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Atrial Fibrillation

What is Atrial Fibrillation?

The heart has an electrical system, which provides signals to the chambers of the heart indicating when they should contract (squeeze) or relax. Atrial Fibrillation (Afib) is caused by chaotic electrical signals, which make the upper chambers of the heart (the atria) quiver, instead of fully contracting. For someone with AFib, the atria may beat as often as 300 times a minute, about four times faster than normal. Blood can pool in the atria during AFib, which can allow a clot to form. If a blood clot dislodges from the atria, it can cause a stroke.

How Atrial Fibrillation is diagnosed?

  • 12 lead EKG
  • External heart monitor (Holter, event monitor, or mobile telemetry)
  • Implantable loop recorder (implanted heart monitor) with readings interpreted by an electrophysiologist

Types of Atrial Fibrillation

  • Paroxysmal Afib comes and goes. It typically lasts less than one week and may stop on its own without treatment.
  • Persistent Afib can last greater than one week and may require treatment/intervention.
  • Permanent Afib (long standing) lasts more than a year and is sometimes difficult to treat.

Stroke- A Serious Concern

Per the American Stroke Association, over 795,000 Americans will have a new or recurrent stroke and more than 690,000 are caused when a clot cuts off blood flow to a part of the brain- an ischemic stroke. Stroke is the #1 cause of disability in adults. Stroke kills 133,000 people a year, 1 out of every 20 deaths. Atrial Fibrillation related strokes account for about 22% of all ischemic strokes.

Symptoms of Atrial Fibrillation

(may include but are not limited to)

  • Sensations of a fast, fluttering or pounding heartbeat (palpitations)
  • Chest pain or pressure
  • Dizziness
  • Fatigue
  • Lightheadedness
  • Exercise intolerance
  • Shortness of breath
  • Weakness
  • Some people may be unaware of their irregular heart rhythm and have no symptoms

What causes Atrial Fibrillation?

  • Coronary artery disease
  • Heart attack
  • Congenital heart defect
  • Heart valve problems
  • High blood pressure
  • Lung diseases
  • Physical stress due to surgery, pneumonia or other illnesses
  • Previous heart surgery
  • Problem with the heart’s natural pacemaker (sick sinus syndrome)
  • Sleep apnea
  • Thyroid disease such as an overactive thyroid (hyperthyroidism) and other metabolic imbalances
  • Use of stimulants, including certain medications, caffeine, tobacco and alcohol
  • Viral infections
  • For some people, there is no identifiable cause

Treatment Options for Atrial Fibrillation

Approaches include heart rate control versus heart rhythm control options

  • Rate control (medications) to reduce the risk of heart failure, hospitalization, and improve symptoms. These medications need to be monitored for the potential to induce bradycardia. These medications are frequently associated with side effects such as fatigue, dyspnea, low energy, sexual dysfunction, and mood changes.
  • Rhythm control to reduce the risk of heart failure, hospitalization, and improve symptoms. Rhythm control treatment options include antiarrhythmic medications (a high risk medication class) and ablation procedures (a major procedure that takes several hours and is performed under general anesthesia).
  • Anticoagulation to reduce the risk of stroke, as estimated by CHADSVASC. Anticoagulation also has an inherent risk of major morbidity due to bleeding, as estimated by HASBLED. The risks vs benefits of anticoagulation are weighed on an individual basis. Anticoagulation requires monitoring of side effects and of laboratory studies to assess for toxicity risks.  Testing includes LFTs (liver dysfunction is a HASBLED risk factor), BMP (used for dosing of a renally cleared medication with a narrow therapeutic window. Renal dysfunction is also a HASBLED risk factor), and CBC (to monitor for anemia from bleeding, as well as to evaluate for abnormal platelets which would predispose to bleeding and be a HASBLED risk factor).

Procedures/Surgery

  • Cardioversion
  • Pulmonary Vein Ablation
  • WATCHMAN
  • Referral for MAZE (surgical ablation)
Read More

Prevention (lifestyle modification)

  • Do not smoke
  • Eat a healthy/nutritious diet (Mediterranean Diet)
  • Get regular exercise and maintain a healthy weight
  • Avoid or limit alcohol and caffeine
  • Stress and anxiety management
  • Treat any underlying conditions such as sleep apnea

Resources

  • Heart Rhythm Society Guide to Atrial Fibrillation
  • UpBeat: Stroke Prevention as the Cornerstone of Treatment
  • UpBeat: What to do to reduce AFib and prevent stroke: 5 health tips
  • UpBeat: Following your blood thinner treatment plan
  • UpBeat: A closer look at sleep apnea and AFib
  • Atrial Fibrillation (heart rhythm society handout

When to call 911 or seek emergent evaluation

  • Chest pain or pressure
  • Shortness of breath (beyond your baseline)
  • Lightheadness or dizziness (feeling faint or like you might pass out)
  • Low blood pressure or high blood pressure associated with symptoms
  • Vision changes, sensation changes, speech changes, severe/strong headache
  • A sustained fast heart rate