About Atrial Fibrillation
Atrial fibrillation is a condition characterized by an irregular and rapid beating of the heart's atrial chambers and results when the normal electrical conduction system of the atria is not functioning properly. In atrial fibrillation, there is a storm of electrical activity across both atria causing them to fibrillate (quiver) 300-600 times per minute.
It has been estimated that atrial fibrillation occurs in about 4% of the general adult population and affects approximately 2.2 million people in the United States. About 160,000 new cases of atrial fibrillation are diagnosed each year. Atrial fibrillation occurs about 1.5 times more frequently in males than in females. It is estimated that atrial fibrillation is responsible for over 60,000 strokes each year in the United States.
Atrial fibrillation is recognized as an independent risk factor for stroke and patients with atrial fibrillation are about 5-times more likely to suffer a stroke than people without atrial fibrillation. Other factors that increase the risk of stroke in people with atrial fibrillation include:
- History of previous stroke or "mini-strokes" known as transient ischemic attacks (TIAs)
- Hypertension (high blood pressure)
- Congestive heart failure
- Advancing age (particularly age 75 or older)
- Coronary artery disease
- Diabetes
Some patients with atrial fibrillation may have minimal or no symptoms, whereas others may have severe symptoms especially at the onset of the arrhythmia. At onset, patients may complain of symptoms such as palpitations, shortness of breath, cough, dizziness, fainting, and angina, but as the condition persists, the patient may complain of fatigue, shortness of breath and may show signs of pulmonary edema (fluid in the lungs).
The initial diagnostic evaluation of atrial fibrillation focuses on a careful patient history, physical examination, and specific diagnostic studies such as an electrocardiogram, 24-hour Holter monitor, and transesophageal echocardiography (TEE).
The overall focus of care for patients with atrial fibrillation is the prevention of complications and maintenance of functional ability and quality of life which can be accomplished by achieving the following goals:
- Treating any underlying disorders that may be causing atrial fibrillation
- Restoring the heart back to normal sinus rhythm
- Controlling the ventricular heart rate
- Preventing blood clot formation and stroke
The choice of therapy for patients with atrial fibrillation depends on the individual situation and is based on the degree of disability and symptoms as well as the person's ability to tolerate the various treatments and medications.
Atrial fibrillation can either be managed with rate control or rhythm control. Rate control allows the patient to remain in atrial fibrillation, but controls the heart rate by slowing conduction at the AV node with various medications. The heart rate is considered to be controlled when it is between 60-80 beats per minute at rest and between 90-115 beats per minute during moderate exercise. Rhythm control allows for conversion back to normal rhythm either with medications or by delivering a direct current electrical shock to the heart (electrical cardioversion).
In the event that medications alone are not effective for controlling atrial fibrillation, other treatment options that may be considered include radiofrequency catheter ablation or a type of surgery known as a Maze procedure. The goal of these treatments is to destroy the specific areas of the heart that are the origin of the abnormal elecrical impulses that trigger atrial fibrillation. Select patients may also require an artificial pacemaker or an implantable cardioverter-defibrillator.
A main objective in the management of patients with atrial fibrillation is the prevention of blood clots that can lead to stroke. Studies have established that anticoagulation therapy reduces the risk of stroke in patients with atrial fibrillation. Anticoagulants are "blood thinning" medications that are used to prevent the formation of blood clots that can cause a stroke. Numerous options are available for anticoagulation therapy. In recent years, several newer anticoagulant drugs have been approved for patients with atrial fibrillation. The choice of which agent to use depends on a variety of factors, and it is not uncommon to start patients with one drug and, if necessary, to switch to another.
Symptoms associated with atrial fibrillation such as palpitations, shortness of breath, chest pain, dizziness can be a source of fear and anxiety for patients and also interfere with activities of daily living and overall quality of life. Impairment of quality of life, in turn, can lead to physical and emotional disturbances and can also negatively impact the patient's social well-being. It is, therefore, important for patients and their healthcare providers to aggressively manage atrial fibrillation and bring it under control to the greatest extent possible. Patients who develop anxiety disorder and/or panic attacks associated with atrial fibrillation should be referred to a mental health professional for treatment of the psychiatric disorder.
The Medifocus Guidebook on Atrial Fibrillation is a unique, comprehensive patient education resource that contains vital information about Atrial Fibrillation that you won't find anywhere else in a single resource. The Guidebook will answer many of your questions about this condition that your healthcare provider may not have the time to answer. To learn more about the Guidebook, please click here
