Atrial fibrillation (AF) is the most common ongoing arrhythmia. In this condition the electrical activity in the upper chambers of the heart (atria) is chaotic and the atria don’t contract in an ordered manner. Thorough assessment and personalized treatment is important to reduce the risk of stroke, minimize symptoms and improve prognosis.
This occurs when the electrical activity in the atria (upper chambers) of the heart is chaotic and the normal sequences of the atria becoming activated is lost. The rhythm in the atria is often fast, and in many cases this fast irregular rhythm is transmitted to the ventricles which can cause palpitations, dizziness, shortness of breath and tiredness. In other cases the heart rate can be slow and can cause dizziness and collapses.
In many cases, atrial fibrillation can be asymptomatic but is still important to detect. This is important because atrial fibrillation increases the risk of stroke and often requires treatment with blood-thinning drugs.
An electrocardiogram (ECG) will show atrial fibrillation if you happen to be in this rhythm at the time of the test.
In some cases, the atrial fibrillation can come and go (this is know as paroxysmal atrial fibrillation) and to capture atrial fibrillation a more prolonged period of monitoring may be required such as a 24-hour ECG or an event monitor. Sometimes atrial fibrillation can be detected on small devices that can be purchased to record the heart rhythm, or on watches which monitor the heart rhythm.
An echocardiogram is useful to look for problems with the shape and function of the heart. Sometimes atrial fibrillation can be the only problem, but sometimes it can occur in the setting of problems with the valves or function of the heart. It is important to detect these. The shape of the heart also gives an idea as to how likely it is to be able to put the heart back in a normal rhythm.
You may also need some blood tests to look for the cause of atrial fibrillation including anaemia and problems with thyroid function.
One of the most important aspects is to address the risk of stroke, which may be substantially increased in atrial fibrillation. Depending on other issues (age, blood pressure, diabetes, previous stroke) your doctor will recommend whether you should take an anticoagulant (blood thinning medication).
Apart from thinning the blood, the main treatments are deciding if one should try to put the heart back in a normal rhythm versus accepting atrial fibrillation and controlling the abnormal heart rate. Recent onset of atrial fibrillation, a clear temporary cause (such as chest infection), being symptomatic despite rate control or evidence of heart failure all favour a strategy trying to put the heart back in a normal rhythm.
There are several different ways to try and put the heart back in a normal rhythm, otherwise known as a cardioversion. This can be done chemically (using a medication) or electrically (using a controlled electric shock whilst under anaesthetic). Sometimes a keyhole procedure called ablation can be undertaken which aims to either cure the atrial fibrillation or reduce its frequency. If your heart returns to a normal rhythm it may be possible for you to stop taking blood thinning drugs in the long term.
The other option is to accept atrial fibrillation. In this situation you may need drugs to control the rate the bottom chambers of your heart (ventricles) response. This is likely to include beta-blockers but may alternatively include calcium channel blockers.
Atrial fibrillation is a common condition but the many different treatments need an expert Consultant Cardiologist to evaluate your condition and present the options. Our cardiologists are available for consultation on any day of the week and weekends as well.
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