Atrial fibrillation

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Artial fibrillation is a common type of arrhythmia where the electrical impulses become uncoordinated, making your heart beat as fast as 300 times per minute. Atrial fibrillation can also be dangerous as the blood pools in the atrium because it doesn’t pump all the blood into the ventricle. This causes a blood clot (thrombus) to form. The clot can break off and travel to another part of the body leading to severe complications like a stroke.

Atrial fibrillation can also be dangerous as the blood pools in the atrium because it doesn’t pump all the blood into the ventricle. This causes a blood clot (thrombus) to form. The clot can break off and travel to another part of the body leading to severe complications like a stroke. (Read: What is arrhythmia and why it is a cause for concern)

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Causes

Dr Vineet Sankhala, Consultant Interventional Cardiologist, Care Institute of Medical Sciences (CIMS) and Hospital, Ahemdabad says, 'Atrial fibrillation (AFL) is one of the commonest arrhythmias encountered in medical practice. It is related with abnormal and chaotic contraction of upper chambers of heart(atria) and can present with faster or slower heart beats.'

The causes of AFL are due to -


  • Electrolyte disturbances

  • Hypoxia

  • Thyroid disorders

  • Structural heart and valvular diseases

  •  Ischemic heart disease

  • Metabolic disturbances

  • Sometimes it can be without any underlying etiology (called as Lone AFL)


AF can occur for a few hours in a day or may even occur for a whole day. In case it continues for a long duration, one should always seek medical treatment.

Risk Factors

Certain cardiovascular disorders such as CAD (coronary artery disease), cardiomyopathy, high blood pressure, a previous heart attack, and a recent heart attack, can all lead to arrhythmia.


Apart from that, arrhythmia can also be caused due to -



Symptoms

Atrial fibrillation (AF) is a condition characterized by irregular heart beat and rapid heart rate. In this condition, the two atria of the heart beat irregularly and hence lose coordination with the ventricles.


Arrhythmia is fairly subjective and so are the symptoms. That being said, the common symptoms of arrhythmia are -




  • Bradycardia (slow heartbeat)

  • Tachycardia (fast heartbeat) or fluttering

  • Shortness of breath

  • Chest pain

  • Lightheadedness or dizziness

  • Fainting or feeling faint


One might feel these symptoms intermittently and it might not mean that something is gravely wrong, but if these symptoms occur suddenly and frequently, you should see a doctor immediately. (Read: Expert tips to prevent heart disease)

Read more about causes, symptoms, diagnosis and treatment of heart disease.

Diagnosis

Dr Sankhala says, 'AFL can be diagnosed by ECG, if the arrhythmia is chronic. If it is paroxysmal then it can be diagnosed by holter monitoring or loop recorders of cardiac rhythm.'

Before treating your arrhythmia, the doctor will first ask about any triggers you might have like heart disease or thyroid problem. After that he/she will try to find out where the arrhythmia starts in the heart and whether it’s abnormal through some diagnostic tests such as -

ECG (electrocardiogram): It measures electrical activity of the heart. In this test, electrodes are attached to the patient’s chest, legs and arms.

Holter monitor: The test is usually used to diagnose brachyardia (slow heart rate), atrial fibrillation, palpitations and arrhythmia. It is also used for patients who have suffered a recent heart attack.

Echo electrocardiogram: Echocardiography is basically real-time imaging of the heart (similar to sonography). It is especially helpful in diagnosis of valvular heart disease, which remains silent for several years.

Stress test: This test will require you to exercise on a treadmill or stationary bicycle while your heart activity is monitored

Tilt table test: To do this test, you are asked to lie flat on a table and the table is then tilted as if you were standing up. Your doctor will observe how your heart responds to the change in angle.

Electrophysiological testing and mapping: In this, your doctor will insert catheters in various parts of your body. At the tip of these catheters are electrodes that will collect information about your heart’s electrical impulses.

Read about 8 tests that can tell if you have heart disease.

Treatment

The method of treatment will depend on your age, if you have any pre-existing conditions, your family history, medications you might be taking, as well as the severity and symptoms of your arrhythmia.


There are a number of treatment options:


Lifestyle changes: Your doctor will ask you to make lifestyle changes that will keep your heart healthy. You may be advised to eat heart-healthy foods, exercise regularly, increase physical activity and cut down on stress, alcohol and caffeine.


Medications: You may be advised to havecertain medication, that when taken exactly as per prescription can help prevent heart attack, stroke, and prevent the progression of coronary artery disease. Dr Sankhala says, ' Currently, we give drugs to control the fast heart rate during AFL, prevent thrombo-embolism and avoid clotting of blood, prevent the recurrence of AFL and treat the underlying condition which precipitates AFL.'


However, there are 4 types of medicines to treat arrhythmia namely -




  • Anti-arrhythmic drugs such as lidocaine, propranolol, etc.

  • Calcium channel blockers such as amlodipine and diltiazem 

  • Beta blockers such as acebutolol and metoprolol to decrease heart rate

  • Anticoagulants or blood thinners (in addition to other medicines) such as aspirin and warfarin to make it harder for the blood to clot and to prevent stroke.


 

Cardiac ablation: Apart from the medication, there are minimally invasive methods such as cardiac ablation which can treat many types of arrhythmias. The procedure destroys or ablates specific cells in your heart that cause your arrhythmia.

Defibrillation: In case you suffer from atrial fibrillation, defibrillation is a procedure for you. In this, a mild electric shock is given to the heart to re-establish normal contraction rhythms of the heart.Implantable devices such as


Implantable devices: These include such as pacemaker for bradycardia and implantable cardioverter-defibrillator (ICD) for ventricular arrhythmias may also be used for treatment.


Surgery: Apart from all this there are surgeries to help ease your troubles, namely the maze procedure (here a number of incisions are made on the walls of the left and right atrium. These incisions form scar tissues that disrupt the uneven electrical impulses) and coronary bypass surgery. (Read: Take the natural route to heart health – home remedies that work!)


Dr Sankhala said that people suffering from atrial fibrillation have to correct underlying precipitating conditions which can lead to AFL. Also, certain drugs which can prevent the occurrence of AFL and anti thrombotic drugs to avoid blood to clot, should be taken as prescribed by doctor. Some arrhythmias may be life-threatening if not treated right away, so do not ignore your symptoms even if they seem harmless. Let your doctor be the judge of it.

Complications

More serious forms of this condition are:


Brain stroke: 'AFL leads to clot formation in the heart which can cause embolism in the brain and lead to brain stroke. It can also lead to cardiac symptoms like breathlessness, angina and heart failure due to loss of effective contraction of upper chamber of heart and decreased cardiac output.' says Dr Sankhala.


Ventricular fibrillation: One of the most deadly types of arrhythmia is ventricular fibrillation. Here, the ventricles begin to quiver instead of pumping blood. Because there is no effective heartbeat, blood pressure drops drastically cutting off blood supply to the organs leading to collapse and cardiac arrest. Death ensues if the person does not get medical attention immediately.


Heart failure: Another complication of atrial fibrillation is heart failure. It occurs when the heart can’t pump enough blood to meet the body’s needs. Fatigue, shortness of breath, and fluid retention are common symptoms of this condition. (Read: Heart disease kills one in three women)


The content has been verified by Dr Vineet Sankhala, Consultant Interventional Cardiologist, Care Institute of Medical Sciences (CIMS) and Hospital, Ahemdabad.

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