ATRIAL FIBRILLATION (A – fib)

WHAT IS IT?

WHY IS IT SO EASELY IGNORED?

Even though I am not a cardiologist, I have seen and took care of many A- fib patients who were on blood-thinner medications and who needed endoscopic evaluations. Additionally, I have two members of my family with A-fib.

I thought it would be a good idea to talk about this common, frequently ignored, and dangerous heart rhythm abnormality in a simple Q and A format to understand the problem better. 

What is A-fib?

A-fib is an atrial heart- rhythm abnormality that is caused by the disturbances of electrical pacing system (pacemaker) of the heart which is located in the left atrium (upper small chamber of the heart). Left atrium instead of sending regular electrical pacing signals to the ventricles (two lower, powerful blood pumping chambers of the heart), it sends multiple, rapid, chaotic, and out of synch signals. Then the ventricles cannot pump sufficient blood to the peripheral organs to function properly.

How common is A-fib?

Lifetime risk of developing A-fib around 20 percent and more than 3 million adults in US are affected by A-fib. It is expected that A-fib would increase significantly in the future, as the population ages and the incidence of hypertension, diabetes and obesity increases. It is believed that the condition directly or indirectly causing over 158,000 death a year in the USA.

What is the etiology (cause) of A-fib?

The most common causes are aging, hardening of coronary heart vessels, atrial valvular abnormalities (mitral stenosis), Overactive thyroid gland (hyperthyroidism), binge drinking and myocarditis (inflammation of heart muscles.

How many types of A-fib exist?

A- fibs are classified according to their onset and persistence. Acute A-fibs are transient, last a short time and spontaneously convert to normal sinus rhythm. That is why it is easy to ignore them, and it is a big mistake. Because it could be easily diagnosed with a simple EKG and/or Holter monitor and A- fib is easier to treat when diagnosed earlier. Chronic A- fibs could be persistent, lasting a week, and can be converted to normal sinus rhythm with treatments. But Permanent A-fibs cannot be converted to normal rhythms with any treatments.

What are the risks and dangers of chronic A- fibs?

Chronic A-fib tends to form blood clots in the left atrium and raise the risk of stroke by a broken by piece of clots by fourfold in men and sixfold in women. It can raise the risk of heart failure threefold in men and elevenfold in women. Chronic A-fib is also could be associated with dementia, secondary to repeated small strokes (TIA) or impaired blood circulation to the brain.

How do one know if they have A-fib?

Those who are affected by A-fib may feel palpitations, raising heart, flutter, fatigue, and shortness of breath that may come and go. These symptoms should not be ignored because they went away, and a doctor must be seen ASAP.

How is A-fib is treated?

It should be treated by a cardiologist. Doctor usually use certain medications (beta blockers, calcium channel blockers) and/or electrical cardioversion, or ablation therapy (a tiny catheter passed through the vein into the left atrium and misfiring cells are destroyed either by freezing or burning them.

What happens if no treatment works?

These patients are prone to large clot formation in the left atrium which cab easily break and cause catastrophic embolisms. Cardiac rate is controlled with medications and these patients are placed on blood- thinners for the rest of their life to prevent embolism and are closely watched.

Are there any new treatments in the horizon?

Yes, but they are not available yet for public use. They are being tested by clinical trials. One of them called “Farapulse”, approved in Europe. It is claimed to be better and safer. It destroys the errant cells with electrical shocks. More information can be obtained at clinicaltrials.gov