Atrial Fibrillation

 

What is atrial fibrillation?

Atrial fibrillation (AF) is an abnormal heart rhythm where the upper chambers of the heart (called the atria) move irregularly and very fast and may cause the lower chambers of the heart to also beat fast. Your provider may describe this condition as having "an irregular heart rhythm". It is also very common in patients with heart failure as the heart becomes enlarged. It is also very common in people over the age of 80 years. When a person has AF, there is less blood being pumped out of the heart to the organs. This leads to symptoms.

What are the symptoms of AF?

  • Tired and fatigued, especially with exercise
  • Shortness of breath
  • Fainting or feeling like you are going to faint
  • Dizziness
  • Palpitations (feeling like your heart is jumping in your chest)
  • Chest pain or pressure
  • Occasionally, increased frequency of urination may accompany these symptoms
  • Sometimes people with AF have no symptoms and the AF is detected on a routine physical exam or EKG.
  • You may not feel symptoms, but AF may be found by taking your pulse at your wrist or listening to your heart, and finding it to be irregular and/or fast.

Atrial Fibrillation Symptoms

What are the risks associated with AF?

People with AF are at risk for having a stroke. Since less blood is getting pumped out of the heart this means more blood is staying inside the heart. Blood can swirl around in the atria (upper chambers of the heart) and form a blood clot. This blood clot can travel to the brain and cause a stroke. To prevent a clot forming in your atria, your doctor may prescribe a blood thinner.

The doctor will ask about your medical history and use a calculation survey tool (CHA2DS2-VASc) to assess your risk for a clot to see if you need an anticoagulant (blood thinner). You may be started on an anticoagulant such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), or edoxaban (Savesa). It is important that you understand how to take this medication and what it is used for. Failure to take this medication as directed could increase your risk for a stroke or bleeding. There may be discount coupons available for the first month of the medication for you.

Your doctor needs to know about all other medicines you are taking or start while taking these medications. Ask your doctor before starting any over-the-counter medications or herbal products if you are taking any prescription drugs.

What are the common causes of AF?

  • High blood pressure
  • Heart failure
  • Coronary artery or heart valve disease
  • Acute infections, especially pneumonia, Urinary tract infections are a common trigger among older patients
  • Electrolyte imbalances (sodium, potassium, magnesium, calcium)
  • Diabetes
  • Lung disease
  • Anemia (low red blood cell count)
  • Pulmonary embolism
  • Sleep apnea
  • Overexertion and stress
  • Dehydration
  • Thyroid Issues
  • Alcohol abuse
  • Obesity
  • After a surgery or procedures, most often related to the heart

What are the types of AF?

There are three types of AF and your treatment will depend on the type of AF that you have:

Paroxysmal:

  • Comes and goes
  • Usually stops on its own

Persistent:

  • Lasts more than a week
  • Can become permanent
  • may be changed to a normal rhythm by medical or electrical treatments

Permanent:

  • AF is continuous
  • cannot be changed to a normal rhythm by medical or electrical treatments. The patient, family and physician may agree to stop trying to get the patient into a normal (sinus) rhythm.

Other than a blood thinner, what are the treatments for AF?

Treatment will depend on the kind of AF that you have, what type of symptoms you are having, and your how you feel when you are in AF.

There are two common treatments:

  • Control the heart rate (slowing the heart rate down). Heart rate control means that patients are left in AF but the heart rate is slowed down (goal of 50-70 bpm usually) to allow the upper and lower chambers more time to fill and pump more blood out of the heart with each beat. This is done by certain medications such as beta blockers, calcium channel blockers, and/or digoxin (Lanoxin).
  • Control the heart rhythm (by getting you out of AF). Heart rhythm control means that attempts are made to convert the heart back into a normal rhythm. This is done through certain drugs such as dofetilide (Tikosyn), amiodarone (Cordarone, Pacerone), dronedarone (Multaq), sotolol (Betapace), flecainide (Tambocor), propafenone (Rhythmol), or diltiazem (Cardizem).

Treatments

What are the Surgical Treatments for AF?

Long term monitoring to see how much AF you have in a given time span will likely be a test performed prior to catheter or surgical treatments. Your physician may refer to these as a Holter monitor or Implantable Loop Recorder. Testing for sleep apnea may also be done before surgical treatment is considered. Heart catheter treatment for AF involves threading a catheter into the heart which then can deliver a tiny burn or freeze to the tissue of the atrium to disrupt the irregular heartbeat. Surgical treatment is similar but is performed during a cardiac surgical procedure. Catheter and surgical treatments may be referred to as an atrial fibrillation ablation, pulmonary vein isolation, an A-V nodal ablation, or a "Maze" procedure.

Heart Catheter or surgical treatment for AF is considered when:

  • Treatment does not control or correct AF and you are still having symptoms
  • Meds for AF cause more harm than good or are not tolerated
  • Blood thinners cannot be taken
  • Blood clots or a stroke occurs

It's a Fact

  • A healthy heart beats between 60 and 100 times per minute. With AFib, it beats much faster – as many as 175 times per minute!
  • 1 in 5 strokes in the U.S. is due to AFib
  • Men are more likely to develop AFib, but women who have it are more likely to die earlier in life
  • Remember, many people with AFib may not have symptoms

 



References:
https://www.cardiosmart.org/Heart-Conditions/Atrial-Fibrillation - accessed September 9, 2017