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Atrial Fibrillation (AF)

Atrial fibrillation is an abnormal heartbeat of the upper two-chamber, pulsing, and beating inconsistently with the lower two chambers.

Atrial Fibrillation (AF)

            Atrial fibrillation is an abnormal heartbeat of the upper two-chamber, pulsing, and beating inconsistently with the lower two chambers. Patients with atrial fibrillation may experience palpitations and shortness of breath which may later disappear or recur. These raise the risk of developing blood clots in the heart which leads to paralysis if the clot slips into the bloodstream.

Symptoms

Atrial fibrillation may be temporary, frequent, or permanent. The symptoms and treatment may vary according to the severity of the individual patient’s condition. Common symptoms seen in people with atrial fibrillation may include: shortness of breath, palpitations, and dizziness. It was found that some patients may not have any symptoms and may not know that they have atrial fibrillation until receiving diagnosis or physical examination. However, if you experience chest pain, it may be a warning sign of a heart attack. You should see a doctor or contact the emergency room urgently.

To prevent the higher level of the disease, seeing the doctor as any symptom above occurs. Electrocardiogram may be ordered purposely to find out the possibility of atrial fibrillation or other heart rhythm disorder.

Cause

This abnormal and rapid heart rate occurs when two-upper chambers of the heart meet disordered electrical signals. There are groups of cells called the sinus node within the upper right chamber of your heart which produce the signal that operates the heartbeat. The movement of the signal that pass through the two champers results heart to squeeze and send blood to your heart and body. When the electrical signals operate irregularly, it leads to a rapid and abnormal heart system. The heart rate in atrial fibrillation may up to the range of 100 to 175 beats a minute while the normal ones is 60 to 100.

Many factors increasing the risk of atrial fibrillation may include: age, heart disease, high blood pressure, alcohol use, obesity, family history, and other chronic conditions.

The older people tend to have the higher risk of atrial fibrillation. It is also recorded that heart disease highers the tendency of developing atrial fibrillation. The risk is increased with the people with high blood pressure and other chronic conditions such as diabetes, thyroid, and chronic kidney disease.  Developing of atrial fibrillation also relates to obesity and ones whose family has atrial fibrillation record.

Diagnosis

             Normally, to evaluate the tendency of the disease, The doctor may review the patient’s historical medications and may require a physical examination. Some tests are also required to diagnose the conditions including:

 

  • Electrocardiogram (ECG)

This  tool is a used to sense and record electrical signals passing through your heart by attaching small sensors to your chest and arms.

 

  • Holter monitoring

This portable ECG recording is intended to record the. To monitor the heartbeat for 24 hours a day or longer. This allows the doctors to monitor the heart’s activity in cases where the heartbeat may show abnormal symptoms during the day.

 

  • Event recorder

Event Recorder functions the same as the holter monitoring portable ECG. This recorder focuses on the recording of multiple weeks of heartbeats or up to several months. In which the patient must press a button when the heartbeat occurs to record the frequency and number of times the anomaly has occurred. This allows the doctor to observe of the abnormal heartbeat as well as abnormal rhythm disturbances.

 

  • Echocardiogram

This method uses high-frequency waves to simulate images of the heart to show anomalies that may occur including the shape of the heart, the condition of the heart valve, and blood clots that may arise within.

 

  • Blood tests

These procedures are used to look for another factors that may cause the development of  atrial fibrillation such as thyroid and other substances in blood.

 

  • Stress test

This exercise test is conducted to monitor your heart while exercising.

 

  • Chest X-ray

Lungs and heart are observed to seek for the other conditions beside atrial fibrillation that can describe your signs and symptoms

 

Treatment.

            Treatments for atrial fibrillation may vary from the severity and duration of the disease. The treatments aims to reset the rhythm or control the heart rate, and to prevent blood clots that may higher the risk of a stroke.

 

 To reset the heart rhythm or to control the heart rate

             Cardioversion is the most common method used toreset the heart rhythm.  The methods vary from the severity and duration of atrial fibrillation in each individual, with two main methods:

 

  1. Electrical cardioversion

This electrical shock is sent to your heart through paddles or patches attached on your chest. This method will stop the heart’s activity for a short period  of time to reset the heart to normal system. A sedative will be given before the procedure. In some cases, other medication may be used along with the procedure to reset the heartbeat.

 

  1. Cardioversion with drug

The medication called antiarrhythmics may be required to restore regular sinus rhythm. Taken by mouth or IV, your heart rate will be monitored in the hospital and evaluated for the further treatments. Normally, if your heart rhythms have gotten back to normal, the same or similar antiarrhythmics will be continued to prevent the developing of atrial fibrillation.

 

Several weeks before this treatment, warfarin and some kinds of blood-thinning medications will be prescribed to prevent the risk of blood clots and a stroke. These medications may be continued at least a month after the treatment.

 

To maintain a normal heart rhythm

 After the procedure of electrical cardioversion, some antiarrhythmic medications may be prescribed to prevent the future atrial fibrillation and to maintain a normal heart rhythm such as:

  • Amiodarone
  • Flecainide
  • Propafenone
  • Sotalol
  • Dofetilide

 

The patients may experience some side effects such as nausea, dizziness, and fatigue after the use of the medications. In some cases, severe rhythm disturbances in heart’s lower chambers may occur. The use of these medications may lead to more seveverity of atrial fibrillation as well.

 

To control the heart rate

 There are some kinds of medications that may be used to control the rapid heart rate and to restore to its normal rate including:

  • Digoxin

This medication control the heart rate during resting. The doctor may prescribe some additional medications such as calcium channel blockers or beta blockers while using this medication.

 

  • Beta blockers

The Beta blockers help regulate the heart rate either at rest or during physical activity. The side effects of the drug may lower blood and may cause hypotension.

 

  • Calcium channel blockers

 Anti-calcium drugs affects in regulating the heart rate. However, it should be avoided because it can cause low blood pressure and may lead to heart failure

 

            The doctor may suggest other procedures to control the heart rate including:

 

Catherter and surgical procedures

             If other treatments do not achieve, catheter and surgical procedures may be recommended as the alternative treatments. The procedures purpose to destroy a part of heart tissue that results abnormal electrical signals to bring back the normal heart rhythms.

  • Catheter ablation

This treatment aims to destroy a part of heart tissue that causes atrial fibrillation. by using high frequency electric waves or radiofrequency energy through a catheter into the heart to destroy the underlying tissue. This will create a scar to help the heart rhythm return to normal.  This procedure is occationally used in patients with congestive heart failure or those who are unresponsive to antiarrhythmics drugs.

 

  • Maze procedure

Maze procedure is a surgical procedure that aim to destroy a part of heart tissue that causes atrial fibrillation. The surgery is performed by opening the heart before destroying the underlying tissue. The procedure will leave a scar which does not conduct electricity and helps the heart rhythm return to normal

 

However, this surgery is only used to treat the patients who have not responded to other treatments because open-heart surgery is complicated. This procedure may be performed during other open-heart surgeries such as coronary bypass surgery.

 

 

  • Atrioventricular (AV) node ablation

This is an alternative procedure for those patients who do not respond to any of other procedures. The procedure implicates with a catheter to send radiofrequency energy to the pathway joining the upper and lower heart chambers. This therapy will destroy a small area of heart tissue to prevent the irregular signaling. A pacemaker implanted is needed to keep the lower heart chambers beating properly. The patients will be required to take blood thinner medications after the therapy to prevent the formation of blood clots that may cause stroke.

 

            To preventing blood clots

             Patients with atrial fibrillation has a high risk of blood clots that lead to a stroke. The risk is even higher with people who are involved with other heart disease. The doctor may prescribe some medications to prevent blood clots such as the two main kinds of medications below:

    • Anticoagulants
 
      • Warfarin

This severe anticoagulant is intended to prevent the formation of blood clots. Patients receiving this drug must strictly follow the doctor’s instructions and must have regular blood tests to monitor the effect of the drug on the blood to prevent bleeding that can be dangerous.

 

      • Newer anticoagulants       

These anticoagulants are often used in patients with atrial fibrillation to prevent a stroke. Newer anticoagulants is shorter-acting than Warfarin, and therefore does not need a blood test to monitor the effects of the drug. However, consult a doctor and follow the advise strictly.

 

Left atrial appendage closure                      

             Left atrial appendage closure is an option for patients with a high risk of blood clot formation or easy bleeding without heart valve problems, and people who cannot use the anticoagulants.

 

            The procedure starts with insertion of a small tube through a vein in the thigh to insert a small umbrella-like appendage to seal the left atrial appendage (left atrial) and allow tissue to wrap over time. This treatment can help prevent the formation of blood clots and replace the use of anticoagulants.

 

Preparing for an appointment

             Before your appointment, you are advised to be aware of restrictions prior the appointment and you may prepare some information including:

    • your experienced symptoms
    • your key personal information
    • all medications you are taking
    • questions that you want to ask the doctor

 

            During the consulting, the doctor may ask some questions including the information such as:

    • the beginning of your symptoms
    • whether your symptoms are continuous or occasional
    • the severity of your symptoms
    • whether anything improve or worsen your symptoms