Atrial Fibrillation

Atrial Fibrillation

What is atrial fibrillation? Atrial fibrillation is an irregular and often rapid abnormal heart rhythm which typically originates from the upper chambers of the heart. This leads to the chaotic contraction of the upper chambers of the heart ( atria) leading to the loss of synchrony with the lower chambers of the heart (ventricles). It is one of the most common arrhythmia affecting the heart. 

Why is it important to know about it? Apart from causing symptoms which we will discuss below, another very important reason to know about it is that atrial fibrillation increases the risk of having a stroke. This abnormal heart rhythm can lead to the development of clots in the heart and lead to strokes when the clots can break and go to the brain. Thus timely detection and treatment of this condition is important. If left undetected it can lead to significant morbidity and mortality. 

What are the risk factors for the development of atrial fibrillation?

Just like other cardiac conditions, there are non modifiable and modifiable risk factors. The non modifiable risk factors include increasing age. Some common modifiable risk factors associated with it include smoking, heavy alcohol use, lack of physical activity, obesity. Other risk factors include coronary artery disease, cardiac surgery. Interestingly, contrary to popular belief, low to moderate caffeine intake has not been strongly associated with triggering atrial fibrillation episodes. However bear in mind every patient is different and if there are certain triggers that you identify that can trigger symptoms, then it is best to avoid them. 

What are the symptoms of Atrial fibrillation? 

Common symptoms reported are palpitations, dizziness, feeling like the heart is ‘skipping a beat’, shortness of breath and chest pain associated with the palpitations. If the arrhythmia leads to the development of heart failure, then associated symptoms of heart failure may be experienced. These include shortness of breath, dyspnea on exertion and lower extremity swelling among others. 

It is important to know that it can also remain asymptomatic in a significant number of people and may be incidentally detected during an office visit for something else, while getting a physical exam or can be detected on a wearable device like a smart watch. Thus once a suspicion arises, it is very important to establish the diagnosis so that it can be appropriately treated. 

What can be done to prevent Atrial fibrillation?

Prevention largely focuses on the control and modification of the risk factors that can lead to atrial fibrillation as discussed above. Once you have atrial fibrillation, it also becomes important to try and identify triggers for the symptoms and attempt to control them. These would typically include encouraging physical activity for weight loss if obese, control of blood pressure, smoking cessation, control of diabetes among others. 

When should you see a doctor?

You should see a doctor if you experience symptoms of palpitations or fast heart beat, chest pain, shortness of breath, dizziness among others as described above. Also if your smart watch or wearable device brings to your attention that you have an ‘irregular heart beat’ or a sustained high heart rate then it is recommended to make an appointment for a more complete evaluation. 

What can be done to treat Atrial Fibrillation?

The treatment of this condition mainly focuses on two important aspects. These are symptom control and stroke risk reduction. 

In terms of stroke reduction,  we will typically calculate your stroke risk using a variety of factors and then determine the right blood thinner for you to reduce this risk. 

In terms of symptom reduction, this includes medications and procedures to try to maintain the patient in a normal heart rhythm. A variety of medications are available and they are chosen based on multiple factors including the symptom burden and co morbidities. A patient may even be a candidate for an ablation procedure to try and maintain a normal sinus rhythm however this is determined by your physician, typically a cardiologist or an Electrophysiologist. Thus it is important to discuss all your treatment options with your physician.