Atrial fibrillation – a major health concern for the future

04 October 2019

As our population ages medical experts are predicting one of the major health issues of the future could be atrial fibrillation.

Commonly known as AF, atrial fibrillation occurs when the heart’s upper chambers contract irregularly or, at times, so quickly that the heart muscle cannot perform its task of providing regular contractions – a regular heartbeat.

At Spire Cardiff Hospital Consultant Cardiologist and Heart Rhythm Specialist Dr Peter O’Callaghan, explained that although case numbers were expected to rise, treatments were also improving.

But he stressed that changes in lifestyle continued to be the best way that people could improve their heart health and thus avoid developing the condition.

“Medical advancements mean that more and more people are surviving heart attacks which is something to be applauded.

“However, the down side is that more people are then living with chronic heart conditions so are moving into old age with a much greater risk of developing AF,” Dr O’Callaghan explained.

An increase in obesity, which in turn can lead to diabetes, along with smoking and excessive use of alcohol are all things which can result in heart problems such as AF.

Statistics from the British Heart Foundation show that around 1.3 million people in the UK have been diagnosed with atrial fibrillation.  It is the UK’s most common heart rhythm disorder; affecting up to 15% of people over the age of 80.

 “The most common symptom is palpitations – a change in the regular heartbeat, normally making it beat faster and irregularly. This can be accompanied by shortness of breath, dizziness and chest pains,” says Dr O’Callaghan.

Although AF can be manageable, spotting the symptoms is important as it can also lead to other problems.

People with AF have a greater risk of stroke, but this isn’t applicable to all patients, and it can appear in different ways.

“With our ageing population, the number of people with AF in the UK will substantially increase and as a result so will the risk of stroke, therefore spotting the signs and visiting your GP is of paramount importance.”

Dr O’Callaghan continues, “Some patients can have a ‘silent’ AF, which can be difficult to detect and can increase chances of a stroke risk.  When visiting your local doctors, screenings are available from your GP or practice nurse to detect a silent AF before it has the opportunity to cause a stroke.”

AF can take different forms. Some people suffer self-terminating episodes called paroxysmal AF. Others stay in AF until a procedure such as an electrical intervention (cardioversion) restoring sinus rhythm.

Permanent AF is accepted when the patient and doctor agree to stop trying to restore the heart to its original rhythm.

With so many different varieties of the condition, and with its increase in the ageing population, there are a variety of methods to help diagnose the condition.

When visiting your GP, they will encourage patients with an irregular pulse to undergo an ECG which is the main method of diagnosing AF.

If you have intermittent symptoms a more pro-longed approach will be needed. Monitoring devices will be used, or an injectable loop recorder may be required to confirm the diagnosis.

However, if you are new to AF, blood tests followed by a scan of the heart called an echocardiogram, are the first steps for diagnosis.

Dr O’Callaghan advises, “No matter what age you are, you should never hesitate about getting your health checked. As you get older, your bodies change and if you are having symptoms of AF, there are a range of treatments to help minimise the impact of AF on your health.”

Symptoms can be treated through two strategies: maintaining a sinus rhythm and via rate control.

Maintaining sinus rhythm can be achieved in a number of ways.

A non-surgical approach is through the treatment of drug therapy. Patients on these tablets are regularly monitored through an ECG or an exercise stress test to measure the hearts rhythm.

Other treatments Dr O’Callaghan explains, “can include a direct current cardioversion. This is usually a day-case procedure whereby an external shock is delivered while the patient is anaesthetised using a short acting general anaesthetic.

“Another option is an AF ablation. This option is considered in select patients with highly symptomatic AF who have failed a trial of drug therapy. This is performed in a cardiac catheterisation laboratory and involves isolating the pulmonary veins either by heating or freezing the tissue.”

When focusing on a rate control strategy, this concentrates on the number of times the heart pumps to push blood around the body.

Rate control can be achieved by AV nodal blocking drugs such as beta blockers and calcium channel blockers. 

Highly symptomatic patients who fail medical therapy and who are not suitable for an AF ablation can be considered for a Pace and Ablate strategy.  This involves two day case procedures, the first to implant a permanent pacemaker and the second to ablate the electrical connection between the top and bottom chamber of the heart (AV node ablation).  This ‘Pace and Ablate’ strategy permanently controls the heart rhythm and is normally reserved when other AF treatments have been ineffective.

While it’s important to be aware of the symptoms and treatments, it also essential to note that AF is a chronic condition and most patients can live full and active lives once they have been stabilised on the most appropriate treatment strategy.

Dr O’Callaghan elaborates, “Sometimes finding the optimal treatment is a matter of trial and error with close collaboration between the patient and the treating physician in order to achieve a good outcome.

“Considering lifestyle changes is important. Reducing alcohol consumption, achieving a healthy weight and controlling any risk factors such as hypertension and diabetes, can all help reduce the symptoms and complications associated with AF.  Today AF is common but it can usually be treated or managed satisfactorily either with medications or ablation procedures as appropriate.”

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