Atrial fibrillation (AF) is a form of arrhythmia or heart rhythm disorder characterised by an irregular heartbeat. It occurs due to problems with the heart’s electrical activity and can cause mild to severe symptoms, such as palpitations, dizziness, breathlessness and fatigue – although many people experience no symptoms at all. Atrial fibrillation is also a major risk factor for stroke, so getting it properly diagnosed and treated is very important.
Concerned you may have AF, or want to find out more about AF treatments? Leading London cardiologist Dr Syed Ahsan treats patients with a wide range of heart-related symptoms and conditions, including atrial fibrillation, and is a catheter ablation specialist: Get in touch via our online booking form to book a consultation or give us a call on 0203 303 0325.
Not everybody with AF experiences noticeable symptoms. In fact, a significant number of people are only diagnosed after routine health checks, or tests carried out for other reasons.
For some, however, atrial fibrillation can be very unpleasant and debilitating and have a big impact on quality of life, causing symptoms such as palpitations and an erratic, irregular pulse, dizziness and feeling lightheaded, breathlessness and fatigue. In fact, fatigue – or extreme, unusual tiredness – is one of the most widely reported symptoms for people with AF. Symptoms may be constant or occur in episodes.
Atrial fibrillation is very common, and one in four people will develop it at some point. An estimated 1.5 million across the UK and in excess of 16 million worldwide are effected.
While it’s not always clear why some people develop atrial fibrillation, there are a number of risk factors. The biggest is age – the vast majority of people diagnosed with AF are 65 and over – although younger people can develop it too. People with a family history of AF may also be more likely to develop it, as well as those with certain pre-existing conditions, such as high blood pressure, diabetes, overactive thyroid and other heart conditions. Lifestyle factors, such as being overweight, smoking and drinking too much alcohol can also increase the risk of AF.
AF occurs due to problems with the heart’s electrical conduction system, which regulates the heartbeat and keeps the heart functioning normally. In people with atrial fibrillation, the electrical system in the heart’s upper left chamber – the part of the heart that receives oxygen-rich blood from the lungs – becomes disrupted. In a healthy heart, the upper chamber efficiently pumps this oxygen-rich blood into the lower chambers, which then pump it into the arteries to be carried around the body. But when atrial fibrillation occurs and the system becomes erratic, blood can pool in the upper chambers instead.
AF can occur in brief bouts or episodes (paroxysmal AF), while for others it can be constant (persistent AF). Paroxysmal AF may develop into persistent AF over time. You can read more about the condition in our blog: 9 things everybody should know about atrial fibrillation.
Anybody experiencing an irregular heartbeat, or symptoms that may indicate a heart problem, should see a doctor and get things checked – whatever your age and fitness levels.
Diagnosing atrial fibrillation is relatively straightforward. It’s sometimes possible to feel that your pulse is erratic (although not always, if the AF is episodic), and your doctor will start by talking to you about your symptoms and general health. You will then probably be referred for an electrocardiogram (ECG), which records the electrical activity of the heart. Some people may need to wear a small heart-monitor for a few days or up to a week, to monitor their heart rate over a period of time. This can be useful if a standard ECG failed to detect any abnormalities, or if symptoms are occurring in brief bouts at various times of the day or night.
You may also be sent for other tests, such as blood tests and an echocardiogram (an ultrasound scan of the heart), to check for other conditions that may be linked with the AF or causing the symptoms.
Not everybody with AF will experience serious complications. However, atrial fibrillation is a major risk factor in stroke – as when blood pools in the heart, it’s easier for clots to develop. Every 15 seconds, someone suffers an AF-related stroke, and these tend to be debilitating with higher mortality rates.
The good news is, AF-related strokes are largely preventable if the AF is adequately managed and treated. Your consultant will be able to assess your risk of suffering a stroke and whether preventative treatment is required. There are also very effective treatments available to help manage symptoms of AF.
These are the key treatment options for atrial fibrillation:
Medications are available to specifically reduce the risk of stroke (blood thinners), as well as certain medications to help control the AF. Drugs are usually a first line of treatment for AF. If you experience any side-effects, it’s important to discuss these with your doctor before stopping any treatment.
In patients with persistent AF, an 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 eventually.
A 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. Our ‘What is catheter ablation?’ information video explains more.
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.
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.