The heart pumps blood constantly toward the entire body by squeezing it's
different parts in a special way. The top part, called the atria, squeezes first
then the bottom part of the heart, called the ventricles, squeezes next. Atrial
fibrillation is an abnormal heart rhythm that causes a fast and irregular pulse.
In atrial fibrillation parts of the atria send disorganized electrical
impulses into the top of the heart. These abnormal discharges cause the atria to
shake like jelly. This activity takes over the heart's normal beats and the
body is not able to control how fast the hart is beating. This causes the most
common symptom of atrial fibrillation: fatigue. Atrial fibrillation is the most
common type of abnormal heart rhythm. An estimated 3 to 6 million Americans have it.
In fact, it happens so commonly doctors have a nickname for it: "a-fib".
Most often the risk of afib increases as we get older. As people age so does their
heart and age is the biggest risk factor for developing afib. Just 2% of people
under the age of 65 have atrial fibrillation but as high as 9% of those
over the age of 65 have it. Age is not the only thing that brings on afib, other
things can cause it too. Problems like obesity, thyroid disorders, too much
alcohol, caffeine and energy drinks, high blood pressure, lung problems like COPD,
and even sleep apnea can trigger this arrhythmia. Also being very sick like
with a serious infection can throw the heart into this abnormal rhythm. Atrial
fibrillation causes two main problems: the symptoms it can cause, and the
increased chances of stroke. To understand how atrial fibrillation
causes strokes we need to look at a part of the heart called the left atrial
appendage. This part of the heart is kind of like the hearts tail. When afib
starts, the atria shakes like jelly. This type of movement does a bad job at
pushing blood out of the top part of the heart and into the bottom. Because of
this, some of the blood pools inside the heart's little tail where it settles and
can form blood clots. In afib some of these formed clots inside the appendage
can detach. If the heart breaks out of afib and starts squeezing normally again
the tail appendage can squeeze the clots out. The clots can then be launched into
the body. The most common place of blood clot goes
after it leaves the heart is the brain. If a clot lands in your brain it can
obstruct the blood flow and cause a stroke.
A stroke can have a huge impact on a person's life even taking away their
ability to talk and move independently. If you have afib it is important to find
out your chance of having a stroke so you can decide if you need to protect
yourself from one. Fortunately there is a tool that can help you and your doctor
quickly determine your risk. This tool is called the CHADS VASC2 score. This score
looks at all the factors that increase the chances of stroke in people with
afib. If your score adds up to zero or one
then your chance of having a stroke is low. For any score over two: protection
with a blood thinner or what is called an "occlusion device" is recommended.
Until recently coumadin was the only choice of blood
thinner available for patients with afib. Coumadin can protect from a stroke but
it is a very difficult drug to take as it requires frequent testing. Fortunately
there are now four new oral blood thinners that do not need regular blood
draws for monitoring and have minor interactions with food and other
medications. If a patient is bleeding or is at high risk of bleeding because of
frequent falls, job activities or sports or has had head trauma an occlusion
device is recommended. An occlusion device may also be used if the patient
has a history of not taking their prescribed medications. Doctors in the
U.S. offer two occlusion devices that can protect you permanently from a
stroke. The first of these devices is called the Watchman® device: a plug is
placed inside the heart's tail so that clots will not settle inside of it.
The second device option ties off the heart's tail altogether so it can no longer
cause the problem. Symptoms of afib can be different for everyone. The same
irregular heart rhythm can cause severe symptoms in one person and nothing in
others. The most common symptom of afib is fatigue but people with afib can also
feel their heart racing or palpitations, shortness of breath, chest pain and even
anxiety. There are medications available that can help treat the heart so that afib
happens much less often. This can lead to an improvement in symptoms. These
medications are called "antiarrhythmics." Antiarrhythmics have a limited ability
to control afib and can cause side effects. The most common and powerful of
these medications is called amiodarone. Amiodarone is effective at controlling
atrial fibrillation but it can affect the thyroid gland making it either
over-active or under-active. Also taking amiodarone for a long time can change
the skin's colour and cause permanent lung scarring. Over the last two decades
atrial fibrillation has also been treated with a procedure called an
"ablation". The ablation procedure was invented in the 1990s and has been
dramatically improved over time. It can help reduce patient's symptoms and
mortality while reducing the need for medications and their side effects. With
an ablation, doctors can target the root of the problem that causes afib. They do
this by tracing the abnormal electrical discharges that cause the irregular
heartbeat and locating the parts of the heart where they occur. Up to 85% of
these discharges happen in the part of the heart that receives blood from the
lungs: the pulmonary veins. Once they locate these trigger areas doctors then
enter the heart using a minimally invasive approach. Inside the atrium they
target and zap or "ablate" these abnormal trigger areas while leaving the normal
parts alone. The earlier the problem is treated the
more effective an ablation will be. Ablations are successful at treating
afib that comes and goes called "paroxysmal" up to 90% of the time. The
procedure can be up to 80% effective for those with persistent afib that has been
occurring for less than one year and as high as 60% effective at treating it if
it has been happening for over a year. Since 2016 the procedure of afib
ablation has begun to expand to include the left atrial appendage. When the left
atrial appendage is ablated in addition to the ablation around the pulmonary
veins the procedures effectiveness improves by approximately 20%. Many
studies have shown that this updated ablation procedure is safe and does not
increase the risks related to ablation. Regardless of how long a thief has been
going on it is never too late for treatment. Even in those who have had it
for a long time, reducing the amount of time the heart stays in afib can lead to
an improvement in symptoms.