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Atrial Fibrillation

January 2012

Atrial fibrillationEach year in the UK more than 46,000 people are diagnosed with atrial fibrillation. It's slightly more common in men than women and is more likely to develop as people get older (the risk doubles with each decade after the age of 50).

The fact that our heart is continually beating to keep us alive is something many of us don’t really like to think about, as the fear of it going wrong is just so frightening. The heart relies on electrical impulses which travel to the heart muscle to trigger it to contract or beat. If something interferes with the transmission of these electrical impulses, then the beat of the heart can vary. It can go faster, or beat in an irregular fashion, and this is called fibrillation.

Generally, it is the atria, the upper chambers of the heart, which go into fibrillation. This can cause a blood clot to form in the chamber, and if the clot or parts of the clot and travel into the brain, this can cause a stroke. A person suffering from atrial fibrillation is six times more likely to have a stroke than if they have normal heart rhythm.

If the large chambers of the heart rather than the atria go into fibrillation, then this can be fatal because it interferes with their pumping action and the brain can be starved of oxygen quite quickly.

Atrial fibrillation seems to develop when tiny waves of electrical current start travelling randomly around the atria. There are a number of conditions which can contribute to this happening. Most cardiovascular problems such as high blood pressure and coronary artery disease can lead to fibrillation, and other problems such as an overactive thyroid gland, diabetes, excess alcohol, low potassium and even hypothermia can all bring on fibrillation. But in many cases the original cause is not fully understood.

The main symptoms are often described as “palpitations of the heart”. The heart suddenly feels it is racing, and there can be a thumping sensation in the chest. There can also be symptoms of feeling faint or being a bit light-headed. Other indications can be swollen ankles or shortness of breath.

If you have any of these indications and consult a doctor, you may be advised to have an ECG test (electrocardiogram). This will show any irregular electrical pattern from the heart. Sometimes a chest x-ray is also recommended.

If you are diagnosed with atrial fibrillation, then the key is to restore a regular heart rhythm and there are a number of ways this can be achieved. Often, to begin with, an electrocardio diversion may be used to try and shock the heart back into its normal rhythm; this is especially effective if the fibrillation has only been going on for a short time. Sometimes medicines are also used to try and encourage the heart to switch back to a regular rhythm. It is important to seek help quickly if you think you have a problem, because if the fibrillation goes on for any length of time, then the heart becomes adapted to the new rhythm or lack of rhythm and it can be more difficult to restore it to normal.

Treatment is also usually geared at preventing clots forming and causing strokes, and this is usually done through blood-thinning medications.

If the fibrillation doesn’t respond to initial treatment, then techniques to destroy the abnormal electrical pathways are sometimes used. This is usually done through a system called radiofrequency catheter ablation but it only works in just over half of patients. Other treatments can include surgery and sometimes pacemakers are used to control the atria.

Pacemakers are today a common treatment for arrhythmia - a change in the normal sequence of electrical impulses that cause the heart to beat and this can be too fast, too slow or erratically. Atrial fibrillation is one of many forms of arrhythmia and pacemakers can be useful. New techniques are also coming into use now and the prognosis for people with severe atrial fibrillation is improving all the time. The key, as with so many conditions, is time. If you feel you have a problem with the rhythm of the beating of your heart, see your doctor without delay.

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