Demystifying atrial fibrillation

What is atrial fibrillation (AF), and how does it affect the heart's rhythm?

Atrial fibrillation (AF) is a common heart rhythm disorder that affects the upper chambers of the heart, known as the atria.

In AF, the atria quiver instead of contracting effectively, leading to an irregular and often rapid heartbeat. This irregular rhythm can disrupt the normal flow of blood through the heart.

Dr Shahnaz Jamil-Copley, leading cardiologist and electrophysiologist with expertise in cardiac arrhythmias, goes into expert detail in this informative article.

How prevalent is AF, and what are the risk factors associated with it?

AF Prevalence

AF is the most common sustained cardiac arrhythmia, with an estimated overall prevalence in England of 2.5 per cent. It is more common in older patients. Other common risk factors include high blood pressure, obesity, heart disease and diabetes. There is also a strong link between AF and obstructive sleep apnoea, which should be considered and, if identified, treated in all patients.

What are the symptoms of AF, and when should one seek medical attention?

AF symptoms

Some patients are unaware that they have AF as they experience no symptoms. In others, AF can manifest in various ways. Symptoms may include:

• palpitations;
• dizziness;
• breathlessness;
• chest discomfort, and/or
• fatigue

When to seek medical attention

AF is not a life threatening disorder, however due to its associated link with stroke, and rarely heart failure, diagnosis and treatment is crucial. If you experience persistent symptoms like palpitations or have risk factors for AF, it is crucial to seek prompt medical attention. Early detection and management can help prevent complications.

How is AF diagnosed and what tests are involved?

AF Diagnosis

Diagnosing AF involves a thorough evaluation of symptoms, medical history, and a physical examination. Additionally, several tests may be conducted to confirm the diagnosis:

Electrocardiogram (ECG)

An ECG records the heart's electrical activity, identifying irregularities in rhythm.

Holter Monitor

This portable device continuously records the heart's rhythm over a prolonged period of time eg 24hrs to 1 month thus providing a more extended assessment.

What are the treatment options for AF, and how are they determined?

Treatment approaches

As AF is not a life limiting disorder, the management aims to control symptoms (if present). Critically the aim is to reduce the risk of complications such as stroke and heart failure. Whilst restoration of normal rhythm is desirable, it is not always possible and requires expert assessment by an electrophysiologist.

Treatment options may include:

Medications

Anti-arrhythmic medications for rate or rhythm control and blood thinners to prevent blood clots.

Cardioversion

This is a common procedure which involves the delivery of an electric shock to the heart, under general anaesthesia, to restore normal rhythm.

Ablation

Some patients will be suitable for an AF ablation as an invasive treatment option, restoring normal rhythm and allowing patients to stop some, or all, of their medications in the long term. Patients require assessment by an electrophysiologist.

What lifestyle modifications can help manage AF?

Lifestyle changes

Certain lifestyle modifications can complement medical treatment and help manage AF.

• Weight loss and maintaining a healthy Body Mass Index is crucial in the development and symptoms of AF.
• Adopting a heart-healthy diet: low in sodium and saturated fats.
• Regular exercise: Engaging in regular, moderate exercise can contribute to overall heart health.
• Stress management: Practices such as mindfulness and stress reduction techniques can be beneficial.

How can AF be prevented, and what is the role of lifestyle in prevention?

Preventive measures

While some risk factors for AF are beyond one's control, adopting a heart-healthy lifestyle can contribute to prevention:

• Regular health check-ups: Routine check-ups can help monitor and manage risk factors like high blood pressure and diabetes.
• If you snore and suspect that you suffer from obstructive sleep apnoea, then formal assessment should be sought.
• Healthy lifestyle choices: Maintaining a healthy weight, managing stress, and avoiding excessive alcohol consumption.
• Conclusion: Taking charge of your heart health

Understanding atrial fibrillation empowers individuals to make informed decisions about their heart health. If you suspect AF or have risk factors, seeking timely medical advice is crucial. With advancements in medical science and personalised treatment approaches, managing AF and leading a heart-healthy life is within reach for many.

If you’re concerned about atrial fibrillation, arrange a consultation with Dr Jamil-Copley via her Top Doctors profile.