". . . and then my heart skipped a beat."

It's an old cliche that's the mainstay of many a gooey love song.

But when it's your own heart that's skipping beats - and the object of your affection is nowhere to be seen - you might consider that you could have atrial fibrillation (AFib), a medical condition shared by almost 3 million Americans.

According to Dr. Eteri Byazrova, a Kootenai Health cardiologist specializing in cardiac electrophysiology, "Atrial fibrillation is a very common arrhythmia. If you're over 60, probably 5 percent of the population either currently has it or has had it in the past."

This irregular heartbeat, Byazrova said, does not lead to an immediate decline in health or even to death, but years of it can do exactly that. And AFib does increase the risk of stroke and congestive heart failure.

The Mayo Clinic defines AFib as "an irregular and often rapid heart rate that commonly causes poor blood flow to the body. During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly - out of coordination with the two lower chambers (the ventricles) of the heart." Normal beating of the heart is called "sinus rhythm."

In visual terms, the atria may be moshing, while the ventricles are doing the waltz. And in the same way that a clumsy dance doesn't go anywhere, a heart in atrial fibrillation doesn't beat particularly efficiently.

"When I got atrial fib, it felt like my heart was all over my chest," said Mary Sperber, a Coeur d'Alene resident in her late 60s. "It's a scary experience - most of the time mine would happen between 1 and 4 in the morning. It would wake me up and I'd be like, 'Oh no, not again."

A traditional or old-style treatment strategy for AFib is called Rate Control. "We currently do this for people who have minimal symptoms, are asymptomatic or elderly," Byazrova said. 'We'll give you medications to slow down your heart rate (beta blockers) and let you either continue in atrial fibrillation or go in and out of it. Then we may or may not give you blood-thinner medications, depending on other medical conditions."

Blood thinners such as Warfarin serve to help prevent strokes. With atrial fibrillation, an out-of-sync rhythm may cause blood to pool in the atria and then form clots. These clots in turn can travel upward to the brain, impede blood flow and result in a stroke. When blood has been thinned, there is less tendency for it to clot.

According to Byazrova, a more aggressive treatment involves administration of antiarrhythmic medications, such as amiodarone. These are aimed at patients who have pronounced symptoms, such as palpitations, shortness of breath, tiredness, daytime somnolence and angina - moderate to severe symptoms related to their arrhythmia.

"Their effectiveness in maintaining sinus rhythm is about 30 percent," she said. "Also, most of these medications have a small risk of significant side effects."

Tim Biediger, a registered pharmacist with Medicine Man Pharmacy in Coeur d'Alene, said that amiodarone, as well as most of the other arrhythmic drugs, carries a black box warning. "This is an indication that a major problem with the drug could occur. It doesn't necessarily mean it will occur, but, rather, that it has occurred in significant enough numbers that people need to know about it.

"With amiodarone, for instance, the black box warning is that pulmonary toxicity seems to occur in quite a few people who take it. There is also a warning there for liver toxicity."

Byazrova said, "Based on findings of the AFFIRM study, a treatment with antiarrhythmic drugs did not seem to improve outcomes in patients with atrial fibrillation. From analyzing the data, we came to a conclusion that adverse effects of the medications cancel out the benefit of maintaining sinus rhythm in the 30 percent of patients in which they are effective."

One of the treatments often held out in recent years to be "the answer" for AFib patients is a surgical procedure known as catheter ablation. But, as it is with most fixes, the "answer" is not so simple.

"Where are we at with catheter ablation?" Byazrova said. "As of 2013, we reserve it only for patients with symptomatic atrial fibrillation. I believe it does improve morbidity and mortality, but we don't have a trial and we don't have proof yet whether catheter ablations improve outcomes, even though we suspect they do.

"We need to prove they will make you live longer as well as making you feel better."

Byazrova said the success rate of catheter ablations depends on the type of atrial fibrillation or atrial fibrillation burden involved. Rates are generally better in patients who are mostly in sinus rhythm with brief periods of AFib in between.

"The more atrial fibrillation you have, the more your heart becomes used to it. The average success rate of a single catheter ablation is about 60 to 70 percent," she said. "If you take 100 patients and you do one, two or three procedures, the success rate is about 90 percent.

"We define success as either freedom from atrial fibrillation or a 90 percent reduction in atrial fibrillation burden at two years. After an initially successful ablation, however, each subsequent year brings about a 5 percent chance of your having atrial fibrillation."

Sperber had an ablation in April of this year. "Dr. Byazrova explained what was going to happen to me - that they'd go into the veins on one side of my heart and then into the veins on the other and when they found the vein that was giving me the trouble, they would cauterize it. She also prepared me that maybe my AFib would come back, but so far it hasn't."

The procedure itself - an uncomplicated catheter ablation can take between two and four hours - involves general anesthesia and a one- or two-night stay in the hospital.

Byazrova said that the cauterization Sperber described is actually a high frequency electrical current that gets transformed into heat. "We cauterize the cells that are redundant," she said. "There is rarely any pain in the procedure - only some mild discomfort lasting no more than a few days."

Beth Stern and Steve Parker are electrophysiology technicians working in Kootenai Health's electrophysiology lab - the unit in which catheter ablations are performed. Both have more than eight years experience and are present to assist during the procedures.

"Essentially what we do is fix the electrical system of the heart," Stern said.

In addition to carrying out sophisticated tasks such as inserting catheters into target veins, Parker said the technicians run the 3D cardiac mapping system during the procedure. "This allows us to limit x-ray exposure to the staff and the patient."

Safety is always a major concern. "We troubleshoot our machinery on a daily basis," Stern said. "Every day we have a checklist and safety sheet we go through.

"You know, I really love this job because you have people who come here feeling rotten and you get to make them feel better."

Mary Sperber is one of those patients. "I have to tell you, I don't miss my AFib one bit. I'd recommend the procedure to anybody. I just have so much more energy now. The fear is pretty much gone, too, though I do have to admit that every once in a while I'll take my pulse, just to make sure."