ATRIAL FIBRILLATION: AN IRREGULAR IRREGULARITY

Learn how modern therapy can substantially reduce the risk of atrial fibrillation.

Atrial fibrillation (AF) is a common medical condition that arises from a problem within the electrical system of the heart. Although it is widespread – 30 million sufferers worldwide – one of its peculiarities is that many sufferers are not aware they have it and it is discovered after a collapse or as an ‘incidental finding’, for example, when a patient’s pulse is being monitored in association with surgery or other medical procedure.

The heart is still pumping, so what is the problem? AF’S Danger - Stroke

AF can be:

• overt or symptomatic (symptoms are experienced) or

• silent or asymptomatic (symptoms are not felt)

Thus, it puts people at higher risk of stroke caused by a blood clot moving from the heart to the brain. This neurological problem can result in:

• localised weakness

• difficulty with speech

• difficulty with vision or

• lead to death.

One-quarter to one-third of strokes are due to clots formed in the heart in someone with AF. The clot breaks off and causes a blockage in the blood flow to the brain.

This risk can be substantially reduced with modern therapy. To receive this benefit, people need to know that they have AF and then what they should do. AF requires a team effort involving the people who suffer from AF and their

families, their doctors and other health professionals. There can be a number of options for treatment and people need to work with their doctors to agree on what is best for them. As a doctor, my aim is to minimise the symptoms as safely as possible and to maximise the prognosis. I want my patients to ‘live as well as possible, for as long as possible’.

Remainder-of- life management

Once AF has been diagnosed using an electrocardiogram (ECG), there are three foci for AF management:

1. Heart rate

Because of the chaotic beat within the atria, the heart is racing, sometimes over 200 beats per minute. At an elevated rate, the heart does not work properly so the rate needs to be slowed using drugs such as beta-blockers, digoxin, calcium channel blockers and amiodarone.

2. Risk of stroke

When the atria are not contracting properly, the blood can pool and a clot can form, break off and make its way to the brain where it lodges, causing a stroke.

To lower this risk, the blood needs to be ‘thinned’ by using warfarin or novel (nonvitamin K) oral anticoagulants (NOACs) such as apixaban, dabigatran and rivaroxaban.

3. Normal sinus rhythm

Should the patient be returned to normal (sinus) rhythm, a person has symptomatic benefits, i.e. the person feels better. However, surprisingly it does not reduce the risk of an adverse event, such as stroke, in the long term.