Attacking Atrial Fibrillation

My late mother-in-law is one of the millions of Americans who suffered with atrial fibrillation. She took Coumadin and eventually had a pacemaker operation. But still, I wanted to learn more about this condition.

Atrial fibrillation (AFib) is when the two upper chambers of the heart don’t beat, they twitch instead. They’re squirming, hence the fibrillation. That has three bad consequences. First, it speeds up the heartbeat and reduces pumping efficiency. Second, it makes the heart beat very erratically, another contributor to ineffective heart pumping. Third, it can cause a stroke.

My mother-in-law suffered many strokes over a course of five years. There were times when these strokes were serious enough to hospitalize her and rob her of gross and fine motor skills where she had to engage in physical therapy at a rehabilitation center.

In the fibrillating atria, blood stagnates. Stagnate blood clots. Pieces of those clots can be carried via the circulation to the brain and plug a brain artery. The result is a stroke.

Causes of AFib include a defective blood supply to the heart muscle, high blood pressure, heart valve deformities, and chronic lung disease. Sometimes one may develop the condition without a traceable cause.

According to the Centers for Disease Control and Prevention, it is estimated that 12.1 million people in the United States will have AFib in 2030. In 2019, AFib was mentioned on 183,321 death certificates and was the underlying cause of death in 26,535 of those deaths. More than 454,000 hospitalizations with AFib as the primary diagnosis happen each year in the United States. People of European descent are more likely to have AFib than African Americans. More women than men experience AFib.

Some symptoms of AFib are sensations of a fast, fluttering or pounding heartbeat (palpitations), chest pain, dizziness, fatigue, lightheadedness, reduced ability to exercise, shortness of breath, and weakness. Risk factors for the condition include advancing age, high blood pressure, obesity, diabetes, heart failure, ischemic heart disease, hyperthyroidism, chronic kidney disease, moderate to heavy alcohol use, smoking, and enlargement of the chambers on the left side of the heart.

It is important to note in 10 percent of cases, no underlying heart condition is found for those with AFib. AFib may be related to alcohol or excessive caffeine use, stress, certain drugs, electrolyte or metabolic imbalances, severe infections, or genetic factors. In some cases, no cause can be found.

According to the Mayo Clinic, AFib can be:

·       Occasional (paroxysmal atrial fibrillation) where AFib symptoms come and go, lasting for a few minutes to hours. Sometimes symptoms can occur for a week and episodes happen repeatedly. Symptoms may go away on their own. Some people with occasional AFib need treatment.  

·       Persistent where the heart rhythm doesn’t go back to normal on its own. If a person has AFib symptoms, cardioversion or treatment with medications may be used to restore and maintain a normal heart rhythm.

·       Long standing persistent. This type of AFib is continuous and lasts longer than 12 months.

·       Permanent. In this type of AFib, the irregular heart rhythm can’t be restored. Medications are needed to control the heart rate and to prevent blood clots.

To diagnose AFib, your doctor will run several tests including an electrocardiogram which measures the electric activity of the heart. Your doctor will also perform blood tests to rule out thyroid problems or other substances in the blood that may lead to AFib. A holter monitor is used to record the heart’s activity for 24 hours or longer. An event recorder which is similar to the holter monitor is used to record irregular heart rhythm. An echocardiogram uses sound waves to create images of the heart’s size, structure, and motion. A stress test involves running tests on the heart while exercising on a treadmill or exercise bike. A chest X-ray allows you to see the condition of your lungs and heart.

To treat AFib, your doctor may rely on medications, therapy, surgery or catheter procedures. Prescribed medication controls how fast your heart beats and restores it to a normal rate. Medication may also prevent blood clots, which is a dangerous complication with AFib. Medications used to treat AFib include beta blockers, calcium channel blockers, digoxin, anti-arrhythmic drugs and blood thinners.

Your physician may also wish to reset your heart rhythm using a procedure called a cardioversion. Cardioversion can be done in two ways. Electrical cardioversion is a method of resetting the heart rhythm by sending electric shocks to the heart through paddles or patches (electrodes) placed on the chest. Drug cardioversion are medications given through IV or by mouth to reset your heart rhythm. Cardioversion is usually done as a scheduled procedure but it may be done in an emergency procedure. After electrical cardioversion, anti-arrhythmic medication may be prescribed indefinitely to prevent future episodes of AFib.

If your AFib doesn’t get better with medications or other therapies, your doctor may suggest a procedure called cardiac ablation. Atrioventicular (AV) node ablation uses heat or cold energy applied to the heart tissue at the AV node to destroy the electric signaling connection. After the AV node ablation, a pacemaker operation will need to be performed. Then there’s the maze procedure, where your surgeon uses heat or cold energy or a scalpel to create a pattern of scar tissue (the maze) in the upper chambers of the heart. Because scar tissue doesn’t send electrical signals, the maze interferes with the stray heart signals that cause atrial fibrillation.

Atrial fibrillation may return after cardiac ablation. At that point, another cardiac ablation or another heart treatment may be recommended.  After cardiac ablation, lifelong blood thinners are needed to prevent strokes.

If for some reason a person can’t take blood thinners, then your doctor may suggest a catheter procedure to seal a small sac (appendage) in the left upper heart chamber where AFib related clots form. This procedure is known as the left atrial appendage closure. A closure device is guided through a catheter to the sac. Once the device is in place, the catheter is then removed. The device is left permanently in place.

Your doctor may also recommend a heart healthy regimen to follow. Eating healthy meals, exercising regularly, quitting smoking, maintaining a healthy weight, keeping blood pressure and cholesterol levels under control, limiting alcohol consumption, and getting follow-up care are just some of the ways you can monitor your condition for the better.

AFib doesn’t have to be a lifelong sentence of misery. This condition is manageable with the right people and treatment behind your situation. Talk to your doctor to determine what works best for you.