Atrial Fibrillation

Overview

Atrial fibrillation is a kind of arrhythmia in which the atria beat
irregularly out of rhythm with the ventricles and the heart rate
can vary from 100 to 175 bpm. This may cause blood clots in
the heart and raise the chances of having a stroke, heart
failure, or other heart-related issues. AFib may be
asymptomatic in many patients, on the other hand, it can
produce palpitations, shortness of breath, and weakness.
Atrial fibrillation episodes might come and go, or they may be
persistent. Although this condition is seldom fatal, it is a
significant medical disease that needs prompt treatment to
avoid stroke.
Medication, therapy to reset the heart rhythm, and catheter
operations to block incorrect cardiac impulses are all possible
treatment options for atrial fibrillation.
A person with atrial fibrillation may also have atrial flutter, which
is also a cardiac rhythm disorder. Although atrial flutter is a
distinct arrhythmia than atrial fibrillation, the therapy is quite
similar.

Symptoms

Atrial fibrillation may show no symptoms, but there are some
signs and symptoms that may be present; like dizziness,
fatigue, less exercise endurance, weakness, and shortness of
breath.
The American College of Cardiology and the American Heart
Association announced new guidelines in 2014 that modified
the categorization of atrial fibrillation from two to four types:
1. Paroxysmal AFib
Paroxysmal AFib is a kind of AFib that comes and goes. It
starts and ends on its own. The episode might last for a
few seconds to a week. Most episodes of paroxysmal
AFib, on the other hand, resolve within 24 hours.
This type of AFib can be asymptomatic. In addition to
drugs as preventive measures, lifestyle adjustments such
as decreasing caffiene and lowering stress is the first line
of therapy for asymptomatic paroxysmal AFib.
2. Persistent AFib
Persistent AFib can also start on its own. It lasts at least
seven days and may be self-terminating. To terminate an
acute, prolonged AFib episode, medical intervention such
as cardioversion may be required. As a preventative
approach, lifestyle modifications and drugs may be
considered.
3. Long-standing persistent AFib
AFib that can present for at least a year is known as
long-standing persistent AFib.this kindis frequently linked
to structural heart damage.
This type of AFib is challenging for the doctors. Usually,
medications are not successful enough for this case.
Some further invasive options may be require; such as
electrical cardioversion, catheter ablation, or pacemaker
implantation.
4. Permanent AFib
When therapy fails to restore normal heart rate or rhythm,
long-term persistent AFib can become permanent. In this
case, there is no need for further treatment efforts as the
heart is always in an AFib state.
This type can cause more severe symptoms, a worse
quality of life, and a higher chance of a serious cardiac
event.

Doctor consultation

There is no perfect time for doctor consultation, however, in
case of noticing any of the previous symptoms in addition to
any degree of chest pain, it’s critical and needs more
investigation.

Causes

The atrial fibrillation is associated with some heart conditions
including:
● CAD
● Heart attack
● congenital heart defect
● Heart valve problems
● High blood pressure
● Lung diseases
● Surgery, pneumonia or other physical stress
● Earlier heart surgery
● Sick sinus syndrome
● Sleep apnea
● Thyroid disease
● Use of stimulants, like caffeine, tobacco, alcohol, or other
medications
● Some viral infections
There are many factors that may increase the risk of AFib
including age, hypertension, thyroid problem, heart diseases,
some chronic diseases, alcohol consumption, obesity, and
family history.
AFib can be triggered by some factors; like excessive alcohol
consumption, obesity, increase caffiene consumption, addiction
to some drugs as amphetamine and smoking.

Diagnosis

The main test to diagnose atrial fibrillation is ECG. Conducting
an ECG during an atrial fibrillation attack will result in a HR over
bpm in an irregular pattern. During an attack, it may be
challenging to capture the episode by the ECG, so there are a
variety of different tests that may be performed; such as: an
echocardiogram, a chest X-ray, holter monitor, stress test,
event recorder, and some blood tests to rule out any thyroid
dysfunction or other causes.

Treatment

Medicines that lower heart rate and minimise the risk of stroke,
as well as treatments to restore normal cardiac rhythm, are
used to treat atrial fibrillation. The treatment options may
include medications, cardioversion, and surgery or
catheterization.

Medications

Some medication options are:
● Beta blockers: to regulate the heart rate.
● Ca channel blockers: control the heart rate.
● Digoxin: to control heart rate at rest and during the
exercise.
● Antiarrhythmic medications: to maintain the normal heart
rhythm, but they have more side effects than other drugs.
● Blood thinners: to reduce the risk of blood clotting. Some
prescribed blood thinners are warfarin, apixaban,
dabigatran, edoxaban, and rivaroxaban. Considering
blood tests to monitor the level of warfarin is critical.

Cardioversion

A procedure which used to reset the heart rhythm. Cardioversion can be electrical; in which electric shocks are sent to the heart through paddlers or patches. Other type is a drug cardioversion; in which doctors uses IV or oral drugs to reset the heart rhythm.
Surgery or catheterization
In case of resistant AFib cases, the ablation option is suggested. This can be done by using radiofrequency energy or cryoablation to create some scars in the heart which can block abnormal signals. common types of cardiac ablation are AV node ablation and Maze procedure. Cardiac ablation can be repeated if the atrial fibrillation returns after the first ablation. After the procedure, it’s suggested to use blood thinner to reduce the risk of strokes. In case of the inability to use blood thinners, a doctor may recommend a catheter procedure to seal an appendage in the left upper chamber. After placing the appendage, the catheter is removed and surgery can be done to close the left atrial appendage.

Resources

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