Atrial fibrillation: Triggers, symptoms and treatment

Atrial fibrillation, sometimes referred to as AFib, has a range of associated symptoms, including palpitations, breathlessness and fatigue. To learn more about the heart condition, we invited revered consultant cardiologist and electrophysiologist Dr Senthil Kirubakaran to share his expert insight on which factors may trigger atrial fibrillation, as well as the key aspects involved in treatment.

What is atrial fibrillation?

Atrial fibrillation is a specific rhythm of the heart, characterised by the top chamber or the atria, beating very irregularly and chaotically.

The normal rhythm of the heart relies on the top chamber of the heart beating in a coordinated way and this usually pumps blood into the main pump of the heart. When the top chamber of the heart becomes very irregular, not only does it lose its contractility but also results in the heart beating quite fast and irregularly - this is atrial fibrillation.
 

Is atrial fibrillation a serious condition?

In some patients, atrial fibrillation can be associated with serious consequences and there are two areas in particular which need to be addressed.

One such key area is the risk of strokes. When the top chamber of the heart doesn't beat properly, it can encourage blood clots to form within it. These blood clots can then embolise to other areas of the body and can cause problems to other organs, in particular the brain where there is an elevated stroke risk in some patients.

The second important area to address relates to heart muscle weakness. When the heart beats quite fast and irregularly, if left untreated, this can result in the muscle of the heart becoming quite weak. This can cause ventricular dysfunction or heart failure in the future.

What are the symptoms of atrial fibrillation?

The symptoms of atrial fibrillation are quite varied and depend on the type of atrial fibrillation the individual has.

The first type is termed paroxysmal atrial fibrillation, where patients are not in the rhythm disturbance all of the time, but rather it comes and goes. These patients typically describe a sudden change in their heartbeat from beating normally to beating very fast and irregularly. This causes symptoms of palpitations which is an awareness of the heart beating fast and irregularly.

The second type of atrial fibrillation is where the rhythm is irregular all the time. Although these patients also describe their heart beating irregularly or palpitations, they additionally report other symptoms, including increased breathlessness, reduced exercise tolerance, lethargy and fatigue.

In some patients, it can also cause dizziness and chest pains. Although the symptoms for atrial fibrillation are quite varied, the predominant symptom is palpitations (the feeling of the heart beating irregularly).

How is atrial fibrillation treated?

Treatment of atrial fibrillation is broadly described in two categories.

One such area aims to try and reduce the individual risk of stroke. This is based on a risk stratification scheme that we use, which determines whether the patient requires anticoagulation to reduce their risk of stroke.

The second area relates to trying to treat the rhythm itself. In most individuals, particularly if they are symptomatic with atrial fibrillation, treatment will be aimed at trying to keep the heart in a normal rhythm as much as possible. This could involve drugs specifically prescribed for atrial fibrillation which help to keep the rhythm normal as much as possible.

In some patients, an electrical resetting procedure called cardioversion is required to reset the heart from atrial fibrillation to a normal rhythm. In other patients where the atrial fibrillation is causing quite significant symptoms and affecting the individual's quality of life, mini-surgical procedures called ablations are available which try and treat the rhythm itself. These procedures can help patients stay in a normal rhythm as much as possible and thereby increase the patient's quality of life and reduce symptoms related to atrial fibrillation.

Can stress cause atrial fibrillation?

I would say stress is not the most common cause or trigger for atrial fibrillation. In some people, it can be associated with or caused by sleep while at the other extreme, it can be associated with high adrenergic events such as exercise.

Generally, however, the causes behind atrial fibrillation tend to be multifactorial. Although it's perfectly normal for patients to try and find triggers for their atrial fibrillation, in my experience it is very often sporadic and unpredictable. Indeed, this unpredictability is what tends to have the biggest impact on the individual's quality of life.



If you are concerned about your heart health or are seeking treatment for atrial fibrillation and wish to schedule a consultation with Dr Kirubakaran, you can do so by visiting his Top Doctors profile.