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Atrial Fibrillation

How is atrial fibrillation treated?

Some patients require no treatment.  The atrial fibrillation goes away by itself and the normal heart rhythm is restored.  This is often the cause for people who have one episode of atrial fibrillation.  Most people however require treatment with tablets.

The tablets are used for the following reasons:

Slow the heart rate — this usually relieves most of the symptoms of palpitations and breathlessness.  Most people with chronic AF are on these tablets.  These drugs are Digoxin (Lanoxin), Atenolol (Tenormin, Noten), Verapamil (Isopten, Vercaps) or Diltiazem (Cardizem).

Restore and maintain normal heart rhythm — these drugs are useful in people who have episodic (paroxysmal) atrial fibrillation to reduce the frequency of recurrences and sometimes prevent episodes altogether.  These drugs include Sotalol (Sotacor), Flecainide (Tambocor) and Amiodarone (Cordarone).

Reduce risk of blood clots — anticoagulation.  These drugs are used to prevent blood clots forming in the heart.  Some patients only need Aspirin but others require Warfarin (Coumadin), an anticoagulant drug which requires regular blood tests to maintain careful control.

In some patients who have had an episode of AF, the tablets do not restore normal rhythm.  In these cases, an electric shock is required to reset the heart rhythm (this is called a ‘cardioversion’).  It is performed under a brief general anaesthetic and requires coming into hospital for a day.

What is atrial fibrillation?

Atrial fibrillation (AF) is an abnormal rhythm of the heart when the heart beats in a fast, irregular fashion.  It is a common heart rhythm disturbance which usually causes palpitations—a fluttering, pounding feeling in the chest.

What is the normal rhythm of the heart?

The heart has four chambers: the left and right atrial which set the heart rhythm and the left and right ventricles which pump blood around the body.

The heart beat is triggered by an electrical signal which starts in the top of the heart (the sinus node in the right atrium) and spreads through the atrial.  It then travels through a narrow zone in the middle of the heart, the atrio-ventricular node (AV node), to reach the ventricles where it triggers the pumping action.  This rhythm is called “sinus” rhythm.  The normal pulse rate varies between 40—60 per minute during sleep, 60—80 per minute at rest and 80—150 per minute during exercise.

What happens in atrial fibrillation?

In atrial fibrillation, the atria send out electrical signals in a very rapid, disorganised manner.  The ventricles beat rapidly causing a fast pulse rate (up to 200 per minute).  The pumping efficiency of the heart is reduced.

What causes atrial fibrillation?

Atrial fibrillation may occur without any underlying heart disease.  It is more common in older people but can occur at any age. 

The most common conditions are:

  • High blood pressure (hypertension)
  • Coronary artery disease (angina and heart attacks)
  • Heart valve disorders
  • Chronic lung diseases
  • Heart failure
  • Thyroid gland overactivity

Atrial fibrillation commonly occurs in the week following open heart surgery. It may occur shortly after other surgery.  Heavy alcohol use (binge drinking) can bring on an episode of atrial fibrillation.

Is atrial fibrillation there all the time?

Some people have episodes (or “paroxysms”) of atrial fibrillation which can last from a few seconds to several days.  Other people remain in atrial fibrillation indefinitely (called chronic atrial fibrillation). Atrial fibrillation can be diagnosed on an electrocardiogram (ECG), but if it occurs intermittently, may only be recorded using a 24 hour ECG monitor.

What are the symptoms of atrial fibrillation?

Many people have no symptoms at all.  In chronic atrial fibrillation the heart rate can usually be controlled with medication and patients have a few symptoms.

Symptoms often experienced are:

  • Palpitations—fluttering, pound of the heart in the chest.
  • Shortness of breath especially on exertion.
  • Fatigue
  • Light headedness
  • Chest discomfort, pain or pressure

Can atrial fibrillation cause any serious problems?

Atrial fibrillation itself is usually a benign problem which causes uncomfortable symptoms but does not damage the heart.

However, blood clots can form inside the heart and if they break lose, can travel to the brain causing a stroke.  About 5% of patients with AF have a stroke each year.  This is five times the rate in people without atrial fibrillation.

Do I have to watch out for any other problems?

Notify my office immediately if the pacemaker site becomes red, painful or swollen or if the skin becomes very thin or eroded over the pacemaker.  These signs may indicate an infection.