Atrial fibrillation is an abnormal heart rhythm which is essentially a chaotic, irregular
rhythm generated from the top left chamber in the heart, which we call the left atrium.
Essentially, abnormal electrical wavelengths come into the heart and take over the normal
heart beats. This leads to an irregular pulse and can also worryingly put patients at risk
of stroke. We know that strokes related to atrial fibrillation, are more severe and can
lead to higher mobility and mortality. Essentially, to summarise, atrial fibrillation is a very common,
irregular heart rhythm which can put patients at risk of stroke
but it can also cause patients to have a lot of symptoms.
Atrial fibrillation can lead to variety of symptoms
the most common symptom patients get with atrial fibrillation is a sensation of an irregular heartbeat
or irregular palpitations. This may be a feeling in their chest where they feel their heart
beating irregularly or when they feel their pulse, it feels irregular. However, other symptoms
may also occur from atrial fibrillation. Some patients have shortness of breath when doing
normal activities. You may find that you’re not able to walk as far or do as much you were previously.
Very occasionally, people get dizziness. Also importantly, a lot of patients with atrial fibrillation
don’t know they have atrial fibrillation as they have no symptoms. That’s why it’s
important for patients over 65 to have regular pulse checks to check very quickly and easily
if your pulse is irregular. If it is irregular, atrial fibrillation can be diagnosed on a
very simple test called an ECG.
Atrial fibrillation causes an irregular heartbeat.
Not all patients have palpitations, but certainly, a lot of patients feel their heart racing
irregularly and palpitations are essentially a sensation of your heart beating abnormally.
With atrial fibrillation, the heart can sometimes go very fast but also very slow and some patients
have a normal heart rhythm for a lot of the time and have episodes where their heart beats
irregularly. That’s what we call paroxysmal atrial fibrillation. To summarize, palpitations
are a symptom. Atrial fibrillation can lead to palpitations and a sensation of your heart
beating irregularly or erratically.
Atrial fibrillation is a disease which tends
to happen more frequently as we get older and is often referred to a disease of the
elderly. What that means is that as we age, specifically as we get over 65 and 75, our
risk of developing atrial fibrillation increases. However, overall, about half the patients
with atrial fibrillation are younger than 65. We see a huge age range of patients.
Any heart condition, for example coronary artery disease, high blood pressure, structural
heart disease can all increase your risk of developing atrial fibrillation. Other conditions,
particularly diabetes, obstructive sleep apnoea, and high blood pressure can also increase
your risk of atrial fibrillation. Finally, our lifestyle factors play a big role in this.
Obesity, heavy alcohol consumption and lack of fitness can all increase your risk of developing
atrial fibrillation. We can classify three groups—structural
heart disease or non-structural heart disease and also lifestyle factors. Many patients
with AF have none of these and it’s a disease which just develops with no particular trigger.
Atrial fibrillation leads to an irregular heart rhythm and the heart beating irregularly
can lead to the formation of blood clots which can potentially cause strokes. Therefore,
the most important thing in assessing any patient with atrial fibrillation is what is
your risk of stroke? We do that based on your comorbidities or other conditions such as
high blood pressure, your age and we work out what your risk of stroke is. If your risk
of stroke is higher that we’d like, we will start you with a blood thinner or anticoagulant.
Once we’ve dealt with your risk of stroke, which may be very, very low in some people
and you don’t need to start on blood thinners, we can then deal with treating symptoms from
atrial fibrillation. Symptoms that we’ve discussed include palpitations, shortness
of breath and dizziness. Depending on the type of atrial fibrillation you have, we may
use medications, drugs such as beta blockers or calcium channel blockers to try and prevent
episodes of AF to try and regulate your heart rate.
In some patients who are in AF all the time, we may perform a cardioversion. This is an
electric shock where we shock your heart back to a normal rhythm to see if you benefit.
This is done under general anaesthetic and is a very straight forward procedure. However,
most patients at some point for the cardioversion will revert back to atrial fibrillation but
there’s a useful tool for us to see if you notice an improvement in your symptoms.
Finally, if you have a lot of symptoms and the drugs aren’t working or you don't want
to take drugs or you felt a lot better being in normal rhythm, we can offer you what we
call an ablation. This involves passing wires from the top of the leg into the heart and
removing or treating the abnormal triggers for AF either using freezing or with high
frequency energy. The success rates depend on the type of atrial fibrillation that you
have but in general are very good. The procedure is very safe and carries a small risk of complications
and is usually performed as a day case or an overnight stay.