07 August 2019
Consultant Cardiologist and Electrophysiologist Dr Riyaz Somani answers questions he is frequently asked about atrial fibrillation.
What is atrial fibrillation?
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 symptoms such as palpitations, dizziness, breathlessness and fatigue. Symptoms for some can be highly intrusive and impact on quality of life, whereas for others AF does not cause any symptoms at all and the diagnosis is only made after routine health checks, or tests carried out for other reasons. AF is a major risk factor for stroke, so getting it properly diagnosed and treated is very important.
What causes atrial fibrillation?
AF is very common, and one in four people will develop it at some point. An estimated 1.5 million people across the UK and over 16 million people worldwide are affected. Although it is not always clear why some people develop AF, there are a number of recognised risk factors. The biggest factor is age with the majority of people diagnosed with AF being over 65 (although younger people can develop it too). A family history of AF is also being increasingly recognised as a risk factor, as well as those with certain pre-existing conditions, such as high blood pressure, diabetes, an overactive thyroid, obstructive sleep apnoea and other heart conditions. Lifestyle factors, such as being overweight, smoking and drinking too much alcohol also increase the risk of developing AF. AF can occur as brief episodes (paroxysmal AF) or be constant (persistent AF) and it is possible for paroxysmal AF to progress into persistent AF over time.
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 AF, the electrical system in the heart’s upper left chamber (left atrium) becomes disrupted leading to an erratic heart rhythm which in-turn can lead to blood pooling in the upper chambers of the heart and increasing the risk of stroke.
How is atrial fibrillation diagnosed?
Diagnosing AF can be straightforward and may be detected by the presence of an irregular pulse (although not always, if the AF is episodic). Your doctor will start by talking through symptoms and your general health before recommending tests to confirm the diagnosis. Further tests are individualised but may include:
- Blood tests – to exclude reversible causes.
- Electrocardiogram (ECG) – an electrical trace of the heart.
- Echocardiogram - an ultrasound scan of the heart.
- A heart monitor (for between 24-hours and up to 2 weeks) to wear at home.
How is atrial fibrillation treated?
AF is a major risk factor for stroke. Every 15 seconds, someone suffers an AF-related stroke, and these are often debilitating with higher mortality rates. The good news is AF-related strokes are largely preventable if AF is diagnosed and the risk is appropriately assessed and addressed. The risk is assessed on an individual basis with effective treatments (anticoagulants or ‘blood thinners’) available. Additional treatments are also available to help treat the symptoms associated with AF, with medication usually used as the first-line option.
Other treatment options for atrial fibrillation:
Lifestyle factors and managing other conditions
Addressing lifestyle factors can be very important in controlling AF. This might include weight loss, stopping smoking or reducing alcohol intake for some. Treatment for co-existing conditions such as high blood pressure, diabetes and obstructive sleep apnoea can also help to reduce the overall burden of AF.
In patients with persistent AF, an electrical cardioversion may be useful. This involves delivering a small electrical shock through the heart, with a view to stunning the heart back into a normal rhythm. This is done using pads applied to the chest under a light general anaesthetic. The procedure is very quick and safe and takes a few minutes. However, it is unlikely be a long-term treatment and most patients will revert to AF eventually.
Pulmonary vein isolation - radiofrequency ablation/cryoablation
An ablation procedure is a minimally invasive surgical procedure that can vastly improve AF symptoms and is particularly useful for patients with severe symptoms, or when medication alone is not controlling matters.
The procedure involves passing very fine catheters (wires) through a vein at the top of the leg into the heart. Electrodes at the tip of the wires can be used to measure electrical signals within the heart and identify problematic areas. Radiofrequency ablation (heat) or cryoablation (freezing) can then be used to target these triggers for AF, preventing them from entering the heart. Catheter ablation can be performed under local anaesthetic with sedation, or general anaesthetic. Success rates generally range from 60-70% depending on the severity of the AF, and some people may require more than one procedure.
Some people with AF may eventually benefit from having a pacemaker fitted to regulate the heartbeat.
Dr Riyaz Somani is a leading Cardiologist and Electrophysiologist with a specialist interest in heart rhythm disorders, including atrial fibrillation. He has a regular clinic at Spire Leicester Hospital.
To book an appointment with Dr Somanai, call 0116 265 3685.