Atrial fibrillation

Last updated date: 28-Aug-2023

Originally Written in English

Atrial Fibrillation 

 

Atrial fibrillation is a common form of heart arrhythmia (irregular heart rhythm) that disrupts normal blood flow. Because of this interruption, you are at risk of blood clots and even a stroke. Atrial fibrillation normally affects the two heart upper chambers (atria). This causes blood flow disruption to the ventricles and the lower chambers and throughout the whole body. 

Atrial fibrillation can be fatal if left untreated. In addition, it can be temporary, intermittent, or permanent. It is also more prevalent in adults above the age of 65. Luckily, one can live a normal and active life with the appropriate medical care. 

 

Signs and Symptoms of Atrial Fibrillation 

Not all individuals who have atrial fibrillation show symptoms and are aware of the situation till a physical exam reveals it. On the other hand, those who have atrial fibrillation signs and symptoms may experience the following:

  • Palpitations; sensations of uncomfortable, racing, irregular heart pulse or a chest flip-flopping.
  • Breathing difficulty
  • Chest ache
  • Decrease in exercise capacity
  • Dizziness
  • Fatigue
  • Lightheadedness
  • Weakness

These signs and symptoms may appear and disappear depending on the severity of the disorder. In general, atrial fibrillation can be;

Occasional: This is known as paroxysmal atrial fibrillation. You might experience intermittent symptoms that last from a few minutes to several hours. The symptoms can last up to a week at times, while the episodes may occur repeatedly. Also, the associated symptoms may resolve on their own, or you might require medical treatment. 

Persistent: The heart rhythm does not return to normal in this form of atrial fibrillation. So if you have persistent atrial fibrillation, you will need to be treated with an electrical shock or prescription medications to help restore the normal heart rate.

Long-standing persistent: With this form of atrial fibrillation, you will experience ongoing symptoms that last for more than a year.

Permanent: It’s impossible to restore the abnormal heart rhythm in this kind of atrial fibrillation. Therefore, you will have atrial fibrillation for the rest of your life, and you will frequently need medicines. This helps manage your heart rhythm and prevents the formation of blood clots.

 

Causes of Atrial Fibrillation 

Causes of Atrial Fibrillation

There are four chambers in the heart: two atria and two ventricles. Therefore, atrial fibrillation occurs if these chambers fail to function properly due to faulty electric signaling. 

The atria and ventricles normally contract at a similar rate. However, the atria and ventricles are often out of sync in atrial fibrillation since the atria contract rapidly and irregularly. 

It is not always possible to determine the actual cause of atrial fibrillation. Nonetheless, the following health conditions can cause heart damage and result in atrial fibrillation:

  • Congenital heart defects (heart defects that are present at birth).
  • Congestive heart failure
  • Coronary heart disease
  • Heart valve disease
  • Hypertrophic cardiomyopathy, a condition in which the heart muscle thickens.
  • Increased blood pressure
  • Overactive thyroid gland
  • Pericarditis, an inflammation of the heart's sac-like covering.
  • Surgery on the heart
  • Thyroid disorder
  • Use of certain drugs 
  • Bingeing on alcohol

 

Risk Factors of Atrial Fibrillation 

The following factors can raise your chances of having atrial fibrillation:

Age: As you grow older, you are more likely to develop atrial fibrillation.

High blood pressure: Increased blood pressure, particularly if not controlled through lifestyle modifications or drugs, can increase your risk of atrial fibrillation.

Heart disorders: A person who has a certain heart disease is at a higher risk of developing atrial fibrillation. These diseases can include congestive heart failure, heart valve problems, coronary artery disease, or congenital heart disease. Heart surgery or a previous history of a heart attack also increases the risks. 

Certain long-term conditions: Individuals who have sleep apnea, thyroid problems, metabolic syndrome, chronic kidney disease, diabetes, and lung disease are more likely to develop atrial fibrillation.

Alcohol consumption: Drinking alcohol could result in an episode of atrial fibrillation in some people. Also, binge drinking can increase your risk even further. 

Family history: Some families are at a high risk of developing atrial fibrillation. 

Obesity: Obese people are more likely to develop atrial fibrillation.

 

Atrial Fibrillation Diagnosis 

The doctor or cardiologist may conduct a physical examination, inquire about your signs or symptoms, and review your general medical history during atrial fibrillation diagnosis. To confirm the condition, the doctor may order a number of tests, such as: 

Electrocardiogram (ECG): This test detects and records electric signals while moving through the heart using electrodes or small sensors connected to the chest and arms. ECG with atrial fibrillation is the most commonly used for diagnosis.

Event recorder: This is small portable ECG equipment designed to track heart activity for weeks to months. When you have symptoms of a rapid heartbeat, you press a button, and the device strip of the previous and subsequent few minutes is recorded. This allows your provider to determine the heart pulse at the period of the symptoms. 

Holter monitor: This small ECG tool fits in the pocket or is worn on a shoulder strap or belt. It records the activity of the heart for 24 hours or even more. This gives the doctor a more in-depth look at the heart rate. 

Atrial Fibrillation Diagnosis

Echocardiogram: This test employs sound waves to generate moving images of the heart. A wand-like device (transducer) is usually held against the chest. A flexible tube containing a transducer is sometimes directed down the throat and into your esophagus. Your medical provider can recommend an echocardiogram to check for structural heart disease and any blood clots within the heart.

The stress test:  Stress testing, also known as exercise testing, entails performing tests on your heart when exercising. 

Blood tests: These tests assist your doctor in ruling out thyroid issues and any other content in the blood that might cause atrial fibrillation.

Chest x-ray: Your doctor can use the x-ray images to determine the health of your lungs as well as the heart. An x-ray can also help rule out other conditions apart from atrial fibrillation that could be causing your symptoms. 

 

Atrial Fibrillation Treatment 

The goal of atrial fibrillation treatment is to alleviate symptoms while lowering the chances of associated complications. In most cases, prescription medications might be sufficient to address the symptoms. Cardiologists, on the other hand, can suggest medical interventions in certain circumstances. 

Your doctor will come up with an inclusive treatment plan. Hence, he or she will review your symptoms, underlying health condition, lifestyle, and function of the heart. 

The treatment options can include;

  • Medications

Medications can regulate heart rate, avoid clot formation, and, in other cases, normalize the heart pulse. 

Controlling heart rhythm:

For a high heart pulse, it is critical to lower it in order to avoid heart failure and limit the symptoms associated with atrial fibrillation.

The medications function by slowing down the signals which instruct the heart beating process. Some of the examples are; 

  • Beta-blockers, including metoprolol and atenolol
  • Calcium channel blockers, including verapamil and diltiazem
  • Digoxin

Blood clots prevention:

At times, your medical provider can recommend anticoagulant medications or blood thinners to prevent blood clots. They work by making it more difficult for blood to clot.

Using blood thinners can raise your risk of severe bleeding. On the other hand, the benefits of preventing blood clots outweigh the bleeding risks for most people. Your doctor will help you determine if blood-thinning drugs are suitable for you or not.  

Normalizing the heart pulse:

Rather than recommending a heart rhythm regulating medication, the medical provider may attempt to restore normal heart rhythm with medicine. This is known as chemical cardioversion or pharmacologic cardioversion.

Sodium channel blockers, including potassium channel blockers (amiodarone) and flecainide, are some medications that aid in the conversion of atrial fibrillation to a normal beat. They are known as anti-arrhythmias.

Mostly, even after your heart pulse goes back to normal, you may still require blood-thinning drugs.

  • Other treatment procedures

If the heart condition does not improve with medication, more treatment procedures might be required. These can aid in regulating the heart rhythm, the normalization of the heart pulse, or the prevention of atrial fibrillation complications.

The medical provider can thus recommend the following surgical procedures:

  • Electrical cardioversion: This involves delivering a synchronized electric shock into the heart. It can cause the irregular heart rhythm to return to a normal rate.
  • Surgical ablation: During an open-heart procedure known as a maze procedure, the surgeon can take out the heart tissue that causes the irregular rhythm. Mainly, they can only perform this procedure in conjunction with other heart procedures.
  • Catheter ablation: This procedure destroys the tissue triggering the irregular beat. If the atrial fibrillation returns, the surgeon might have to repeat the process.
  • Pacemaker placement: This is a device that tells the heart to beat normally. A pacemaker is sometimes implanted in a patient with intermittent atrial fibrillation. 

 

Conclusion 

Atrial fibrillation is a heart rhythm disorder that causes an irregular heartbeat. It is more common after 65 and might or might not trigger any symptoms. If blood collects in the heart and a clot forms and goes to the brain, it can result in a stroke. 

The treatment aims at restoring normal heart pulse and preventing any complications. A cardiologist can prescribe medications to control heart activity as well as blood thinners to prevent clots. In some cases, they may suggest surgical procedures.