The Most Popular Rhythm: Atrial Fibrillation

Atrial Fibrillation is the most common, sustained cardiac rhythm disorder. The incidence and prevalence of atrial fibrillation increases with age. Upward of 3 million people have atrial fibrillation. It is characterized by a rapid and irregular heartbeat that can be symptomatic with palpitations, dizziness, shortness of breath, fatigue, exercise limitation or chest discomfort. In other patients, atrial fibrillation is asymptomatic. Patients are unaware that they have the disorder and it is diagnosed via electrocardiogram (ECG) during routine clinic visits.

By Rupa Bala, MD

Risk Factors associated with the development of atrial fibrillation:

  • Advanced age
  • High blood pressure
  • Diabetes
  • Chronic kidney disease
  • Heart disease: abnormal heart valves, coronary artery disease, heart failure
  • Sleep apnea
  • Chronic lung disease
  • Abnormal thyroid gland
  • Obesity
  • Alcohol/excessive alcohol

Talk with your primary care physician about ordering these tests to help diagnose atrial fibrillation and direct therapy:

  • Electrocardiogram (ECG): analyze your heart rhythm
  • Teaching you how to take your pulse and assess a regular vs. irregular rhythm
  • 30-day event monitor (mobile cardiac outpatient telemetry - MCOT): worn for 30 days, it has the ability to detect symptomatic and asymptomatic rhythms; an auto-trigger function automatically stores and alerts your physician to abnormal heart rhythms. It also has a patient triggered button that allows you to alert your physician as to what symptoms you are experiencing and how they correlate to your heart rhythm
  • Sleep study to diagnose sleep apnea; there is a known association and link between sleep apnea and atrial fibrillation. If you have the following symptoms, you should be screened for sleep apnea:
    • Loud snoring
    • Episodes in which you stop breathing during sleep
    • Excessive daytime sleepiness
    • Frequent nodding off during the day
    • Morning headaches
    • Irritability
    • Difficulty staying asleep
  • Echocardiogram: to assess the pumping function of your heart, check your heart valves, look for any abnormal problems

Types of Atrial Fibrillation:

Atrial fibrillation is a progressive disorder. Once diagnosed, it is often here to stay. There is an old saying that atrial fibrillation begets atrial fibrillation and it holds true. There are different phases of atrial fibrillation:

  • Paroxysmal AFib: rhythm comes and goes on its own. Can last seconds, minutes or hours. This often is the most symptomatic phase for patients.
  • Persistent AFib: may occur occasionally or continuously for more than seven days and requires medications or an electrical shock (cardioversion) to restore a normal rhythm.
  • Permanent AFib: long standing atrial fibrillation that has been present for many years; often resistant to medications or other attempts to restore a normal rhythm.

Prevention: What can you do to help prevent/reduce episodes of atrial fibrillation?   

  • Eating a heart-healthy diet (Read - “One-Page Guide to a Heart-Healthy Diet.”)
  • Avoid Smoking
  • Avoid excessive drinking and caffeine use
  • Exercise – minimum of three times a week for 30 minutes
  • Maintain a healthy weight
  • Reduce stress

Therapy and Treatment (Medications and Anticoagulation):

The next step is therapy and treatment. Your primary care physician will refer you to a general cardiologist or an electrophysiologist (specialist in heart rhythm disorders) to help manage your atrial fibrillation. One of the main questions that will help your physicians’ direct therapy is whether you are symptomatic from atrial fibrillation. There are two main treatment strategies for atrial fibrillation treatment:

  • Rate Control: Using medications such as beta-blockers (metoprolol) or calcium channel blockers (Cardizem) to help control the heart rate during atrial fibrillation.
  • Rhythm Control: Using special medications called antiarrhythmic medications to help restore and maintain a normal heart rhythm. Examples of these types of medications include flecainide, sotalol, rythmol, amiodarone, tikosyn. Once medications fail or if side effects develop, the next strategy is cardiac ablation.

Your physician will also discuss your risk of stroke with atrial fibrillation and whether you should be taking blood thinners, Coumadin (warfarin) or one of the newer anticoagulants, for stroke prevention.

The most effective treatment and management of atrial fibrillation involves everyone: the patient, their families, your primary care physician, general cardiologist and electrophysiologist. It takes a village to achieve the best care possible.

Dr. Rupa Bala, Cardiac Electrophysiologist, UA Sarver Heart Center Dr. Rupa Bala, cardiac electrophysiologist] Dr. Rupa Bala, board certified in clinical cardiac electrophysiology and cardiovascular disease, specializes in the management of complex arrhythmias, including atrial fibrillation, ventricular tachycardia and premature ventricular contractions. She is an associate professor in the University of Arizona College of Medicine - Tucson Division of Cardiology and director of the Cardiac Electrophysiology Laboratory.

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