Atrial fibrillation is a very common condition which is characterized as an irregular, fast heartbeat that comes from the top of the heart. It can trigger the electricity in the top of the heart go as fast as 400 to 600 beats per minute, but luckily not all of it get to the ventricles. So, if you have just been diagnosed with atrial fibrillation, there are three questions you have to ask yourself and your physician.
- Why Did I Develop Atrial Fibrillation?
The first question patients usually wonder is what caused the condition in the first place. Well, atrial fibrillation is usually triggered by obstructive sleep apnea or long-standing hypertension. As obstructive sleep apnea is also the common cause of hypertension, you should also get a sleep test to get a proper diagnosis. Moreover, atrial fibrillation can also be caused by structural heart problems or hyperthyroidism, which means that you need to check the thyroid-stimulating hormone level and undergo an echocardiogram. In a nutshell, some of the most common causes for the abnormal heart rhythm include is chemic heart disease, pulmonary embolus, anaemia, thyroid disease, sleep apnea, hypertension, advanced age, and rheumatic valvular disease.
- What Can I Do to Relieve the Symptoms?
Patients are usually then interested in learning the possible treatments for the symptoms they experience. However, the condition is different from patient to patient, which means that the treatment also differs and this question is very hard to answer. Therefore, taking an individualized approach is a must. There are atrial fibrillation cases in which the condition comes and goes, other in which it comes and stays, while in others it stays for the rest of their life.
Likewise, it’s important to note that some people have no symptoms at all, while others experience dizziness, heart racing, fatigue, and shortness of breath. There are people who experience some very serious symptoms such as dramatic shortness of breath or passing out. Therefore, your physician will probably guide you towards adopting a simple, step-wise approach to relieve your symptoms. In case that doesn’t work, you might need an intensified therapy. Relieving the symptoms is not an impossible task, but it takes some time and effort. Here are several steps you will probably undertake:
A Heart Rate Control Strategy
First and foremost, your physician will give you medication, such as beta-blockers or non-dihydropyridine calcium channel blockers, to slow the heart rate down. If this works and you feel great, it means that everything is perfect. Many people only require one medication while others need several. However, in case this step doesn’t work and the medications don’t seem to help your symptoms, you will need to undertake the following steps.
Cardioversion
So, if medications don’t work for you, you definitely need a more aggressive therapy, known as cardioversion. This means that you will receive electrical cardioversion or a strong medication (chemical cardioversion) that can put the heart back into normal rhythm. This is a simple procedure even though it sounds a bit scary. Moreover, the procedure comes with very low risk, but you first need to check that you do not have a blood clot in the heart. However, if the atrial fibrillation returns despite the cardioversion, you will need to move to the next step.
Stronger Medications
The third step involves stronger medications, called antiarrhythmic drugs. These drugs work to stabilize the electricity in the atrium. So, they can convert your heart beat to normal and eliminate atrial fibrillation. If you’re wondering why this isn’t the first step in your treatment and you had to go through the first steps, you should know that these drugs come with risks and some possible side-effects. Antiarrhythmic drugs are very complex and aren’t given to everyone as they can actually worsen the condition in some people. If the doctor gives you these drugs and your heartbeat doesn’t become normal, you will have to try cardioversion again. Moreover, if this also doesn’t work, you are usually either prescribed a different antiarrhythmic drug or move to the next step.
Atrial Fibrillation Ablation or AV Node Ablation
The fourth step is also the very last resort and it involves atrial fibrillation ablation, which is a procedure where an electrophysiologist finds the location from where the atrial fibrillation is originating and eliminates it. Even though this isn’t a major surgery, we cannot say it’s a simple procedure. In fact, it is an invasive procedure which lasts several hours and comes with a high risk for complications and no success guarantee.
Nevertheless, some patients aren’t good candidates for this procedure, especially if their heart rate doesn’t slow down with medications. Thus, another procedure, called AV node ablation is performed where the electricity that comes from the top of the heart (atrium) from the bottom (ventricles) is disconnected. However, this procedure usually causes the heart rate in the ventricles to go very slow and thus, a pacemaker must be inserted to keep the heart rate up.
- How Do I Stop Atrial Fibrillation from Causing a Stroke?
The third and last question is about the prevention of a life-threatening condition which can be caused by atrial fibrillation. This is a very important point to consider because the risk of a stroke is high and the consequences can be devastating. The abnormal heart rhythm makes the top chambers quiver and not squeeze enough blood down. Consequently, there is less blood flowing in the top chambers and can result in a blood clot. So, if the clot breaks loose, it can travel to the brain and cause a stroke.
You should check about your risk of stroke with your physician and probably take some blood thinners, such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). Which blood thinner you will take depends on the cause of your atrial fibrillation, as well as, on your kidney function and insurance coverage for the drugs.