immediate medical attention for anyone experiencing heart palpitations, lack of energy, feeling over-tired, racing irregular heartbeat, shortness of breath, dizziness or fainting, or “butterflies” in the chest. An electrocardiogram (EKG) is the primary diagnostic tool, but for intermittent symptoms, a halter monitor may be used for a more extended period to capture the irregular rhythm.


It’s also possible to not experience any symptoms at all. “For some, AFib may be discovered on a pre-operative EKG for some kind of elective surgery, where then their surgery gets canceled and treatment for AFib is addressed,” explains Dr. Johnkoski.


Treatment Strategies for AFib

The management of AFib is multi-faceted, with several approaches available, depending on the patient’s condition. Dr. Johnkoski emphasizes the importance of medications for heart rate control and rhythm maintenance. Anticoagulation therapy, or the use of blood thinners, is another critical aspect, especially for stroke prevention. Fortunately, newer blood thinners have simplified this aspect of treatment.


When medications are insufficient or poorly tolerated, minimally invasive surgery is considered. These procedures involve accessing the heart through small punctures on each side of the chest to create lines of scar on the outside of the heart.


For those who are having open heart surgery and also have AFib, a maze procedure is likely. “A maze procedure is where we create lines of scar on the inside and the outside of the heart at the time of the surgery designed to get and keep your heart in rhythm,” explains Dr. Johnkoski. He continues,“AFib is really an electrical disorder of the heart and really has nothing to do with pumping. If we create a line of scar, it will not conduct an electrical impulse. A line of scar is kind of like the insulation on your pair of pliers at home – it won’t conduct electricity.”


Preventing the Unthinkable

Dr. Johnkoski encourages anyone who thinks they're having AFib to go to either to the walk-in or to the emergency room right away.He highlights the 48-hour window after first experiencing symptoms as a critical period to initiate treatment and prevent clot formation.


Hope on the Horizon

Dr. Johnkoski is optimistic about the future of AFib management, especially for those being treated at Aspirus Health. He notes, "we have been addressing AFib in a very aggressive way for the better part of 20 years. We have a lot of experience here, and a surgical program that most places don't have in terms of treatment options – particularly minimally invasive options." He also anticipates the integration of robotic surgery in the treatment of AFib, further enhancing patient outcomes.


The Atrial Fibrillation Clinic at Aspirus Heart Care offers care for patients with atrial arrhythmias. The clinic offers the ability to see an electrophysiologist (EP) and cardiothoracic surgeon in the same setting to learn about treatment options. For information regarding referrals, scheduling or to answer general questions, please call 866.783.6266.


For more information on all things AFib, including available treatments and patient testimonials, visit



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