Atrial Fibrillation Diagnosis and Treatment

Types of Atrial Fibrillation

There are several forms of AFib, including:

• Occasional (paroxysmal AFib): It can vary in duration, ranging from a few minutes to hours and occasionally even up to a week. While some people need therapy, episodes may end on their own.
• Persistent: Without medical assistance to re-establish a normal rhythm, the irregular heartbeat persists and is continuous.
• Prolonged persistent: AFib need medication or treatments to rectify the heart rhythm if it persists for longer than a year.
• Permanent: There is no way to fix the erratic beat. To control heartbeat and lower the danger of blood clots, medications are required.

Symptoms

AFib can cause various symptoms, including:

• A fast, fluttering, or pounding heart rhythm (palpitations)
• Chest pain
• Fatigue
• Dizziness
• Light-headedness
• Reduced ability to exercise
• Weakness
• Shortness of breath

Some individuals with AFib might not have any noticeable symptoms.

Causes

Heart structural abnormalities are the main cause of AFib. AFib can also result from a number of cardiac disorders and other medical situations, such as:

• Congenital heart defects, or birth defects in the heart
• Sick sinus syndrome, a condition caused by the heart's own pacemaker
• The sleep condition known as obstructive sleep apnoea
• Heart attack
• High blood pressure.
• Coronary artery disease (narrowed or clogged arteries)
• Heart valve disease
• Lung conditions, including pneumonia
• Heart surgery or physical stress from disease or medical treatments
• Viral infections
• Thyroid abnormalities, particularly an overactive thyroid

AFib can sometimes happen without any underlying cardiac injury or illness.

Lifestyle Triggers for AFib

Certain habits can provoke AFib episodes, including:

• Excessive alcohol or caffeine consumption
• Illegal drug use
• Smoking or tobacco use
• Stimulant-containing medications, such as over-the-counter cold and allergy remedies

Complications

One of the most serious complications of AFib is the formation of blood clots, which can increase the risk of stroke.

The likelihood of a stroke due to AFib rises with age and is further heightened by certain health conditions, including:

• High blood pressure
• Heart failure
• Diabetes
• Certain forms of heart valve disease

Diagnosis

AFib is sometimes discovered during a routine health check-up, even if no symptoms are present. To diagnose the condition, a healthcare provider will review your medical history, ask about symptoms, and conduct a physical examination. Additional tests may be performed to identify underlying conditions, such as heart disease or thyroid disorders, that could be causing irregular heartbeats.

Tests:

• Blood tests: Check for health problems or substances that might be affecting heart function.
• Electrocardiogram (ECG or EKG): A quick, painless test that measures the heart’s electrical activity to detect irregular rhythms. Electrodes are placed on the chest, arms, and legs, with results displayed or printed. This is the primary test for diagnosing AFib.
• Holter monitor: A portable ECG device worn for 24 to 48 hours to track heart activity during daily activities.
• Event recorder: Similar to a Holter monitor, this gadget only records for a few minutes at a time during specific times. Usually, it is worn for 30 days or so, and whenever you experience symptoms, you press a button. When an irregular heart rhythm is identified, certain devices begin recording automatically.
• Implantable loop recorder (cardiac event recorder): This device constantly monitors the heartbeat for a maximum of three years. The gadget displays your heart’s rhythm as you go about your regular business. It can be used to determine how frequently you experience episodes of AFib. Occasionally, it also helps identify infrequent episodes of AFib in people at high risk of developing the cardiac condition.
• Echocardiogram: Uses sound waves to create pictures of the heart, showing blood flow and valve function.
• Exercise stress test: Monitors heart function while walking on a treadmill or cycling. If exercise isn’t possible, medication may be used to simulate exertion and sometimes combined with an echocardiogram.
• Chest X-ray: Provides images of the heart and lungs to check for other conditions that may contribute to AFib.

Treatment

The primary goals of AFib treatment are to restore and control the heart’s rhythm while preventing complications like blood clots. The treatment approach is based on:

• How long the condition has been present
• The severity of symptoms
• The underlying cause of the irregular heart rhythm

AFib treatment options may include:

Medications:

Different types of medications may be prescribed to regulate heart rate speed, restore normal rhythm, or prevent blood clots.

Common medications include:

• Beta-blockers: Help slow down the heart rhythm.
• Calcium channel blockers: These control heart rate, although they may not be suitable for those with heart failure or low blood pressure.
• Digoxin: Slows the heart pulse at rest but may be less effective during physical activity. Digoxin is often used with other medications like beta-blockers or calcium channel blockers.
• Anti-arrhythmic drugs: Help maintain a normal heart rhythm but are used cautiously due to potential side effects.
• Blood thinners (anticoagulants): Lowers the risk of blood clots and stroke. Examples are warfarin, dabigatran (Pradaxa), apixaban (Eliquis), edoxaban, and rivaroxaban (Xarelto). Warfarin requires regular blood tests to monitor its effects.

Cardioversion therapy:

Cardioversion may be recommended if symptoms are annoying or if it’s the first episode. It helps reset the heart’s rhythm in a procedure known as cardioversion.

There are two ways in which cardioversion can be done:

• Electrical cardioversion: Electric shocks are delivered to the heart via paddles or patches attached to the chest to reset the heart rate.
• Drug cardioversion: Medications administered orally or through an IV to restore normal rhythm.

Normally, cardioversion is a planned hospital procedure but can be performed in emergencies. If scheduled, blood thinners like warfarin may be prescribed beforehand to lower the risk of stroke.

Even after cardioversion, medication may be necessary to maintain a regular heart rhythm and avoid future episodes. However, AFib may still return despite treatment.

Surgery or catheter procedures:

If medications and other treatments fail to manage atrial fibrillation, cardiac ablation might be required. In some cases, ablation is recommended as the first treatment option.

Cardiac ablation creates small scars in the heart using heat or cold energy to block irregular electrical signals and restore a normal heartbeat. The procedure involves inserting a thin, flexible catheter into a blood vessel, particularly in the groin, and it is guided into the heart.

Multiple catheters can be inserted, and sensors attached to the tip can apply heat or cold energy to targeted areas.

In rare cases, ablation is performed with a scalpel during an open-heart surgical procedure.

Types of cardiac ablation for AFib:

The choice of ablation depends on overall health, symptoms, and whether other heart surgeries are planned. They include:

• Atrioventricular (AV) node ablation: Destroys the electrical connection at the AV node using heat energy. It requires a permanent pacemaker to regulate the heartbeat afterwards.
• Maze procedure: Uses cold, heat or a scalpel to create a maze-like pattern of scar tissue in the heart’s upper chambers. This prevents abnormal electrical signals from spreading. If done with a scalpel, it requires open-heart surgery and is often conducted alongside other heart surgeries like bypass or valve repair.
• Hybrid AFib ablation: Combines catheter ablation and surgery to address long-term persistent AFib.
• Pulsed-field ablation: Utilises high-energy electric pulses instead of heat or cold to create scar tissue. It targets abnormal electrical impulses causing AFib.

Conclusion

Atrial fibrillation (AFib) can be a challenging and sometimes overwhelming condition, but you are not alone. Millions of people manage AFib while continuing to lead fulfilling lives. By staying informed and working closely with our healthcare provider, we can help you navigate the condition with confidence.

Exploring treatment options is essential, as every medication or procedure comes with potential risks. However, managing AFib effectively is crucial for maintaining heart health and lowering the risk of stroke. You can find a treatment plan that works best for you with the right support and guidance.

For more information or to address any concerns, book an appointment with us today.