AFib — Know It All!

All you need to know about Atrial Fibrillation.

Know your ailment well, so you can manage it better!!

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What is Atrial Fibrillation?

Atrial fibrillation is an abnormal and frequently quick heart rhythm that can raise the risk of strokes, heart failure, and other risks associated with the heart.

The heart’s two upper chambers (the atria) beat chaotically and irregularly during atrial fibrillation, out of sync with the heart’s two lower chambers (the ventricles). Symptoms of atrial fibrillation often include palpitations in the heart, shortness of breath, and fatigue.

Atrial fibrillation episodes may come and go, or you may experience atrial fibrillation that does not go away and may need counseling. Although atrial fibrillation itself is typically not life-threatening, it is a significant medical condition that needs emergency care often.

The ability to form blood clots inside the upper chambers of the heart is a major problem with atrial fibrillation. These heart-forming blood clots will circulate to other organs and lead to blocked flow (ischemia) of blood.

Atrial fibrillation therapies can include medicines and other procedures that attempt to change the electrical system of the heart.

What causes Atrial Fibrillation?

There are four chambers in the heart: two auricles and two ventricles.

Atrial fibrillation occurs when, due to defective electrical signalling, these chambers don’t fit together as they should.

The atrium and ventricles normally contract at the same pace. The atria and ventricles are out of alignment in atrial fibrillation since the atria contract very rapidly and irregularly.

We may not always know the origin of atrial fibrillation. Conditions that can cause heart damage and contribute to atrial fibrillation include:

• Elevated Blood Pressure
• Congestive Heart Insufficiency
• The disease of the coronary arteries
• Disease of the Heart Valve
• Hypertrophic cardiomyopathy, when the tissue of the heart becomes dense
• Heart procedure
• Congenital heart defects, that is, heart defects in which you are born
• The overactive gland of the thyroid
• Pericarditis, an infection of the heart’s sac-like lining,
• Take some drugs
• Drinking spree
• Thyroid sickness

Your risk of AFib can be minimized by an overall safe lifestyle. Not all triggers, however, are preventable.

In order to help recognise the causes of your AFib and be better able to handle it, it’s important to tell your doctor about your full health history.

What are the risk factors of Atrial Fibrillation?

While the exact cause of AFib isn’t always known, there are some factors that may put you at a higher risk for this condition. Some of these may be prevented, while others are genetic.

Talk to your doctor about the following risk factors:

• increased age (the older you are, the higher your risk)
• being white
• being male
• a family history of atrial fibrillation
• heart disease
• structural heart defects
• congenital heart defects
• pericarditis
• history of heart attacks
• history of heart surgery
• thyroid conditions
• metabolic syndrome
• obesity
• lung disease
• diabetes
• drinking alcohol, especially binge drinking
• sleep apnea
• high-dose steroid therapy

What are the complications of Atrial Fibrillation?

Your doctor’s routine medical care and checkups will help you prevent complications. But if atrial fibrillation is left untreated, it can be extreme and even fatal.

Heart failure and stroke have severe complications. In people with AFib, drugs and lifestyle patterns may also help avoid this.

As a result of a blood clot in the brain, a stroke occurs. It deprives your brain of oxygen, which can contribute to continuous damage. Often, strokes can be fatal.

Heart failure happens when the heart can’t function properly anymore. As the ventricles in the lower chambers begin to work harder to make up for the lack of blood flow in the upper chambers, AFib will wear down the heart muscle.

Heart failure occurs over time in people with AFib. It is not a sudden event, such as a heart attack or stroke.

Your overall chances of complications due to AFib can be minimized by following your treatment plan.

Take all your drugs according to your doctor’s order. And read about potential problems with AFib and its symptoms.

What are the types of Atrial Fibrillation?

The symptoms are generally the same; however, the duration of the AFib and underlying reasons for the condition help medical practitioners classify the type of AFib problems.

• Paroxysmal fibrillation is when the heart returns to a normal rhythm on its own, or with intervention, within 7 days of its start. People who have this type of AFib may have episodes only a few times a year or their symptoms may occur every day. These symptoms are very unpredictable and often can turn into a permanent form of atrial fibrillation.
• Persistent AFib is defined as an irregular rhythm that lasts for longer than 7 days. This type of atrial fibrillation will not return to normal sinus rhythm on its own and will require some form of treatment.
• Long-standing AFib is when the heart is consistently in an irregular rhythm that lasts longer than 12 months.
• Permanent AFib occurs when the condition lasts indefinitely and the patient and doctor have decided not to continue further attempts to restore normal rhythm.
• Nonvalvular AFib is atrial fibrillation not caused by a heart valve issue.

Paroxysmal fibrillation over a period of time may become more frequent and more enduring, often leading to permanent or chronic AFib. Both forms of AFib will improve the risk of stroke. And if you have no symptoms at all, you are almost 5 times more likely to have a stroke than someone who does not have atrial fibrillation.

What are the symptoms of Atrial Fibrillation?

There are no signs in certain people with atrial fibrillation and they are unaware of their condition unless it is detected through a physical examination. There may be signs and symptoms for those who have atrial fibrillation symptoms, such as:

• Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest
• Weakness
• Reduced ability to exercise
• Fatigue
• Lightheadedness
• Dizziness
• Shortness of breath
• Chest pain

Atrial fibrillation may be:

• Occasional. In this case, atrial fibrillation is called paroxysmal (par-ok-SIZ-mul). You may have symptoms, typically lasting for a few minutes to hours, that come and go. For as long as a week, symptoms often persist and episodes may occur repeatedly. Your symptoms can go away on their own, or medication may be required.
• Persistent. Your heart rate doesn’t go back to normal on its own with this form of atrial fibrillation. If you have chronic atrial fibrillation, you will require care to restore your heart rhythm, such as electrical shock or medication.
• Long-standing persistent. This form of atrial fibrillation lasts more than 12 months and is continuous.
• Permanent.The irregular heart rhythm can’t be restored in this form of atrial fibrillation. You will permanently have atrial fibrillation, and you will also need medicine to regulate the heart rate and avoid blood clots.

How is Afib Diagnosed?

Your doctor can review your signs and symptoms, review your medical history, and perform a physical examination in order to diagnose atrial fibrillation. In order to diagnose your condition, your doctor can order several tests, including:

• Electrocardiogram (ECG). An ECG uses small sensors (electrodes) attached to your chest and arms to sense and record electrical signals as they travel through your heart. This test is a primary tool for diagnosing atrial fibrillation.
• Holter monitor. This portable ECG device is carried in your pocket or worn on a belt or shoulder strap. It records your heart’s activity for 24 hours or longer, which provides your doctor with a prolonged look at your heart rhythms.
• Event recorder. This portable ECG device is intended to monitor your heart activity over a few weeks to a few months. When you experience symptoms of a fast heart rate, you push a button, and an ECG strip of the preceding few minutes and following few minutes is recorded. This permits your doctor to determine your heart rhythm at the time of your symptoms.
• Echocardiogram. This test uses sound waves to create moving pictures of your heart. Usually, a wandlike device (transducer) is held on your chest. Sometimes, a flexible tube with the transducer is guided down your throat through to your esophagus. Your doctor may use an echocardiogram to diagnose structural heart disease or blood clots in the heart.
• Blood tests. These help your doctor rule out thyroid problems or other substances in your blood that may lead to atrial fibrillation.
• Stress test. Also called exercise testing, stress testing involves running tests on your heart while you’re exercising.
• Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. Your doctor can also use an X-ray to diagnose conditions other than atrial fibrillation that may explain your signs and symptoms.

Treatment Options:

The most effective atrial fibrillation treatment for you will focus on how long you have had atrial fibrillation, how annoying your symptoms are, and the underlying cause of your atrial fibrillation. The treatment targets for atrial fibrillation are generally:

Reset the rate or monitor the rhythm: Prevent blood clots, which can minimize the risk of having a stroke

The approach you and your doctor prefer depends on many things, like whether you have any heart issues and whether you can take drugs that can regulate your heart rhythm. More invasive care may be needed in some cases, such as surgical procedures using catheters or surgery.

A particular event or an underlying condition, such as a thyroid disorder, can cause atrial fibrillation in some people. Treating the condition that causes atrial fibrillation can help reduce issues with your heart rhythm. Your doctor may attempt to reset the rhythm if your symptoms are annoying or if this is your first episode of atrial fibrillation.

Resetting your heart’s rhythm

Ideally, the heart rate and rhythm are reset to normal to treat atrial fibrillation. To correct your condition, doctors might be able to use a procedure called cardioversion to restore the heart to its normal rhythm (sinus rhythm), depending on the underlying cause of atrial fibrillation and how long you’ve had it.

Cardioversion can be done in two ways:

• Electrical cardioversion. In this brief process, via paddles or patches put on your chest, an electric shock is applied to your heart. For a brief moment, the shock stops the heart’s electrical activity. The aim is to reset the regular rhythm of your heart.
• Before the treatment, you will be given a sedative, so you shouldn’t feel the electric shock. Before the treatment, you can also receive medicine to help restore a normal heartbeat (antiarrhythmics).
• Cardioversion with drugs. To help restore normal sinus rhythm, this type of cardioversion uses drugs called antiarrhythmics. You can receive medication through an IV or by mouth, depending on your heart condition, to help return your heart to a regular rhythm.
• This is often achieved with constant monitoring of the heart rate in the hospital. Your doctor will also prescribe the same or similar anti-arrhythmic medicine if the heart rhythm returns to normal to try to avoid further periods of atrial fibrillation.
• In order to minimize the risk of blood clots and strokes, you might be given warfarin or another blood-thinning drug for several weeks prior to cardioversion. If your atrial fibrillation episode has lasted for more than 48 hours, you will continue to take this type of drug for at least a month after the heart blood clot prevention operation.

Maintaining a normal heart rhythm

After electrical cardioversion, your doctor may prescribe anti-arrhythmic medications to help prevent future episodes of atrial fibrillation. Medications may include:

• Dofetilide
• Flecainide
• Propafenone
• Amiodarone
• Sotalol

Although these drugs may help maintain normal heart rhythm, they can cause side effects, including:

• Nausea
• Dizziness
• Fatigue

They will occasionally cause ventricular arrhythmias, life-threatening disruptions of the rhythm occurring in the lower chambers of the heart. These medications may be needed indefinitely. Even with medications, there is a chance of another episode of atrial fibrillation.

Heart rate control

You may be prescribed medications to control how fast your heart beats and restore it to a normal rate.

• Digoxin. This medication may control the heart rate at rest, but not as well during activity. Most people need additional or alternative medications, such as calcium channel blockers or beta-blockers.
• Beta-blockers. These medications can help to slow the heart rate at rest and during activity. They may cause side effects such as low blood pressure (hypotension).
• Calcium channel blockers. These medicines also can control your heart rate but may need to be avoided if you have heart failure or low blood pressure.

Catheter and surgical procedures

Catheter ablation to isolate the pulmonary veins to treat atrial fibrillation

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

• Catheter ablation. A doctor implants long, thin tubes (catheters) into your groyne during this operation and directs them to your heart through blood vessels. Radiofrequency energy, intense cold (cryotherapy) or heat is generated by the catheter ‘s tip to kill areas of heart tissue that cause fast and erratic heartbeats. Scar tissue shapes, which helps to return the signal to normal. Without the need for medication or implantable devices, cardiac ablation can correct arrhythmias.
• If you have atrial fibrillation, and otherwise your usual heart and medicine have not improved your symptoms , your doctor may prescribe this procedure. For patients with heart failure who have an implanted system and do not take or tolerate anti-arrhythmic drugs, it can also be beneficial.
• Maze procedure. The maze technique has many variants. To build a pattern of scar tissue that interferes with stray electrical impulses that cause atrial fibrillation, the doctor may use a scalpel, radiofrequency, or intense cold (cryotherapy).
• There is a high success rate for the maze processes, however atrial fibrillation may come back. You will need another cardiac ablation or other heart medication if this happens.
• Since open-heart surgery is needed for the surgical maze operation (using a scalpel), it is normally reserved for patients who do not get better with other procedures or when it can be performed during a necessary heart surgery, such as coronary artery bypass surgery or repair of the heart valve.
• Atrioventricular (AV) node ablation. AV node ablation may be an alternative if drugs or other types of catheter ablation do not function or cause side effects, or if you are not a good candidate for these therapies. The procedure includes using a catheter to supply the pathway (AV node) linking the upper and lower heart chambers with radiofrequency energy.
• A small area of heart tissue is damaged by the operation and improper signalling is stopped. The upper chambers of the heart (atria) will still be quivering, however. To keep the lower chambers (ventricles) beating properly, you’ll need a pacemaker to be inserted. During this treatment, you’ll need to take blood thinners to minimize the risk of stroke due to atrial fibrillation.

Preventing blood clots

There is a particularly high risk of blood clots that can lead to a stroke in certain people with atrial fibrillation or others who are undergoing such atrial fibrillation treatments. If other heart diseases along with atrial fibrillation are present, the risk is even higher.

Anticoagulants

Your doctor may prescribe blood-thinning medications (anticoagulants) such as:

• Warfarin. Warfarin may be prescribed to prevent blood clots. If you’re prescribed warfarin, carefully follow your doctor’s instructions. Warfarin is a powerful medication that may cause dangerous bleeding. You’ll need to have regular blood tests to monitor warfarin’s effects.
• Newer anticoagulants. Several newer blood-thinning medications (anticoagulants) are available to prevent strokes in people with atrial fibrillation. These medications include dabigatran, rivaroxaban, apixaban and edoxaban. They are shorter acting than warfarin and usually don’t require regular blood tests or monitoring by your doctor. These medications aren’t approved for people who have mechanical heart valves.

Many individuals have atrial fibrillation spells and do not even know it, but even after the rhythm has been returned to normal, you may require lifelong anticoagulants.

Left atrial appendage closure

A procedure called left atrial appendage closure may also be considered by your doctor.

Doctors insert a catheter through a vein in the leg in this operation and ultimately direct it to the upper left heart chamber (left atrium). In order to close a small sac (appendage) in the left atrium, a device called the left atrial appendage closure device is then inserted through the catheter.

In certain individuals with atrial fibrillation, this can decrease the risk of blood clots, as many blood clots that occur in the left atrial appendage form in atrial fibrillation. Many that do not have heart valve issues, who have an elevated risk of blood clots and bleeding, and who are unable to take anticoagulants may be candidates for this procedure. You will be reviewed by your doctor and determined whether you are a candidate for the procedure.

References:

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https://www.healthline.com/health/living-with-atrial-fibrillation#diagnosis

https://www.heart.org/en/health-topics/atrial-fibrillation/what-are-the-symptoms-of-atrial-fibrillation-afib-or-af

https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.