Atrial Fibrillation

Atrial Fibrillation (AFib) is a common type of irregular and often rapid heartbeat (arrhythmia) that can lead to serious complications like stroke, heart failure, and other heart-related problems. In AFib, the heart’s two upper chambers (atria) beat chaotically and irregularly, out of coordination with the two lower chambers (ventricles).

Causes:

AFib can be caused by damage to the heart’s structure, often due to underlying conditions. It becomes more common with age. Factors that can lead to AFib include:

• High Blood Pressure (Hypertension): The most common risk factor, as it can stiffen and thicken the heart muscle, affecting its electrical activity.
• Coronary Artery Disease (CAD): Narrowed arteries reduce blood flow to the heart, potentially damaging heart tissue.
• Heart Attack: Damage to the heart muscle from a heart attack can disrupt electrical signals.
• Heart Failure: A weakened heart muscle struggles to pump blood effectively, leading to chamber enlargement and electrical issues.
• Heart Valve Disease: Damaged or leaky heart valves can cause the atria to enlarge or work harder.
• Overactive Thyroid (Hyperthyroidism): Excess thyroid hormone can speed up the heart rate and contribute to arrhythmias.
• Congenital Heart Defects: Heart abnormalities present at birth.
• Lung Diseases: Chronic lung conditions like COPD or asthma can strain the heart.
• Sleep Apnea: Repeated pauses in breathing during sleep can affect heart rhythm.
• Obesity: Increases the risk of AFib and other heart conditions.
• Excessive Alcohol Consumption: Particularly binge drinking, often referred to as “holiday heart syndrome.”
• Stimulants: Caffeine, nicotine, and certain medications (e.g., cold and cough medicines containing pseudoephedrine).
• Stress: High levels of stress can sometimes trigger AFib episodes.
• Family History: A genetic predisposition can increase risk.
• Age: Risk increases significantly with age.

Symptoms:

Some people with AFib have no symptoms and are only diagnosed during a routine physical exam. When symptoms do occur, they can include:

• Palpitations: A sensation of a rapid, fluttering, or pounding heartbeat.
• Shortness of breath: Especially during exertion or at rest.
• Fatigue and weakness.
• Dizziness or lightheadedness.
• Fainting (syncope).
• Chest pain or pressure: Can be a sign of a more serious heart problem.
• Confusion.

Symptoms may come and go (paroxysmal AFib) or be persistent (persistent AFib) or long-standing persistent, or permanent.

Diagnosis:

Diagnosing AFib involves a physical examination and tests to assess heart rhythm and structure.

• Medical History and Physical Exam: The doctor will ask about your symptoms, medical history, lifestyle, and family history. They will check your pulse for irregularity.
• Electrocardiogram (ECG/EKG): This is the primary diagnostic tool. It records the electrical activity of your heart and can show if your heart is beating irregularly.
• Holter Monitor: A portable ECG device worn for 24-48 hours (or longer) to record heart activity during daily routines, catching intermittent AFib episodes.
• Event Recorder: A portable device worn for weeks or months that you activate when you feel symptoms, or it may automatically record abnormal rhythms.
• Implantable Loop Recorder: A small device implanted under the skin to continuously monitor heart rhythm for up to several years.
• Echocardiogram: An ultrasound of the heart to visualize its structure and function, check for valve problems, or assess for heart failure.
• Blood Tests: To check for underlying conditions like thyroid problems, kidney function, and electrolyte imbalances.
• Chest X-ray: To check the condition of the lungs and heart.
• Stress Test: May be performed to evaluate heart function during exertion.

Treatment:

Treatment for AFib aims to:

• Control heart rate: Slow down a rapid heart rate.
• Control heart rhythm: Restore and maintain a normal heart rhythm.
• Prevent blood clots: Reduce the risk of stroke.
• Manage underlying conditions.

Treatment options include:

• Medications:
  • Rate Control Medications: Slow the heart rate (e.g., beta-blockers, calcium channel blockers, digoxin).
  • Rhythm Control Medications (Antiarrhythmics): Help restore and maintain a normal heart rhythm (e.g., flecainide, propafenone, amiodarone, sotalol).
  • Anticoagulants (Blood Thinners): Reduce the risk of stroke by preventing blood clots (e.g., warfarin, dabigatran, rivaroxaban, apixaban, edoxaban). This is a critical part of AFib management for most patients.
• Procedures:
• • Cardioversion: Delivers an electrical shock to the heart to reset its rhythm. Can be done electrically or with medications.
  • Catheter Ablation: A procedure where thin, flexible tubes (catheters) are inserted into the heart to create small scars that block abnormal electrical signals causing AFib.
  • Left Atrial Appendage Occlusion: For some patients who cannot take blood thinners, a device is implanted to close off the left atrial appendage, where most stroke-causing clots form in AFib.
  • Pacemaker Implantation: May be used if AFib causes a very slow heart rate.
  • Maze Procedure: A surgical procedure to create scar tissue in the atria to block abnormal electrical signals.
• Lifestyle Changes:
• • Manage underlying conditions: Control blood pressure, diabetes, and thyroid issues.
  • Healthy Diet: Heart-healthy eating.
  • Regular Exercise: As advised by your doctor.
  • Maintain a Healthy Weight.
  • Limit Alcohol and Caffeine.
  • Quit Smoking.
  • Manage Stress.

Regular follow-up with a cardiologist is essential for managing AFib, monitoring symptoms, and adjusting treatment to minimize risks and improve quality of life.