Atrial Fibrillation – Keeping the heart’s electrical system in order

Atrial fibrillation (AF) is defined as an irregular and frequently rapid heart rate that causes poor blood flow to the body. The two upper chambers of the heart, called atria, beat in a disorganized way and out of coordination with the two lower chambers of the heart, called ventricles.

In India, there is very little epidemiology data to reflect the true picture of AF patients. However, it is known that Indian AF patients are younger than their Western counterparts and are more likely to die of the disease.

Symptoms

Most people suffering from AF show no signs and the disease is not detected unless a physical examination is done. For others, one or more of the following symptoms may be experienced:

• Palpitations, or feeling of racing heartbeat
• Fatigue
• Dizziness
• Shortness of breath
• Chest pain
• Decreased ability to exercise
• Lightheadedness
• Confusion
• Weakness

Causes

The most common cause of atrial fibrillation is damage to the structure of the heart. Other possible causes are:

• High blood pressure
• Coronary artery disease
• Abnormality in heart valves and especially mitral valve
• Hypoxia
• Heart attacks
• Exposure to caffeine, alcohol, medication, or tobacco
• Sleep apnea
• Viral infections
• Sick sinus syndrome

Risk factors and complications

There are some factors that put a person at risk of developing Atrial Fibrillation:

• Heart disease: A person with heart problems such as congenital heart disease, coronary artery disease, heart valve problems, congestive heart failure, or a medical history of heart attack or heart failure is more likely to suffer from AF.
• High blood pressure: Uncontrolled high blood pressure puts a person at increased risk of developing AF.
• Age: The older the person grows, the more likely he or she is to get AF.
• Obesity: Obese people are at an increased risk of developing AF.
• Chronic conditions: If a person is suffering from chronic conditions such as diabetes, sleep apnea, metabolic syndrome, thyroid issues, chronic kidney or lung disease, then he or she is at a higher risk of getting AF.
• Family history: Some families are predisposed to getting AF.

Tests and diagnosis

In order to diagnose AF, the following tests are conducted at cardiology hospitals in hyderabad

• Electrocardiogram (ECG): ECG is the primary tool used to diagnose AF.
• Holter monitor: This is a portable device that records the activity of the heart for 24 hours or longer and are used to identify the arrhythmia.
• Echocardiogram: It is performed to evaluate size of atria and size and function of ventricles and to detect possible valvular and Pericardial disease.

Treatment

• Catheter ablation: Catheters are inserted through the groin in order to destroy tiny areas in the heart that are firing off abnormal electrical impulsesand causing atrial fibrillation.
• Surgical maze procedure: Scar tissue is surgically created in the upper chambers of the heart to correct irregular heartbeats.
• Atrioventricular node ablation: Radiofrequency energy is applied to destroy a small area of tissue between the upper and lower chambers of the heart. Then, a permanent pacemaker is placed to help the ventricles beat properly.

Heart rhythm may be reset using synchronised electrical cardioversion or cardioversion with drugs. Another important treatment goal is to prevent blood clotting using blood-thinning drugs based on CHADS2 score such as Warfarin, Dabigatrin, Rivaroxaban, or Apixaban.

The treatment method followed depends on the patient’s health and body situation.