Atrial fibrillation (AF) is one of the most common sustained heart rhythm disorders or arrhythmias.
What is Atrial Fibrillation?
In AF the electrical activity in the upper chambers of the heart (atria) become chaotic, leading to an irregular heartbeat that is often rapid. AF can also present itself as a very slow heart rate leading to fatigue and in some cases, pauses between beats can be prolonged and lead to dizzy spells.
There are many causes of atrial fibrillation. Advanced age, congenital heart disease, underlying heart disease (valvular disease, coronary artery disease, structural heart disease), increased alcohol consumption, hypertension, fever, infection, stress and obstructive sleep apnea are all common causes of atrial fibrillation.
Who is at Risk for Atrial Fibrillation (AF or AFib)?
Although AF becomes increasingly more prevalent with aging, it also affects young people; 0.5% of people under 40 years of age suffer from AF, with >5% of those over 65 and >10% of those more than 80 years of age being affected.
One of the causes why it is more prevalent in aging people and relapses / reoccurs in more frequent intervals with age is the scaring/fibrosis of the heart muscle cells and its electric conduction system leading to disruption of its electric stability.
The source of AF is an electricity conductive area mainly around the pulmonary veins entering the heart. Increasing age makes the occurrence of atrial fibrillation more likely and makes it clearly the most common treatment requiring arrhythmia.
When atrial activity is chaotic, blood flow through the heart is reduced, leading to stagnation and possible clot formation. The formation of these clots in patients with AF puts them at a significantly increased risk of thromboembolization, causing for example a stroke or other occlusions of arteries in the body like limbs or organ infarctions. The risk of thromboembolic events like a stroke can be reduced with blood thinning drugs (anticoagulants).
What are the symptoms of Atrial Fibrillation?
Atrial fibrillation presents itself in many different ways. The most common symptoms are palpitations, which are often rapid and irregular. Patients may also feel tired, dizzy, short of breath or experience chest pains. Others may have simple fluttery stomach sensations.
In some patients, there are no symptoms, and the discovery of AF is an incidental finding. Atrial fibrillation can lead to symptoms and can alter prognosis and therefore needs treatment to control and to reduce the risk of a stroke.
What assessment do I need if I have Atrial Fibrillation?
If atrial fibrillation is suspected, your cardiologist will need to confirm the diagnosis, and this can be done with a simple electrocardiogram (ECG) if the rhythm is persistent. In many cases, atrial fibrillation comes and goes (paroxysmal) and in order to make the diagnosis, longer periods of ECG monitoring are needed with ambulatory ECG Monitoring devices (a heart monitor which is worn for 1 or more days, ECG recording devices like Kardiva AliveCor -Medtronic, medical wearable devices like the Apple Watch, fitbit and other modern recording gadgets). Under the skin (subcutaneous) implantable small event-recorders / loop-recorders from Medtronic (link reveal) or Biotronik (Biomonitor III) are further important options to detect paroxysmal arrhythmias.
An echocardiography, referred to as an 'echo', is performed to evaluate the structure and function of the heart in some detail, which may reveal structural causes of the atrial fibrillation, like heart chamber dilatation or valvular disease. In many patients, additional tests like blood analysis will also be required to identify the underlying cause.
One of the most important aspects of your assessment will be to evaluate your individual risk for a stroke to determine whether you will benefit from blood thinning medication (anticoagulants). Your cardiologist will be able to discuss this in detail with you.
What are the treatments for Atrial Fibrillation?
There are a number of different approaches to the treatment of atrial fibrillation that can be tailored to your individual circumstances. All patients need an assessment of their stroke risk and placed on appropriate treatment as needed.
There are essentially three strategies to treat AF:
Cardioversion, electrically or with medication,
Cryoablation Therapy with a Balloon Catheter and/or Radiofrequency ablation therapy
What intervention/treatment does CardioCare offer for Atrial Fibrillation?
We perform planned and emergent electric or medical induced cardioversions.
Our EP-lab is well equipped to perform Medtronic Cryo-Balloon catheter ablation ArcticFront. We are also fully equipped for Radiofrequency ablation therapy.