You may have been told by your doctor that you have atrial fibrillation or “AF”. AF means that your heart does not beat at a regular rate because there is a problem with its electrical activity – usually causing it to beat too fast. Many people with AF do not experience any symptoms at all, which is why the diagnosis can be quite frightening – after all, no-one wants to hear they have a problem with their heart.
Yes. The reason that AF matters is twofold.
Firstly because of the symptoms it causes. Although many people have no symptoms very many others have problems of tiredness, fatigue, breathlessness and palpitations, and these can be quite disabling.
The second and more important reason that AF matters is that it increases your risk of having a stroke. This is why even if you do not have much in the way of symptoms it is very important that AF is properly diagnosed and treated by an experienced cardiologist.
Because the heart is beating irregularly in AF, this means blood clots can form inside the chambers of the heart. If they get dislodged and sent elsewhere around the body this leads to serious problems. For example, if they travel to the brain they can cause a stroke.
This is why treating AF is so important – it will improve your symptoms but most importantly dramatically reduce your risk of having a stroke.
Not everybody with AF experiences any symptoms at all. In fact many people have no symptoms and are only diagnosed after routine health checks. The main symptoms it can cause include:
In more severe cases it can also cause
AF can be persistent or come and go (“paroxysmal AF”) which means the symptoms too may be constant or come and go with no real pattern.
Atrial fibrillation is very common, and one in four people will develop it at some point in their lives. The main risk factors are:
Atrial fibrillation is not a condition you can diagnose yourself. If you have any of the symptoms I described – extreme tiredness, irregular heartbeat, lightheadedness or palpitations – you should see your doctor without delay.
Your doctor will discuss your symptoms with you before examining you – including checking your pulse, listening to your heart with a stethoscope, performing an ECG (heart tracing) and checking your blood pressure.
Quite often he or she will be able to make a diagnosis right away, but occasionally further tests may be required, such as wearing a heart monitor for a few days (it’s about the size of a cigarette packet). This is a particularly useful test if your AF comes and goes (“paroxysmal AF”)
AF can be very effectively treated by an experienced cardiologist to improve your symptoms and reduce your risk of having a stroke. Treatments include:
Lifestyle factors and managing other conditions
If lifestyle factors could be triggering your AF, then taking steps to address these can be important. This might include stopping smoking, or ensuring you’re getting enough sleep. It’s also vital to ensure any co-existing health conditions that may be contributing to the AF such as diabetes or high blood pressure are being well managed. While these aren’t direct treatments for AF, they can play an important part.
Medicines to “thin” the blood are often given to reduce the risk of stroke as well as medicines to control the rate the heart beats. These medicines are the first treatments your cardiologist will likely offer you.
In patients with AF that does not respond well top medication, electrical cardioversion may be useful. This involves delivering a small electrical shock across the heart, which will often restore the heart to a normal rhythm. This is done via pads on the chest and/or back under a light general anaesthetic. The procedure is very quick and safe and takes a few minutes. However, it isn’t a long-term treatment and most patients will revert to AF once again.
Catheter ablation is a minimally invasive surgical procedure that can vastly improve AF symptoms, sometimes permanently, and is particularly useful for patients with severe symptoms, or when medication alone isn’t effective or suitable.
The procedure involves passing very fine catheters (wires) through a vein at the top of the leg and into the heart. Electrodes at the tip of the wires are then able to measure electrical signals within the heart and identify problematic areas. Radio-frequency waves transmitted via the wires will then be used to administer heat to the target area, stopping it from sending further AF signals to the heart.
Catheter ablation can be performed under local anaesthetic with sedation, or general anaesthetic. It’s very quick and patients can usually go home the same day or the following morning. Success rates generally range from 60-90% depending on the severity of the AF, and some people may require more than one procedure to be performed.
An alternative to radio-frequency ablation is the cryoballoon procedure. The procedure is performed in a similar way to catheter ablation but rather than delivering heat, it involves a technology which uses a ‘freezing balloon’ to prevent the signals that trigger AF from entering the heart.
Some people with AF may eventually opt to have a pacemaker fitted – a small implanted device that regulates the heartbeat.
If you are worried about AF simply ring my secretary on (0203) 303 0325. I can usually see you within a day or two – and often even the same day.