Atrial Fibrillation

Atrial fibrillation, also known as AF or AFib, is the most common type of arrhythmia. Atrial fibrillation occurs when the heart quivers in a rapid and irregular rate and fails to beat effectively to promote normal blood flow into the ventricles. Patients with atrial fibrillation face an elevated risk of stroke as the blood clots formed in the heart could travel to the brain and cause blockages.

A healthy heart beats in a regular pattern which allows blood to flow quickly and smoothly around the body; but for patients with atrial fibrillation, their heart fails to contract normally, which causes blood to pool in the atria and form into clots. Blood tends to be collected in the left atrial appendage, an ear-shaped sac in the muscle wall of the left atrium, as it has a very uneven surface which is made up of raised pectinate muscles. If the blood clots are pumped out of the heart, there is a risk that they can travel in the bloodstream and block one of the arteries leading to the brain.

The risk of atrial fibrillation increases with age. The “three hypers”, which refers to hypertension (high blood pressure), hyperglycaemia (high blood glucose level), and hyperlipidaemia (high blood lipid level), also put patients at higher risk for atrial fibrillation. Some patients have no symptoms, but others may experience palpitation, tightness in the chest, dizziness, and shortness of breath. If symptoms of stroke are developed, it is very likely the situation has already reached a life-threatening stage.

Atrial fibrillation can be mainly divided into 3 types – paroxysmal, persistent, and long-term persistent. Holter monitor, which is a small portable device that keeps tracks of one’s heart activity, can be used to diagnose atrial fibrillation. However, for patients suspected of having paroxysmal atrial fibrillation, this device may not be able to make correct diagnosis. In this case, implantable cardiac monitor might be needed for long-term management.

Medication Treatments

Anticoagulants, also known as blood thinners, are commonly used to treat atrial fibrillation. One of the traditionally prescribed oral anticoagulants is warfarin. However, this kind of medication may cause side effects, including bleeding and interaction with certain food and medicines. The new generation anticoagulants overcome some of the difficulties seen with the traditional drug by directly targeting the coagulation factors. Yet, the new medication is still not suitable for patients with poor kidney and liver function or with high bleeding risk.

Surgery and Other Procedures

Left atrial appendage occlusion (LAAO), a minimally invasive procedure, is an alternative solution to oral medication treatment. During the operation, a catheter is delivered to the heart through a vein in the leg. Once the catheter reaches the left atrial appendage, it will open up like an umbrella and closes off the opening, preventing clots from travelling from the left atrial appendage. Compared with the traditional open-heart surgery, left atrial appendage occlusion is much less invasive. Patients can get out of bed on the same day of the surgery and are allowed to return home after two to three days.

Virtus Cardiology Specialists