Atrial Fibrillation 101

MEANING OF ATRIAL FIBRILLATION

Atrial fibrillation (AF) is a form of arrhythmia (the most common form of arrhythmia) that can distort the normal flow of blood. This means that one is at a greater risk of developing blood clots and stroke.

About 2.7 to 6.1 million people in the United States have atrial fibrillation. In this condition, the left and right atrial chambers are affected. This causes a reduction in the blood flow to the ventricles, the receiving chamber, and subsequently the rest of the body. When there is no intervention, atrial fibrillation can be fatal. It can occur as a temporary, intermittent, or even a permanent condition. It is commonly seen in adults above the age of 65. When proper medical care is given, one can lead a normal, productive life.

SYMPTOMS OF ATRIAL FIBRILLATION

Some people with this condition may not manifest symptoms while others will experience symptoms such as:

• Heart palpitations: the feeling of hearing your heart beating too fast or hard or even missing a beat
• Chest pain
• Tiredness
• Malaise
• Lightheadedness
• Fainting
• Dizziness
• Confusion
• Exercise intolerance

These symptoms can be intermittent depending on the severity of your condition.

A typical example is paroxysmal atrial fibrillation, a form of AF that is self-limiting and does not require medical intervention. Still, you may have to take medications to prevent any recurrence or likely complications.

In all, the symptoms of AF may last for several minutes or even hours. Chronic cases of AF may have persistent symptoms, lasting over several days. Inform your doctor about any symptoms you may be experiencing, especially if there is a deviation.

TREATMENT OF ATRIAL FIBRILLATION

Those who are asymptomatic, those who do not have other heart co-morbidities, and those who have AF symptoms that stops on its own, may not need treatment.

Those who need treatment are usually prescribed the following drugs:

• Beta-blockers: to slow down the heart rate
• Calcium channel blockers: to slow down the heart rate and relax the muscles of the artery
• Sodium or potassium channel blockers: to regulate the heart rhythm
• Digitalis glycosides: to strengthen the contractions of the heart
• Blood thinners: to prevent the formation of blood clots

The preferred blood thinners for use in AF are the non-vitamin K oral anticoagulants. Examples include rivaroxaban (Xarelto) and apixaban (Eliquis).

The main reason for taking drugs in AF is to ensure stabilization of the heart rate and improvement in the overall functioning of the heart.

These drugs can also prevent blood clots from forming in the future, and also associated complications such as heart attack and stroke. A combination of AF medications may be recommended if your AF symptoms are really severe.

CAUSES OF ATRIAL FIBRILLATION

The heart is made up of four chambers. The two atria (upper chamber) and the two ventricles (lower chamber).

These chambers ideally work in unison but if there is any faultiness in the electrical signal thereby making the heart chambers not to work together atrial fibrillation results.

The atria and ventricles usually contract at the same speed but in AF, the atria and ventricles are not in synchrony because the contraction of the atria is very rapidly and irregularly.

The exact cause of AF is not known but there are certain conditions that have been known to cause heart damage, thereby resulting in AF. These conditions include:

• High blood pressure
• Congestive heart failure
• Coronary artery disease
• Heart valve disease
• Hypertrophic cardiomyopathy, where the heart muscles are thickened
• Heart surgery
• Congenital heart defects, meaning heart defects present at birth
• Hyperactive thyroid gland
• Pericarditis, an inflammation of the heart’s covering
• Taking certain medications
• Binge drinking
• Thyroid disease

Adopting a healthy lifestyle can reduce your chances of developing AF though not all causes of AF are preventable.

Open up to your doctor about your complete health history so the exact cause can be traced and effectively managed.

RISK FACTORS FOR ATRIAL FIBRILLATION

Although the exact cause of AF is not known, there are some conditions that make an individual more likely to develop AF than other individuals. These factors are either genetic factors or non-modifiable factors. They include:

• Increased age (AF is more in the elderly)
• White race
• Male gender
• Family history of AF
• Heart disease
• Structural heart defects
• Congenital heart defects
• Pericarditis
• History of heart attacks
• History of heart surgery
• Metabolic syndrome
• Obesity
• Thyroid diseases
• Lung disease
• Diabetes
• Alcohol intake, especially binge drinking
• Sleep apnea
• Steroid therapy (high dose)

COMPLICATIONS OF ATRIAL FIBRILLATION

Complications can be prevented by being compliant with treatment and having regular checkup appointments with the doctor. When left untreated, AF can be very serious and even fatal.

Severe complications include stroke and heart failure. Appropriate medications and lifestyle adjustments can prevent these complications in people with AF.

A stroke happens when a blood clot gets to the brain. It causes a state of oxygen deprivation in the brain, which can result in permanent damage. Stroke can also be life-threatening.

Heart failure happens when the heart can no longer function appropriately. AF can cause a wearing down of the heart’s muscles, this occurs while the ventricles are trying to work harder to compensate for the lack of blood flow in the atria.

Heart failure in these people develops gradually, in opposition to the occurrence of stroke or heart attack, which occur suddenly.

When you follow your treatment plan, the chances of developing complications are greatly reduced.

Be compliant with your medications as prescribed by the doctor and learn about the symptoms of AF and their complications.

DIAGNOSIS OF ATRIAL FIBRILLATION

There are numerous tests that can be used to better understand the functionality of the heart.

The following tests can be used by a doctor to make a diagnosis of atrial fibrillation:

• Physical examination to check your pulse, blood pressure, and lungs
• An electrocardiogram (ECG), a test that measures the electrical activity of the heart for some seconds

LEARN MORE: UNDERSTANDING ECG

For those whose episode of AF does not occur during an ECG session, a portable ECG monitor may have to be worn or another test can be done.  The other tests include:

• Holter monitor: this is a tiny, portable device that is worn for 24 to 48 hours to monitor the heart
• Event monitor: is a device that takes a recording of the heart only when there is active fibrillation ongoing.
• Echocardiogram: is a non-invasive test that makes use of sound waves to create a moving image of the heart
• Transesophageal echocardiogram: is an invasive form of echocardiogram that is conducted by passing a probe into the esophagus
• Stress test: is a test that monitors the heart during exercise
• Chest X-ray: is a test that visualizes the heart and lungs
• Blood tests that check for thyroid function and metabolic conditions

ATRIAL FIBRILLATION SURGERY

For severe or chronic cases of AF, surgery may be needed.

The surgeries done are those that target the heart muscle by making it pump blood more effectively. Surgery can also prevent the heart from being damaged.

The types of surgeries that can be used to treat AF include:

Electrical cardioversion

Here, the rhythm of the heart contractions is reset by electrical shock.

Catheter ablation

Here, a catheter is made to deliver radio waves to the heart thereby destroying abnormal tissues that send out irregular impulses.

Atrioventricular (AV) node ablation

AV node connects the atria and ventricles. In this procedure, the AV nodes are ablated so that they can no longer send signals to the ventricles.

A pacemaker is put in there to maintain a regular rhythm.

Maze surgery

This is an invasive surgery that can be done through open-heart or through small incisions that are done on the chest, where the surgeon makes small burns on the atria to produce a maze of the scars that will stop abnormal electrical impulses from getting to other areas of the heart.

This surgery is only indicated where other treatment modalities have been unsuccessful.

The doctor may also recommend other procedures that will treat any underlying health conditions including thyroid diseases, heart disease that may be causing the AF.

Though surgery is another treatment modality, medications and lifestyle changes are the first lines of treatment. Surgery is recommended as the last resort when other treatment modalities have been unsuccessful and the conditions very severe.

PREVENTION

Majority of cases of AF can be managed or treated. AF can recur and even worsen over time.

The risk can be reduced by doing the following:

• Eating a diet rich in fresh fruits and vegetables and low in saturated and trans fat
• Exercising regularly
• Maintaining a healthy weight
• Smoking cessation
• Reduction in alcohol intake or taking only small amounts of alcohol occasionally
• Be compliant with your medications and follow the doctor’s advice for treating any other co-morbidity

The commonest complications of AF are stroke and heart failure. You are five times more likely to have a stroke if you have AF than people who do not have AF if you are not compliant on medications.

ATRIAL FIBRILLATION DIET

There is no particular diet for AF but the foods taken by someone with AF should be heart-healthy foods.

An AF diet should contain plant-based foods such as oats, fruits, and vegetables.

Fish is a good protein source and its omega-3 fatty acid composition makes it very good for the heart.

Some foods can make AF worse and they include:

• Alcohol (particularly when binge-drinking)
• Caffeine: such as coffee, soda, tea, can increase the workload of the heart
• Grapefruit: can affect AF medications
• Gluten: it can worsen inflammation if one has allergy or sensitivity
• Salt and saturated fats
• Foods rich in vitamin K such as dark, leafy greens, as they can interfere with blood-thinning drugs such as warfarin (Coumadin)

An AF diet is similar to a heart-healthy diet. It is a nutrient-rich diet that does not contain irritating substances and low-density foods.

Discuss an eating plan for your condition with a doctor.

NATURAL TREATMENT FOR ATRIAL FIBRILLATION

Other than dietary recommendations, the doctor can advise you to take certain supplements that will replenish essential nutrients that you may be lacking.

Discuss with the doctor before taking any extra supplement as they could have side effects or even cause drug-drug interaction.

The different supplements that can be used include:

• Fish oil
• Magnesium
• Coenzyme Q10
• Wenxin  Keli
• Taurine
• Hawthorn berry

Other natural treatments for AF include healthy lifestyle habits such as exercise and stress reduction. Exercise is important for the health of the heart but do it slowly and not vigorously, especially if you are newly working out.

People with AF do not need high-intensity exercises such as running. Walking, cycling and swimming which are moderate to low-intensity exercises can be accommodated and they still burn calories to strengthen the heart and relieve stress.

It is necessary to maintain a healthy state of mind as stress can have an effect on the health of the heart. Stress can be alleviated by carrying out deep breathing exercises and even yoga class.

Make out time to carry out your favorite hobbies as they will make you relax and improve the health of the heart.

When combining natural treatment with conventional medications, the response is better.

Stick to your medical plan as alternative treatments still need more study to determine if they are helpful. Ask your doctor about their effectiveness and if they should be incorporated into your treatment plan.

ATRIAL FIBRILLATION GUIDELINES

The American Heart Association put out an official guideline for AF which outlines the treatment modalities based on the underlying medical condition and medical history.

The doctor will most likely make use of it when recommending a treatment plan.

Generally, combining lifestyle adjustments and medications can help to prevent stroke and heart failure.

The doctor also classifies the atrial fibrillation you have to know if it is a short-term or a long-term thing. Individual risk factors are also subject to age, gender, and overall health.

In total, the treatment will focus on:

• Controlling the heart rate and rhythm
• Assessing stroke risk
• Assessing the risk of bleeding

ATRIAL FIBRILLATION VS ATRIAL FLUTTER

Atrial fibrillation is sometimes confused with atrial flutter. They have similar symptoms such as a racing heart rate and irregular pulse.

Both of them affect the heart chambers and cause arrhythmias but they are distinct.

Atrial flutters occur when electrical signals in the heart are quickened. The symptoms are seen and the risk factors are the same with AF. Healthy lifestyle modifications and medications will help in the management of the conditions and the doctor will differentiate AF from atrial flutter so that they can treat each one accordingly.