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In the second part of our special focus on atrial fibrillation, Prof Joe Harbison discusses the range of treatment options available for the condition.
As part of our ‘Prevent a Stroke: Feel the Pulse’ campaign, we spoke with Professor Joe Harbison, former National Clinical Lead for Stroke in Ireland, Associate Professor, Professor of Gerontology at Trinity College Dublin, Consultant in Medicine for the Elderly and Stroke Medicine at St James’s Hospital in Dublin and board member of the Irish Heart Foundation, who explained the range of treatment options available for Atrial Fibrillation.
Detect and treat the underlying causes
According to Prof Harbison, if you find you have an irregular heart beat and on examination your heart is otherwise completely normal, then it would be important to determine what was causing the atrial fibrillation and get it treated.
He said there were a number of things that can cause atrial fibrillation in an otherwise normal heart.
These include: an overactive thyroid or other metabolic problems, drinking too much coffee (not a cause but can predispose to it) and other lifestyle factors.
Prof Harbison explained that some people can go into atrial fibrillation if they have a chest infection or pneumonia.
“If they have got a chest infection that is lying in the part of the lung that is right beside the heart that can trigger off an atrial fibrillation. So, the first thing is if you find a cause and treat it,” he said.
"If you find you have an irregular heart beat and on examination your heart is otherwise completely normal, then it would be important to determine what was causing the atrial fibrillation and get it treated,"
If a cause cannot be found or easily treated, or if treating the cause does not get rid of the atrial fibrillation, then doctors can use a technique called cardioversion to knock the heart back into a normal rhythm. This involves giving the heart a small electric shock or using medication to force the heart back into normal rhythm.
If this is unsuccessful then the next step particularly in a younger person or someone with simple atrial fibrillation is to do some electrical work, Prof Harbison explained.
Doctors can use what is known as electrophysiology; the study of the electrical function of the heart, to detect the part in the heart that is causing the atrial fibrillation.
They can then use a procedure called catheter ablation which finds and remove the main cause of the atrial fibrillation.
With catheter ablation, 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. A small circular cryoprobe is inserted along the wall of the artery and this stops any abnormal conduction.
If this is not successful, then people can be put on long-term medication called direct oral anticoagulants which thin the blood to prevent clots forming.
Lastly, Prof Harbison said that in cases where people cannot be put on anticoagulant medications for whatever reason they could undergo a cardiac procedure to have a Watchman device placed into the heart.
"About one in ten people will have extra heart beats and that is often not a problem but if it is A Fib then this would need to be treated,”
He explained that with atrial fibrillation most clots form in a part of the heart called the atrial appendage (a small pouch at the top of the left atrium). The Watchman device blocks off the atrial appendage and stops it releasing clots.
“It is an alternative to anticoagulation rather than something that is better than anticoagulation its most people do absolutely fine with anticoagulation and that is the best thing to do. Watchman devices are for particular circumstances where we cannot use anticoagulation,” Prof Harbison explained.
Check your pulse
In conclusion Prof Harbison said it was important to check your pulse.
“There are plenty benign reasons why our pulse may not feel regular but if you find your pulse isn’t regular then it is very easy to go to your GP or to practice nurse and they can check it to see if that is A Fib. About one in ten people will have extra heart beats and that is often not a problem but if it is A Fib then this would need to be treated,” he said.
The good news is that with early diagnosis, atrial fibrillation is treatable.
For more information see our ‘Prevent a Stroke: Feel the Pulse’ campaign, or call the Irish Heart Foundation’s Heart and Stroke Helpline, Freephone 1800 25 25 50. This campaign is supported by Pfizer and Bristol-Myers Squibb.
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