Atrial Fibrillation

Atrial fibrillation (AF) is a heart condition that causes irregular and rapid heartbeat (arrhythmia). Although atrial fibrillation itself isn’t life-threatening, it can lead to serious complications such as strokes and heart failure.

In a healthy heart, the upper chambers (atria) and the lower chambers (ventricles) coordinate to beat in a regular and orderly fashion. In atrial fibrillation, however, the atria beat irregularly and in a chaotic manner. This causes the atria to quiver or twitch (fibrillation). As a result, blood is unable to travel to the ventricles and the rest of the body effectively.

Atrial flutter is a related condition and occurs in many of the same situations as atrial fibrillation, which is much more common. In atrial flutter, the electrical impulses are more organised and have a typical appearance on ECG.

Atrial fibrillation and atrial flutter symptoms may come and go but can be permanent in some cases. Fortunately, with proper medical care, most patients are able to live normal, active lives.

Symptoms of atrial fibrillation include:

• Heart palpitations (feeling like your heart is racing, skipping a beat, or fluttering)
• Chest pain
• Shortness of breath
• Dizziness, light-headedness, or fainting
• Fatigue
• Decreased exercise tolerance

Sometimes, people with atrial fibrillation may not experience any symptoms and are unaware of their condition. In these cases, atrial fibrillation may be discovered during a routine physical examination.

You should make an appointment to see a doctor if you:

• Notice any sudden changes in your heartbeat (palpitations, pounding, or fluttering heart)
• Experience any symptoms of atrial fibrillation (e.g. shortness of breath, dizziness)
• Have a heart rate that is consistently lower than 60 or above 100 beats a minute

If you have chest pain, seek medical attention immediately as this may be a sign of a heart attack.

The exact cause of atrial fibrillation is unknown. However, it is commonly associated with the following conditions such as:

• High blood pressure
• Coronary artery disease
• Heart valve disease
• Congenital heart disease
• Cardiomyopathy
• Viral infection (myocarditis or pericarditis)
• Hyperthyroidism
• Lung diseases (asthma, chronic obstructive pulmonary disease, pneumonia, lung cancer)
• Sleep apnoea

Sometimes, people who are physically fit with none of the conditions listed above can develop atrial fibrillation. This is known as lone atrial fibrillation.

Certain factors may increase your risk of developing atrial fibrillation, including:

• Advanced age
• Male gender
• Heart disease (e.g. previous heart attack, coronary artery disease, heart valve problems, congenital heart disease, congestive heart failure)
• High blood pressure
• Family history of atrial fibrillation
• Obesity
• Sleep apnoea
• Thyroid disorders
• Drinking alcohol
• Diabetes
• Lung disease

If left untreated, atrial fibrillation can lead to life-threatening complications, including:

Stroke and blood clots

In atrial fibrillation, blood can pool in the heart’s upper chambers (atria) and form blood clots.

A stroke occurs when a blood clot travels to your brain. The clot which blocks off blood supply to the brain may result in irreversible brain damage. Symptoms vary but may include drooping of one side of the face, weakness on one side of the body, and difficulty speaking.

People with atrial fibrillation are 4 to 5 times more likely to develop a stroke.

Sometimes, these blood clots might travel to different parts of the body, such as the kidneys, intestine, or spleen. This blocks the blood supply to these organs and causes serious complications.

Heart failure

Persistent atrial fibrillation can weaken the heart muscles. As a result, heart failure may develop as your heart is unable to pump blood around your body effectively.

Atrial fibrillation is a medical diagnosis by a doctor.

At home:

You may suspect you have atrial fibrillation by feeling your own pulse at your wrist.

To check your pulse:

1. Sit down in a relaxed state for 5 minutes. Do not smoke or drink caffeine before taking your pulse
2. Hold one of your hands out, with your palm facing up
3. Place the index and middle finger of your other hand on the inside of your wrist, at the base of your thumb
4. Press lightly to feel the pulse. If you can’t feel anything, you may have to press slightly harder
5. Count the number of beats for 60 seconds

A normal heart rate should feel regular and be between 60 to 100 beats per minute.

In atrial fibrillation, the heart rate feels irregular and may be significantly faster than 100 beats per minute. Please see a doctor if you may have an irregular or fast pulse.

By a doctor:

Your doctor will confirm the diagnosis of atrial fibrillation by doing an Electrocardiogram (ECG). You may then be scheduled for further tests which may include:

• Ambulatory ECG (Holter ECG) – a continuous ECG recording over 24 hours or more.
• Echocardiogram – an ultrasound scan of the heart to see the structure and function of the heart and heart valves
• Blood tests – to check for other causes of the atrial fibrillation

During your first consultation with your doctor, they are likely to ask you about your medical history and your symptoms. Some of which may be:

• How long have you been having these symptoms?
• Are your symptoms continuous, or do they come and go?
• How severe are your symptoms?
• Is there anything that makes your symptoms better or worse?

It may be helpful to prepare for these questions before your visit. You could also come up with a list of medications you’re taking and a record of your blood pressure and heart rate if you have taken them at home.

Your doctor will then conduct a physical examination, which will also include checking your pulse. Your doctor may order several tests to better diagnose your condition, including an ECG, echocardiogram, and blood tests.

There are many different types of treatment for atrial fibrillation. This usually involves taking steps to decrease your risk of stroke, taking anticoagulants and controlling your heart rate. Your doctor will recommend a treatment plan based on your symptoms, your age, your risk of complications, and whether you have an underlying cause that needs to be treated.

Treating the underlying cause

Firstly, your doctor will try to identify if there is a known cause of your atrial fibrillation. Sometimes, treating the condition that triggers atrial fibrillation is enough to reverse it.

For example, if you have hyperthyroidism (overactive thyroid gland), the most ideal course of action would be to treat your hyperthyroidism in order to stop your atrial fibrillation.

Stroke and blood clot prevention

The key in managing atrial fibrillation is to prevent complications such as stroke. Blood thinners such as direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) such as warfarin, can be prescribed to reduce the overall risk of stroke and blood clots.

Heart rate control

You may be prescribed medications to restore your heart to a normal rate. Examples of these medications include beta-blockers, calcium channel blockers and digoxin.

Heart rhythm control

Another method to treat atrial fibrillation is by restoring a normal heart rhythm. This can be done using medications or cardioversion. Medications that may be prescribed include Amiodarone, Sotalol and Flecainide.

Electrical cardioversion may be used in some patients with atrial fibrillation to reset the heart’s rate and rhythm. Electrical cardioversion is a controlled electric shock delivered to your heart while under sedation.

Catheter ablation

Catheter ablation is a procedure that uses radiofrequency energy to target the diseased area of your heart. A thin catheter is guided through your blood vessels to your heart. The tip of the catheter produces an energy source that creates heat to destroy the part of your heart that is triggering atrial fibrillation. Catheter ablation may be offered if medications have not been effective in managing atrial fibrillation.

Pacemakers

Pacemakers are small electronic devices that stimulate the heart with electrical impulses to maintain or restore a normal heartbeat. Some people with atrial fibrillation have periods of very slow heart rates. In such cases, a pacemaker is needed.

Invasive and surgical procedures

Invasive procedures such as the placement of a left atrial appendage occluder to reduce risk of blood clots, or surgical procedures that are usually performed during concomitant open heart surgery, may sometimes be recommended for selected patients.

Reversible causes of atrial fibrillation are less common, and these are usually due to another underlying disease such as hyperthyroidism and severe infection. In such cases, treating the condition causing atrial fibrillation can reverse it without the need for atrial fibrillation medications.

In many cases, however, atrial fibrillation is not reversible. Fortunately, with proper medical treatment, most patients are able to control their atrial fibrillation and lead a normal and active life.

You can reduce the risk of developing atrial fibrillation by improving your heart health. These include:

• Eating lots of fruits and vegetables
• Avoiding saturated and trans fat
• Exercising regularly
• Maintaining a healthy weight
• Quitting smoking
• Avoiding alcohol or drink in moderation
• Following your doctor’s treatment plan for any chronic health conditions you may have

If you have atrial fibrillation, avoid lifestyle factors that may trigger an uncontrolled episode, including:

• Excessive alcohol consumption
• Excessive caffeine
• Smoking
• Being overweight