An arrhythmia is an abnormal heart beat which is continuously irregular with no pattern to it at all.
It can affect adults of any age but is more common as you get older. 1 in 4 people over the age of 50 are at risk of developing atrial fibrillation. It occurs more frequently in those with underlying heart disease.
With atrial fibrillation your heart beats in a disorganised and irregular way which can lead to a range of symptoms and potential complications. While it is not immediately life-threatening in the same way as some arrhythmias, it can lead to heart failure or stroke and so it has potentially serious effects.
During atrial fibrillation, the normal regular rhythmic activity of the upper chambers or atria is replaced by chaotic irregular activity. This leads to an irregular and usually fast pulse rate which may cause palpitations and congestion of the lungs.
Also, because the upper chambers no longer contract and relax in the normal way, there may be pooling of the blood which can lead to blood clot formation. If a piece breaks off, it can travel in the blood stream and block a small artery somewhere downstream.
The most serious situation is when a clot lodges in an artery in the brain as this can cause a stroke.
Or it may only be diagnosed when they present with complications. Other people feel their irregular heartbeat straight away through a range of symptoms such as:
There are three types of atrial fibrillation:
1. Paroxysmal atrial fibrillation
These episodes usually last a few minutes to hours or days. The episodes come and go on their own, and do not usually last longer than one week. If you have symptoms they may also come and go.
2. Persistent atrial fibrillation
These episodes last longer than one week and do not go away on their own. You will need medical treatment to bring back your normal regular rhythm.
3. Permanent atrial fibrillation
Your irregular heartbeat does not return to normal rhythm and medical treatment cannot return the heart to normal rhythm. You may require medications to control the heart rate.
It is important for you to know which type of atrial fibrillation you have so that you can understand your condition and learn how to manage it. However, the type of atrial fibrillation you have is not fixed. If you have paroxysmal or persistent atrial fibrillation this can become a permanent type over time.
These include high blood pressure, diabetes and heart disease. However, in many patients no underlying cause is found.
The risk factors that mean you are more likely to develop atrial fibrillation include:
* Alcohol abuse, such as drinking large amounts of alcohol over a long time, is a major factor in people developing atrial fibrillation. Even young people can get atrial fibrillation after binge-drinking occasions.
By knowing about the possible complications and working closely with your doctor, you can find out how to lower your chances of them happening to you.
There are some changes you can make to your lifestyle that may help you with your atrial fibrillation:
It is important to talk to your doctor if you have symptoms of atrial fibrillation.
In addition to a careful history and clinical exam, patients will usually have an ECG and ultrasound examination (echocardiogram) of the heart. Sometimes a coronary angiogram will be considered if there are symptoms suggesting angina or associated breathlessness. You may need other tests to help dignose your AF, which include: 24 hour ECG recording (Hotler Monitor), exercise ECG, cardiac event recorder or EP study.
The first step when someone develops atrial fibrillation or AFib is to look for any underlying cause or precipitating factors. The history may reveal a background of high blood pressure, heart valve disease or coronary artery disease.
Alcohol plays an important role in precipitating atrial fibrillation in many patients. An overactive thyroid gland is another potential cause which must be considered.
Often, a chest infection causing irritation around the heart may precipitate atrial fibrillation or certain operations, especially those involving the chest cage.
Other tests, including a blood pressure check and blood tests to measure how well your kidneys and thyroid gland are working, are usually carried out as well.
For more on regular pulse checks see here.
There are several medicines and non-medical options available to help you manage atrial fibrillation. Treatment is depending on the type and how long you have had it; how troublesome your symptoms are; and whether there is an underlying cause.
The mainstays of treatment are heart rate and rhythm control medication and some form of medication to minimise blood clot formation.
There are a number of different medications available some of which prevent the pulse rate from going too fast and others which have a direct action on the rhythm itself.
Other medications reduce the risk of blood clot formation and are known as blood thinners or anticoagulants. As with all medications there are potential side-effects and so the risks and benefits must be weighed up carefully before deciding what tablets are started.
There are also several other treatments that may be required to restore your normal regular rhythm including:
Cardioversion is a procedure where an electrical shock is delivered through special paddles applied to the chest wall. Sometimes, even though the regular rhythm is restored, the atrial fibrillation may come back, so continued follow-up with or without medication is usually required.
Ablation is a procedure that tries to find and remove the main cause of your atrial fibrillation. Narrow, flexible wires, are inserted into a blood vessel, often at the top of your leg or your neck and threaded up to your heart.
High frequency energy is sent through the wire to heat up and destroy an area of tissue that is causing the arrhythmia or irregular heart beat. The most common form of ablation is pulmonary vein isolation.
A pacemaker is a small device that is put in your chest to help control abnormal heart rhythms. A pacemaker uses electrical pulses to prompt your heart to beat at a normal rate if it is going too slowly. A biventricular pacemaker can help the pumping function of your heart at particular times.
Implantable Cardiovertor Defibrillator or ICD
If you have heart failure or other heart rhythm problems as well as AF, your doctor may give you a special sort of pacemaker called an ICD. This device will monitor your heart and give your heart a small electrical shock to stop rhythm disturbances.