Atrial Fibrillation

What is Atrial Fibrillation?

Atrial fibrillation (AF) is the commonest sustained abnormal heart rhythm. The risk of developing AF rises as we get older. Making a diagnosis of atrial fibrillation is important one as the presence of AF can increase your risk of stroke therefore it is important that you are assessed thoroughly by an expert cardiologist who manages atrial fibrillation (an electrophysiologist). Patients who have atrial fibrillation frequently have a fast irregular heartbeat.  There are several patterns of atrial fibrillation.  Some patients experience paroxysmal (intermittent) atrial fibrillation.

This means that the heart rhythm comes and goes from a normal rhythm to atrial fibrillation.  Patients can often experience symptoms as their heart goes in and out of atrial fibrillation.  Atrial fibrillation can also be persistent or permanent ie; the heart is in atrial fibrillation all of the time.

What are the typical symptoms?

The typical symptoms  that patients experience with atrial fibrillation are breathlessness, palpitations, chest pain, fatigue, dizzy spells, reduced exercise capacity, light headedness and excessive sweating.

Some patients however have very few symptoms.  In these patients often the AF is an incidental finding at a routine health screen or a preoperative ECG assessment.  Nevertheless even in the absence of symptoms it is important the patient is investigated to ensure they don’t have any obvious triggers for their atrial fibrillation.  These triggers can include uncontrolled high blood pressure, an overactive thyroid gland-thyrotoxicosis, an abnormal heart valve (either narrowed or too leaky) or an abnormality of the heart muscle itself (a cardiomyopathy). 

What are the types of AF?

Generally speaking AF falls into three categories although the naming of atrial fibrillation and categorisation of it is not perfect. 

Essentially intermittent AF is not present all of time and usually self-limiting.  The heart corrects itself from AF to normal sinus rhythm without intervention by a medical team.  During episodes of atrial fibrillation patients can experience typical symptoms previously discussed.  Typically attacks of paroxysmal AF last less than 48 hours.

Example of a recording of normal heart rhythm from an ambulatory heart monitor. The patient suddenly develops atrial fibrillation (AF). The first three beats on the top trace are normal then rapidly degenerate into AF. This monitor allowed us to make a diagnosis of AF and start the correct treatment for the patient:

This is when atrial fibrillation lasts longer and is more protracted often lasting more than 7 days.  Patients don’t normally go back on their own to normal sinus rhythm and usually require some form of intervention to restore the heart back to normal.  These interventions include cardioversion, (either electrical or chemical with drug therapy) or an AF ablation (a pulmonary vein isolation).

This is when atrial fibrillation is present continuously and either a decision has been made to not attempt to get the patient back into normal rhythm or an attempt has been made and has failed.  Patients who have permanent atrial fibrillation have generally had the rhythm problem for more than 1-2 years and the best way of managing their atrial fibrillation is to control the heart rate and if appropriate treat them with anticoagulant drugs.   

What are the Procedures?

These are the procedures associated with Atrial Fibrillation

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