Atrial Fibrillation - causes, symptoms and treatment

    Chandra Kumbar, MD,  The Heart Group,  Electrophysiologist
     
    I have been practicing as a physician in Evansville for over a decade and greatly enjoy my work in the cardiology field, my colleagues, and patients at The Heart Hospital at Deaconess Gateway. In my role as a heart rhythm specialist with The Heart Group, I treat patients who have irregular heart rhythms. The most common heart rhythm issue, and the one I would like to talk about, is Atrial Fibrillation, or “AFib.”
     
    What is AFib?

    Atrial Fibrillation (AFib) is a serious heart condition where an irregular, often rapid, heart rate commonly causes poor blood flow in the heart, which can significantly increase the risk of stroke and heart problems.   
     
    AFib increases the risk of stroke nearly 6 times. This is because blood can pool in the heart and create blood clots. These clots can travel through the arteries to the brain, causing a stroke. Blood clots can also cause other problems like poor leg circulation, kidney issues, and on rare occasions, heart attack.
     
    AFib can also increase the heart rate, which in turn can weaken the heart if left untreated. While an increased heart rate during exercise is good for the body, increased heart rate at rest (due to AFib) can lead to congestive heart failure.
     
     
    Causes of AFib

    More than 3 million Americans have AFib. This condition is a common problem of aging and is most often found in people age 65 and older. However, there are other medical conditions that can increase the risk of AFib, including:
    • Thyroid disorders (overactive thyroid in particular)
    • Uncontrolled high blood pressure
    • Heart valve problems
    • Infection
    • Radiation (from prior cancer treatments)
    • Excessive caffeine or alcohol consumption
    • Previous heart attacks or surgeries
    • Rarely, it can be seen in multiple family members, so there may be a genetic tie in some cases.
     
    Other medical conditions may worsen AFib. These include:
    • Diabetes
    • High Blood Pressure
    • Sleep apnea
    • Obesity
    • Congestive Heart Failure
    • Vascular Disease (e.g. narrowed arteries or peripheral arterial disease)
     
    Symptoms and Diagnosis

    Most often, people with AFib experience an irregular or erratic heart rate. This can feel like fluttering in the chest, skipped heart beats, heart racing, chest discomfort, uneasiness, or throbbing in the neck. Throbbing in the neck has been described as a pulsing, “full” feeling in the neck that correlates with the heart beating. The pulsing will not feel “even.”

    Sometimes, symptoms can be less specific or clear, such as unexplained poor endurance during exercise, being very tired without explanation, sweating, swelling in the lower extremities, or change in appetite.

    Patients normally are sent to me as a result of a referral from their primary care doctor. In most cases, the patient has experienced some of the symptoms listed above and talked to their doctor. The physician will usually check their pulse, listen to their heart, or conduct an EKG in the office. If those results are abnormal or concerning, they refer a patient to a heart specialist.

    Once the patient is seen by a heart specialist, that physician will work with him/her to confirm the diagnosis, identify the cause, and choose a treatment plan.

    Common Diagnostic Tests
    • EKG. This test, using electrodes placed on the chest, identifies underlying heart rhythm.
    • Holter monitor. A 24-hour heart rhythm monitor, worn on the body, which records heart rhythm while the patient is going about their day.
    • Event monitor. A long-term heart rhythm monitor that can be worn up to 30 days.
    • Patient diary. Patient notes when they experience AFib symptoms, so we can work to find any possible correlation between activity and the irregular heartbeat.
    • Blood test. This identifies thyroid problems, diabetes and other hormonal issues.
    • Echocardiogram. This is an ultrasound of the heart to identify any structural issues with the heart, such as heart valve problems.
    • Exercise stress test. We monitor the patient’s heart while they’re on a treadmill.
    Other tests may be ordered, depending on a patient’s specific needs.

    Treatment for AFib

    For some patients with occasional, no-symptom AFib, no specific treatment is needed. When treatment is required, there are 3 primary goals:
    • Prevention of stroke
    • Adequate heart rate control
    • Restore normal heart rhythm
     
    Medication Options

    Prevention of stroke: Common risk factors (such as diabetes, high blood pressure, congestive heart failure, age, previous history of stroke, female gender, and vascular heart disease) determine the need for anticoagulation drugs, which are commonly referred to as blood thinners.

    Adequate heart rate control: AFib can often cause rapid heart rate, so medications are commonly used to slow down the heart rate.

    Restore normal heart rhythm: For some patients, irregular rhythm, even when the heart rate is under control, can affect quality of life, ability to exercise and more. For these patients, additional medication to treat irregular rhythm is needed. These are stronger medications and therefore can have more side effects. If someone is on these medications, they’ll receive increased monitoring.  

    Non-Medication Options

    To understand treatment options, you need to understand how a normal heart beats. There are two upper chambers (called atrium) and two lower chambers (called ventricle). A normal heart beat occurs when a signal starts in the right upper chamber and travels down to the right and left lower chambers. As the signal travels from the atria to the ventricle, it goes through a “junction box” called AV node. In patients with AFib, the irregular signals start in the left upper chamber and go to the lower chamber through the same AV node. 

    We recommend pacemakers for patients who have persistent fast heart rate despite being on all appropriate medications. When a pacemaker is placed, the AV node is ablated by a procedure called catheter ablation. It’s essentially deactivated by blocking the signal from the upper chamber to the lower chamber. After the AV node ablation, patients feel a regular rhythm supported by the pacemaker.

    There is a new option, called the WATCHMAN.®  The WATCHMAN is implanted in a one-time procedure that reduces the risk of stroke in people with atrial fibrillation.  WATCHMAN is as effective at reducing the risk of stroke as warfarin.

    But unlike warfarin, the WATCHMAN Implant also reduces the long-term risk of bleeding. Newer blood thinners offer an option to warfarin, but they don't take away the long-term risk of bleeding. 

    More details about the WATCHMAN, including informational videos, can be found here. 

    In conclusion

    Finally, remember that not all irregular heartbeats are AFib. Everyone at some time or another may experience a “skipped” heart beat or other feelings that are not normal. It only becomes a concern if it happens regularly. If this should happen, speak to your primary care doctor as soon as possible.  

    Learn more about The Heart Hospital and my practice at The Heart Group.
    Posted: February 16, 2017 by Kate Reibel

    Tags: A, Fib, Fibrillation, heart, Watchman

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