Atrial fibrillation is an irregular rhythm from the upper part of the heart. It is the most common cardiac arrhythmia. Incidence increases with advancing age, with 1 out of 5 over the age 85 having it. It appears this originates due to spontaneous discharges from pacemaker cells in the pulmonary veins at the point where they join the left atrium.
What causes this?
Many causes. The most common used to be valvular heart disease years ago (rheumatic valvular disease). Now many causes including age, cardiomyopathy, inflammation of the pericardium, alcohol, drugs etc
What are the common symptoms?
Some patients are asymptomatic. Some feel the effects of rapid heart beat (palpitations, dizziness, chest discomfort), some feel effects because of irregular rhythm and variable cardiac output (shortness of breath).
Are these the main concerns?
No. The biggest issue is that this predisposes to clot formation in the left atrial appendage and risk of stroke. Because of this concern, most patients need to be on anticoagulants (blood thinners).
Is that coumadin?
This used to be the only agent available. This works indirectly through the liver on production of clotting factors, and has to be monitored, diet controlled and interacts with other medications. Now there are four agents that work directly blocking clotting factors and are easier to take and manage. These are Pradaxa, Xarelto, Eliquis and Sayvesa.
What about the risk of bleeding?
That’s a big concern. Doctors have to weigh that risk, too. In patients with a high risk of bleeding, doctors can go in from the groin and close the left atrial appendage. (WATCHMAN device)
What about ablation?
This is a procedure where an electrophysiologist goes in and ablates (superficial burn) the area near the pulmonary vein. This is especially indicated in patients who can’t tolerate medications to slow the heart rate or control the atrial fibrillation because of side effects, or in patients with congestive heart failure.
Can medications keep one in regular rhythm?
Yes, some medications can be tried and often work. But, doctors have to balance the risk of side effects with the benefit of restoring sinus rhythm.