Atrial Fibrillation: What’s all the fuss?
Atrial fibrillation has become a hot topic in the world of heart health over the past 10-20 years with exciting new advancements in treatment. We set out to discuss what atrial fibrillation is, why it’s important to discuss any potential atrial fibrillation with your doctor, the risk of stroke and heart failure associated with atrial fibrillation, as well as why some individuals are more prone to develop atrial fibrillation and what to do about it.
What is atrial fibrillation?
Atrial fibrillation is an irregular heart rhythm (arrhythmia) that involves the upper chambers of the heart. In normal rhythm, the heart beats sequentially, the two top chambers squeeze the blood to the bottom chambers, and then the bottom chambers pump the blood through both the lungs and the entire body. When atrial fibrillation occurs, the top chambers have unorganized rapid electrical activity that causes them to create a quivering like activity we call fibrillation. This in turn makes the bottom chambers beat irregularly and often very rapid. The presence of atrial fibrillation can cause a variety of symptoms including the sensation of heart racing or beating irregularly (call palpitations), shortness of breath, chest pain, lightheadedness and fatigue to name a few. Additionally, atrial fibrillation increases the risk of stroke by five times compared to those without atrial fibrillation. Atrial fibrillation is more likely to occur in those with high blood pressure, diabetes, sleep apnea, heavy alcohol or caffeine use, as well as those that are overweight.
What are the treatment options for atrial fibrillation?
The most important objective for treatment of atrial fibrillation is determining if a blood thinner is appropriate to reduce the risk of stroke. A healthcare provider will assess an individual’s stroke risk and determine if a blood thinner is appropriate.
Atrial fibrillation is considered a chronic condition, in the sense individuals are rarely “cured” from atrial fibrillation. Although atrial fibrillation may come and go, we can never be sure it will never return. Most treatment discussions center around suppression of atrial fibrillation or reducing the burden of episodes or symptoms related to atrial fibrillation. Atrial fibrillation is generally categorized into two groups, those that are in atrial fibrillation for hours or days at a time (paroxysmal atrial fibrillation) and those that are constantly in atrial fibrillation (persistent atrial fibrillation).
For those individuals with paroxysmal atrial fibrillation, we typically consider two different options, medications call antiarrhythmics, which suppress atrial fibrillation with a 40-50% success rate as well as an ablation procedure which is successful in suppressing atrial fibrillation in 65-70% of individuals at the one-year mark. For individuals that are in atrial fibrillation all the time (persistent atrial fibrillation), we often consider medications called antiarrhythmics that are started prior to a cardioversion, a procedure in which an electrical shock is applied to the chest to stop atrial fibrillation and allow the normal heart rhythm to return. The ablation procedure is also an option for individuals with persistent atrial fibrillation, with a success rate of 50-60%.
An ablation procedure is mostly commonly performed in a hospital setting, in a cardiac catheterization lab. This is a procedure room with highly specialized equipment including a real time x-ray machine, a sophisticated computer system to generate a 3D model of the heart and the equipment to deliver a special type of energy for the ablation itself. During an ablation procedure, a long catheter (similar to a long semi-rigid coated wire) is advanced into the heart to the areas of the heart that are likely responsible for starting atrial fibrillation. Energy is delivered to these areas to render them electrically inactive, or multiple points around other areas to encircle and contain the abnormal electrical signals so they cannot move into the rest of the heart to start atrial fibrillation. The energy delivered can be delivered in two different forms, radiofrequency energy that heats the heart tissue or cryoablation in which the heart tissue is temporarily frozen. Usually, atrial fibrillation is started by a rapid electrical activity in the pulmonary veins (those veins that bring oxygen rich blood back to the left top chamber of the heart). By containing or “isolating” those signals from the rest of the heart, we can suppress atrial fibrillation. Similar to removing a starter on a car engine, it can no longer start up.
What other some other new advances in the area of atrial fibrillation?
An exciting more recent advancement is the use of a device that potentially allows an individual with atrial fibrillation to stop their anticoagulant (a type of blood thinner). These devices are only indicated for use when an individual cannot take a blood thinner long term because of prior major bleeding, such as a bleed inside of the head or in the gastrointestinal tract. The device is placed in an area of the left top chamber of the heart which then blocks blood from entering a small dead end, the left atrial appendage, where most clots for that cause stroke in atrial fibrillation.
Another new advancement in treatment of atrial fibrillation includes a new type of energy for ablation procedures, called pulse field ablation, that can help limit collateral damage to structures near the heart during the ablation procedure.
What can we do other than medications and procedures to help with atrial fibrillation?
A number of measures can be used to help lower the chance of atrial fibrillation returning. These include obtaining quality sleep, treating sleep apnea, reducing or eliminating alcohol use, reducing caffeine intake, weight loss, controlling high blood pressure and optimizing treatment and control of diabetes and blood sugar. In general, sugar free, low processed carbohydrate diets such as Mediterranean diet or DASH diet are recommended. Less common but equality important issues to address include thyroid disorders, inflammatory issues and dehydration and electrolyte abnormalities.
Important Disclaimer:
All questions and concerns regarding atrial fibrillation and heart conditions and treatment should be discussed with a licensed provider. The information found here is educational only and is not meant as a consultation or a substitute for a consultation with your doctor.