Atrial fibrillation

What is Atrial fibrillation?

Atrial fibrillation (AF) is a rhythmic disturbance of heart rate which increases the risk of stroke, heart failure and also other heart related diseases.

?As in heart there are total four chambers in which they were being divided in to two-part atrium and ventricles due to the confused beat of upper chamber (the atria) which unable to coordinate with lower chambers (the ventricles) of the heart.

What are the causes of AF?

As our heart is made up of four chambers i.e. Left Atrium, right Atrium, left Ventricles and right ventricles and this chamber is being divided in to two parts Atrium (Upper chambers) and ventricles (Lower chambers). Sinus node is a group of cells which is situated in right atrium, we can say that this is our natural pacemaker.

The role of sinus node is to produce the signal and starts each heart beats. Normally the heart beat range should be 60 to 100 beats a minute. And what happen in AF it goes to 100 to 175 beat per minute.

As how Signal works? As when it generates the signals it travels through both the chambers of atrium and that signal goes to the both the chambers of ventricles through AV node (Atrioventricular) and hence the heart contract and supply the blood to heart and body.

In AF as there is irregular signals in Atrium and because of that AV node shakes and flood of impulses generated trying to get in to the ventricles. And this may cause following condition…

1.?????? High blood pressure

2.?????? Heart Attack

3.?????? Coronary artery disease

4.?????? Abnormal heart valves

5.?????? Lung disease

6.?????? Heart surgery

7.?????? Viral Infection

8.?????? Stress due to surgery, pneumonia, or other illness

9.?????? Sleep apnea

What are the symptoms of AF?

In the case of AF some may not find any symptoms at the time of physical examination but some people do find the symptoms which is as under.

·???????? Palpitation (Irregular heart beat)

·???????? Weakness (not having energy to carry out day to day activity)

·???????? Decrease in exercise ability.

·???????? Light-headedness

·???????? Wooziness

·???????? Increase in dependability in work

·???????? Tiredness

·???????? Breathlessness

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How many types of AF is there?

There are four types of AF which is as under:

Occasional: This type of atrial fibrillation is also known as “Paroxysmal Atrial Fibrillation”. In these symptoms comes and go for few minutes or an hour that you can’t control on this.

Persistent: what happen is that the rhythm doesn’t go normal unless you go for the treatment like electrical shock or medication as directed by cardiologist or electrophysiologist.

Long-standing persistent: In this it stays for longer period like more than 12 months.

Permanent: In this type of AF the rhythm of the heart beat doesn’t come under normal condition. Patients will have AF permanently and can prevent from plaque or clot by taking regular medicines as directed by cardiologist or electrophysiologist.

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How doctor Diagnosis of Atrial fibrillation?

Firstly, doctor will take history of the patients then see the signs and symptoms after that to confirm the AF they will ask you to do certain test which is mentioned as under:

·???????? Electrocardiogram ECG?

As this is a primary tool to diagnose AF, in ECG there is a small sensor called electrodes which is attached in chest and arms of patients which records electrical signals that comes from patients’ heart.

·???????? Holter monitor:

This is one kind of portable ECG machine which fits on shoulder. It records the activity of heart for 24 hours or longer. This machine will provide your doctor a detailed report of your heart rhythms. So that they guide you accordingly.

·???????? Event Recorder:

With this device doctor can access the heart rhythm at same time of patient’s symptoms. When patient feels the increasing level of heart rate at that time patient has to push one button after that device will record the previous few minute and after few minutes of heart activity. As this is a portable device patient can put this for week or for a month as per the doctor guidance.

·???????? Echocardiogram:

This device generates sound waves which help in creating moving pictures of patient heart. Doctors also used this device to diagnose structural heart disease or blood clots in patients’ heart. A long thin stick device (Transducer) is attached on patient chest. ?Occasionally a flexible tube with transducer is lead by the patient throat through esophagus.

·???????? Blood tests:

To rule out thyroid or other problems that may cause Atrial Fibrillation for that reason doctor used to ask patient to do this test.

·???????? Stress tests:

Real time test like exercising in trade mill with that ECG is attached to the patient to record heart activity while patient is on stress level.

·???????? Chest X-ray:

Doctor used X-ray images to confirm the signs and symptoms that what doctor diagnose and patients experience. They also used to rule out other condition other than Atrial fibrillation.

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What are the treatment options?

Depending on the patient’s history that how long patients suffers from AF and what are the other conditions that patient is associated with it. The main objective to treat AF is to adjust the rhythm and control on heart rate with that doctor also take care that clot formation doesn’t take place to prevent them for stroke or other comorbid condition.

With Atrial fibrillation there are many other factors that doctor have to consider at the time of treating the patient.? Even doctor has to see that weather patients take medication to control the heart rhythm or not. In some case doctor give nosy treatment to patient like medical procedure using catheters or surgery.

There are some conditional events like thyroid disorder, this disorder is one of the triggering factors of Atrial Fibrillation. To relieve the patient heart rhythm problems, doctor need to treat the causing condition of AF. If the patient is having first incident of AF then doctor may adjust the heart rhythm to normal.

Reconstruct the heart rhythm

The objective to treat AF is to reconstruct the heart rhythm to normal. Using cardioversion procedure doctor may reconstruct the patient heart to its regular rhythm (sinus rhythm). This depends upon the severity of the patient.

However, cardioversion can be done in two ways which is mentioned as under:

1.?????? Electrical cardioversion:

The main function of this device is to normalize patient heart rhythm through electrical shock. Patients will get electrical shock that passes to the heart through patches or spade that is placed on chest.

Before the procedure start patients had being given sleeping pill, so that they don’t feel the electric shock. Doctor may also give medication that normalize your heart rate (anti- arrhythmic) before the procedure.

2.?????? Cardioversion with drugs:

The drugs that is use to normalize patient heart rate are anti-arrhythmic. This medication helps to reimpose the heart rate to normal condition. As per the condition of the patient they get the dose through IV route or by mouth to reimpose the normal heart rate.

This therapy can be done in hospital under the supervision of the doctor. As they have to continuous monitor the heart rate. When patients heart rate back to normal after that doctor may prescribe anti – arrhythmic to there patient or similar to that to prevent Atrial fibrillation episode.

Doctor may advice to take warfarin or other clot thinning medication for several week before cardioversion, this will help patient to reduce the risk of blood clots and strokes. This type of medication doctor may advice after procedure if patient meet with an episode of Atrial fibrillation in 48 hours so that blood clot being prevented with this.

Maintaining a normal heart rhythm

After the cardioversion doctor may prescribe medication which can prevent frequent episode of atrial fibrillation. Every doctor has its drugs of choice; however, they may prescribe Dofetilide, Flecainide, Propafenone, Amiodarone, Sotalol.

These drugs may help to maintain the heart rate normal but with this there are some of the side effects like vomiting, light-headedness, tiredness.

This medication can also cause ventricular arrhythmias which is very rare. However, this is life threatening rhythmic disorder that happens in the lower chamber of the heart. Still medication is needed to treat atrial fibrillation. But even there is a chance of atrial fibrillation after taking medication.

Heart rate control

Doctors prescribe medication in such a way that how early patients heart rate can reimpose to normal rate.

·???????? Digoxin: This medication will only help patient when they sit ideally doing nothing but if they start working or doing so activity then another medication is also being advice like beta blockers and calcium channel blockers.

·???????? Beta Blockers: This medication can help patient to decrease the heart rate when they seat ideally or by at the time of activity. The side effect of this medication is that they decrease the blood pressure of patient which bring the condition of hypotension.

·???????? Calcium channel blockers: ?This medication can help to control your heart rate. However, if patient is suffering from heart failure or lower blood pressure then this medication should be avoided.

?Catheter and surgical procedures

This procedure is an option when medication and cardioversion doesn’t show effect to control Atrial Fibrillation. In this procedure doctor will demolish the area of heart tissue that’s create the erratic electrical signals and reimpose the heart to normal rhythm.

The options doctor may give to patients is as under:

1.?????? Catheter ablation: In this procedure doctor place long, thin tube (Catheter) from genitals and lead them to patients’ blood vessels to heart. The catheter’s tip generates radiofrequency energy that can be extreme cold (cryotherapy) or heat to demolish heart tissue that create expeditious or non – uniform heartbeat. Burns formation which helps in signalling normal heartbeat. This method is also known as cardiac ablation which helps to restore the correct arrhythmia. Without any need of medication and implantable device.

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Doctor may advice patient to this therapy when they have Atrial fibrillation and which is not controlled by medication and cardioversion. This method is also useful to those who have heart failure and implant device. And also, to those patients who unable to tolerate anti – arrhythmic medication

2.?????? Maze Procedure: ?There are so many variations for maze procedure. In this procedure doctor might use blade, radiofrequency or extreme cold (cryotherapy) so that to create pattern of burns tissue that obstruct with stray electrical impulses that cause atrial fibrillation.

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However, maze procedure is having a very high success ratio, if atrial fibrillation come back. Then you may need cardiac ablation or other heart treatment as per doctor’s advice.

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Surgical maze procedure (using blade) needs open heart surgery, is advisable to those patients who did not get the control on heart rate from medication or other treatments. As this surgery can be done parallelly with other surgery like coronary artery bypass or heart valve repair.

Atrioventricular (AV) node ablation:

As we have discussed all above condition and still patients do not respond well with above procedure then they are the right patient to go with AV node ablation procedure. In this procedure catheter carry radiofrequency energy from the pathway (AV node) that links the upper and lower heart chambers.

This procedure will take care of abnormal tissue that demolish small area of heart tissue. In this procedure doctor needs pacemaker to be implant in lower chamber (ventricles) so that it beats normally. But the upper chamber of heart (Atria) can still shake. Patient need to take medication of blood thinner to reduce the risk of stroke because of Atrial fibrillation.

Preventing Blood Clots

?Patients who is suffering from Atrial fibrillation are exclusively on high risk of forming a clot, so there will be higher chances of getting stroke. Risk ratio can even be higher if they are having other heart disease with Atrial fibrillation. Doctor may prescribe anti – coagulants to prevent the clot.

1.?????? Warfarin: This is one of the oldest anticoagulants to prevent the clots. If doctor is prescribing this medication then you have to carefully understand and implement the doctor’s instruction. Also, to go for blood test to monitor the dose of warfarin. If you don’t do then there will be the chances of bleeding.

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2.?????? Newer Anticoagulants: There are several new anticoagulants available. The unique thing about these newer anticoagulants is that you don’t have to monitor the dose. dabigatran, rivaroxaban, apixaban and edoxaban are some of the newer anticoagulants are available. So, as per the doctor’s drug’s choice and experience they prescribe medication to their patients. This medication is use to prevent stroke those who are suffering from Atrial fibrillation. But patients who have mechanical valves they can’t take newer anticoagulant.

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Left atrial appendage closure

There is one more procedure that doctor may give to there patient is let atrial appendage closure.

In this procedure doctor place, the catheter from vein in the leg that lead to the upper left heart of the chamber (left atrium). Then a device is placed left atrial appendage closure device. This device is installed by the catheter to close an appendage in the left atrium.

This procedure is for those patients who do not have valve problems, who are having high risk of blood clot formation and bleeding, and for those patients who are unable to take anticoagulant. Before this procedure doctor may take detailed report of the patient then only advice for this procedure if needed.? With this procedure patient may reduce the risk blood clots those patients have atrial fibrillation.