Atrial Fibrillation

Atrial fibrillation is a condition, which causes heart rhythm disorder. Atrial fibrillation treatment aims to recover the normal frequency of heartbeats. AF diagnosis procedures are usually fast and painless. Below we will discuss the details of diagnostics and atrial fibrillation treatment options, including such surgical procedure, as catheter ablation and atrioventricular node ablation.

Atrial fibrillation can increase your risk of stroke, heart failure and other heart-related complications.

What is Atrial Fibrillation (AF)?

It is an irregular and often rapid heart rate. The atria (heart’s two upper chambers) beat chaotically and irregularly, normally out of coordination with the ventricles (heart’s two lower chambers).
Atrial fibrillation; heart rhythm disorder; Atrial fibrillation treatment; catheter ablation; atrioventricular node ablation
Episodes of atrial fibrillation may come and go. If you develop atrial fibrillation that doesn’t go away, you may require treatment.  Even though the condition itself isn’t usually life-threatening, it is a serious medical condition that may lead to complications and may sometimes require emergency treatment. It can lead to blood clots forming in the heart that may be circulated to other organs and lead to blocked blood flow (ischemia).

What are the different types of Atrial Fibrillation (AF)?

The condition is commonly divided into the following types:

  • Paroxysmal AF: This is used to describe recurring or sudden episodes of symptoms. This is the type of AF where you may experience episodes that come and go. Each episode may come on suddenly.However, it will stop without treatment within seven days (normally within two days). The episodes stop just as suddenly as it starts and the heartbeat returns to normal. The time between each episode can vary greatly for different people. Even though it may stop on its own, some people with the condition get treatment as soon as it develops to stop it as quickly as possible.
  • Persistent AF: This used to describe AF that lasts longer than seven days. It is unlikely to revert back to normal without treatment. With that said, the heartbeat can be reverted back with cardioversion treatment. This type of AF tends to be recurrent so it may return at some point even after successful cardioversion treatment.
    This is used describe long-term AF and when the heartbeat has not been reverted back to a normal rhythm. This may be due to unsuccessful cardioversion treatment or because cardioversion has not been tried. The goal of treatment for people with permanent AF is to bring their heart rate back down to normal; however, the rhythm remains irregular.

Is Atrial Fibrillation (AF) common?

Yes, it is common. However, it mainly occurs in older people. It tends to become more common with age. In a research conducted in the UK, about one in two hundred people aged fifty to sixty have AF and it rises to around one in ten people aged over eighty years. It is not common in younger people unless they already have certain heart conditions.

SYMPTOMS OF ATRIAL FIBRILLATION

Some people with atrial fibrillation have no symptoms and are unaware of their condition until it’s discovered during a physical examination. Those who do have atrial fibrillation symptoms may experience signs and symptoms such as:

  • Palpitation (sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest)
  • Weakness
  • Reduced ability to exercise
  • Fatigue
  • Light-headedness
  • Dizziness
  • Confusion
  • Shortness of breath
  • Chest pain

ATRIAL FIBRILLATION TREATMENT OPTIONS

The treatment that’s most appropriate for you will depend on:

  • How long you’ve had atrial fibrillation
  • How bothersome your symptoms are
  • The underlying cause of your atrial fibrillation

The goals of treating AF are:

  • Preventing blood clots from forming (This will lower the risk of stroke).
  • Controlling how many times a minute the ventricles contract (Rate control). Rate control is important as it allows the ventricles enough time to completely fill with blood. This approach will allow the abnormal heart rhythm to continue but you feel better and experience fewer symptoms.
  • Restoring a normal heart rhythm (Rhythm control). Rhythm control lets the atria and ventricles to work together to efficiently pump blood to the body.
  • Treating any underlying disorder that’s causing or raising the risk of AF (For example, hyperthyroidism – too much thyroid hormone).
  • Resetting your heart’s rhythm. The heart rate and rhythm are reset to normal to treat atrial fibrillation. Doctors may be able to reset your heart to its regular rhythm (sinus rhythm) using a procedure called cardioversion to correct your condition depending on the underlying cause and how long you’ve had it.

TWO WAYS OF CARDIOVERSIONS

  • Electrical cardioversion: During this brief procedure, an electrical shock is sent to your heart through paddles or patches attached to your chest. This stops your heart’s electrical activity momentarily. When your heart’s electrical activity starts again, the goal is that it resumes its normal rhythm. You won’t experience the shocks as it is performed during sedation.
  • Cardioversion with drugs: Anti-arrhythmics (medication) is used to help restore normal sinus rhythm. According to your heart condition, your doctor may recommend trying intravenous or oral medications to treat your heart back to normal rhythm. This procedure is often performed in the hospital with continuous monitoring of your heart rate.Your doctor will often prescribe the same anti-arrhythmic medication or a similar one to try to prevent more spells of atrial fibrillation if your heart rhythm returns to normal. You may be given a blood-thinning medication such as warfarin (Coumadin, Jantoven) before the surgery for several weeks to reduce the risk of blood clots and stroke. If the episode lasted less than forty-eight hours, you’ll be required to take warfarin for at least four weeks after the procedure to prevent blood clots from forming even after your heart is back in normal rhythm. Transesophageal echocardiography is another test that can tell your doctor if you have any heart blood clots (before cardioversion).

Maintaining a normal heart rhythm

After electrical cardioversion, anti-arrhythmic medications may be prescribed to prevent future episodes of atrial fibrillation. Medications may include:

  • Dofetilide (Tikosyn)
  • Flecainide
  • Propafenone (Rythmol)
  • Amiodarone (Cordarone, Pacerone)
  • Sotalol (Betapace, Sorine)

While these drugs may help to maintain a normal heart rhythm, they may cause certain side effects such as nausea, dizziness and fatigue.

They rarely cause ventricular arrhythmias (life-threatening rhythm disturbances originating in the heart’s lower chambers). These medications may be needed indefinitely. It is important to note that there is a chance of another episode of atrial fibrillation even with medications.

Heart rate control

Your doctor may prescribe medications to control your heart rate and restore it to a normal rate. Heart rate control can be achieved through several medications such as:

  • Digoxin (Lanoxin): Used to control heart rate at rest (not as well during activity). Additional or alternative medications such as calcium channel blockers or beta blockers are normally required by most people.
  • Beta blockers: Side effects such as worsening of heart failure and low blood pressure (hypotension) may arise from taking beta blockers. Calcium channel blockers can also cause side effects and may need to be avoided if you have heart failure or low blood pressure.

Catheter and surgical procedures

Sometimes, cardioversion or medication to control atrial fibrillation doesn’t work. In such cases, your doctor may recommend a procedure to destroy the area of heart tissue that’s causing the erratic electrical signals and return your heart to a normal rhythm. These options may include:

  • Catheter ablation: Rapidly discharging triggers or hot spots cause AF in most people with the condition who have an otherwise normal heart. These hot spots fire so rapidly that the upper chambers of your heart quiver instead of beat efficiently.During the procedure, long, thin tubes (catheters) are inserted into your groin and used to guide your doctor through blood vessels to your heart. The electrodes at the catheter tips use radiofrequency energy, extreme cold (cryotherapy) or heat to destroy the hot spot to scar the tissue so that the erratic signals are normalized. This procedure corrects the arrhythmia without medications or implantable devices.
  • Surgical maze procedure: This procedure is performed during an open-heart surgery. Several precise incisions are created in the upper chambers of your heart to create a pattern of scar tissue using a scalpel. As scar tissue doesn’t carry electricity, it interferes with stray electrical impulses that AF.Since this procedure requires open-heart surgery, it is normally reserved for patients who don’t respond to other treatments or when it can be done during other necessary heart surgery (coronary artery bypass surgery or heart valve repair). The scars can also be created using radiofrequency or cryotherapy. There are multiple variations of the surgical maze technique and they have a high success rate. However, AF may recur. If AF recurs, some people may need catheter ablation or other treatment.
  • Atrioventricular (AV) node ablation: AV node ablation may be an option for you when medications or other forms of catheter ablation are not effective or if you have side effects or are not suitable for other procedures. It involves administering radiofrequency energy to the path connecting the upper chambers (atria) and lower chambers (ventricles) of your heart to destroy this small area of tissue. This prevents the atria from sending electrical impulses to the ventricles.However, the atria will continue to fibrillate. A pacemaker will then be implanted to keep the ventricles working properly. After the procedure has been performed, you’ll need to continue to take blood-thinning medications to reduce the risk of stroke as your atria is still fibrillating.

Preventing blood clots

There is a high risk in developing blood clots that could lead to a stroke in many people with AF or those who are undergoing certain treatments for AF. The risk of getting blood clots is even higher if other heart disease is present along with AF. You may be prescribed blood-thinning medications (anticoagulants) like:

  • Warfarin (Coumadin, Jantoven): This medication prevents blood clots. You must follow your doctor’s instructions carefully as it is a powerful medication that may cause dangerous bleeding. Regular blood tests are done to monitor warfarin’s effects.
  • Newer anticoagulants: Multiple newer blood-thinning medications (anticoagulants) are available. They are shorter acting than warfarin and they also don’t require monitoring. However, they are not approved for people who have mechanical heart valves. Therefore, it’s very important to take these medications exactly as prescribed.
  • Dabigatran (Pradaxa): An anticoagulant that’s as effective as warfarin (preventing blood clots that can lead to strokes). It also doesn’t require blood tests to ensure that you’re getting the appropriate dosage. Dabigatran shouldn’t be taken if you have a mechanical heart valve. This may increase your risk of stroke or heart attack. If you’re concerned about the risk of a stroke, speak to your doctor about taking this medication as an alternative to warfarin.
  • Rivaroxaban (Xarelto): This is another anticoagulant that’s as effective as warfarin (for preventing strokes). It’s a once-daily medication and like any other anticoagulant, you must follow your doctor’s dosing instructions carefully. Don’t stop taking the medication without consulting your doctor first.
  • Apixaban (Eliquis): This is also an anticoagulant that’s as effective as warfarin (for preventing strokes). Like any other anticoagulant, you must follow your doctor’s dosing instructions carefully. Don’t stop taking the medication without consulting your doctor first.

DIAGNOSING ATRIAL FIBRILLATION

  • History taking and physical exam: Your doctor will ask you questions about your usual life style, symptoms you are having and family history of heart diseases. Then he will perform a physical examination, which includes checking you pulse, blood pressure, auscultation and percussion of your heart.

    • Atrial fibrillation; heart rhythm disorder; Atrial fibrillation treatment; catheter ablation; atrioventricular node ablation

  • Electrocardiogram (ECG): Small sensors (electrodes) are attached to your chest and arms to detect and record electrical signals as they travel through your heart. This is a primary tool for diagnosing AF.
  • Holter monitor: This is a type of ECG where you wear a portable monitor for 24 hours (as you go about normal activities). Certain abnormalities may reveal inadequate blood flow to your heart. Sometimes, this technique may be recommended.
  • Event recorder: This is another type of portable ECG device. It is intended to monitor your heart activity over a few weeks to a few months. Only when you experience symptoms of a fast heartbeat, should you activate it. Simply push a button and an ECG strip of the preceding few minutes and following few minutes will be recorded. This allows your doctor to determine the rhythm of your heart at the time of your symptoms.
  • Echocardiogram: This non-invasive test uses sound waves to produce a video image of your heart. A wand-like device (transducer) that’s held on your chest (transthoracic echocardiogram) directs sound waves to your heart. To detect underlying structural heart disease, the sound waves provide video images of your heart in motion. A type of echocardiogram known as transoesophageal echocardiography may be performed in which they insert a flexible tube with a transducer attached and insert it down your throat into your oesophagus. Sound waves are used to produce images of your heart (seen more clearly with this type of echocardiogram). Doctors may also use this test to detect blood clots that may have formed in your heart.
  • Blood tests: Doctors use blood test to rule out thyroid problems or other substances in your blood that may lead to AF.
  • Stress test: This is also known as exercise testing. It involves running tests on your heart while you’re exercising.
  • Chest X-ray: X-ray images allow your doctor to see the condition of your lungs and heart. X-ray can also help in diagnosing conditions other than AF that may explain your signs and symptoms.