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Atrial Fibrillation
“There is no “typical” Atrial Fibrillation patient. Atrial Fibrillation occurs in men and women, in all races, and can occur at any age.”
Atrial fibrillation is the most common heart
rhythm disturbance affecting approximately 1
million people in the UK alone. If left untreated it
is a significant risk factor for stroke and other
morbidities. Atrial fibrillation is a heart condition
that causes episodes of irregular and often
abnormally fast heart rate. When this happens, the
heart cannot efficiently pump blood around the
body.
A normal heart rate should be between 60 and 100
beats a minute at rest.
There are three main types of atrial fibrillation:
Paroxysmal atrial fibrillation. This comes and
goes and usually stops within 48 hours without
any treatment.
Persistent atrial fibrillation. This lasts for longer
than seven days (or less when it is treated).
Longstanding persistent atrial fibrillation. This
usually lasts for longer than a year.
In atrial fibrillation, the upper chambers of the
heart (atria) contract randomly and sometimes so
fast that the heart muscle cannot relax properly
between contractions.
“There is no “typical” Atrial Fibrillation
patient. Atrial Fibrillation occurs in men
and women, in all races, and can occur at
any age.”
This may lead to a number of problems, including
dizziness and shortness of breath. You may also
be aware of a fast and irregular heartbeat
(palpitations) and feel very tired.
Some people with atrial fibrillation have no
symptoms and are completely unaware that their, heart rate is not regular. There is no “typical”
Atrial Fibrillation patient. Atrial Fibrillation
occurs in men and women, in all races, and can
occur at any age. Atrial Fibrillation is related to
age; the older you get, the more likely you are to
develop it. It affects about 10% of people over 75.
What are the risks of Atrial Fibrillation?
The main risk associated with AF is stroke. This
occurs because the atria are fibrillating and not
beating in a co-ordinated way. This may increase
the risk of blood clots because when the heart
beats irregularly, the blood does not flow properly
through the heart and the rest of the body. People
with AF may need medication to reduce or
prevent this risk. Left untreated or poorly
monitored AF can lead to serious complications
such as heart failure and stroke.
Having an uncontrolled heart rate for long periods
of time (weeks or months) can damage the heart.
You should check with your doctor that your
heart rate is controlled adequately. In extreme
cases, often when the rate is very fast or when it
happens in a damaged heart, AF can cause heart
failure, which means that the heart becomes weak
as a result of the rapid rhythm.
Symptoms of atrial fibrillation
Some people with atrial fibrillation have no
symptoms and it is only discovered during routine
tests or investigations for another condition.
The most obvious symptom of atrial fibrillation is
a fast and irregular heartbeat, usually over 140
beats a minute. You can determine your heart rate
by feeling the pulse in your wrist or neck.
You may also experience:
• tiredness,
• breathlessness,
• dizziness, or
• chest pain (angina).
The way the heart beats in atrial fibrillation
reduces the heart’s efficiency and performance.
This can result in low blood pressure and heart
failure.
Causes of atrial fibrillation
The exact cause of atrial fibrillation is unknown.
Those at risk
Atrial fibrillation is common in people with other
heart conditions, such as:
• high blood pressure,
• atherosclerosis,
• heart valve disease,
• congenital heart disease (heart disease at birth)
• cardiomyopathy (wasting of the heart muscle),
and
• pericarditis (inflammation of the lining
surrounding the heart).
It is also associated with other medical conditions:
• hyperthyroidism (overactive thyroid gland),
• pneumonia,
• asthma,
• chronic obstructive pulmonary disease,
• lung cancer,
• diabetes,
• pulmonary embolism (a blockage in a vessel in
your lungs), and
• carbon monoxide poisoning.
Triggers
Certain situations can trigger an episode of atrial
fibrillation, including:
• drinking excessive amounts of alcohol
(particularlybinge drinking),
• being overweight,
• drinking lots of caffeine, such as tea, coffee or
energy drinks,
• taking illegal drugs (particularly amphetamines
or cocaine), and
• smoking.
An electrocardiogram (ECG) is a test that records
the rhythm and electrical activity of your heart.
Small stickers, called electrodes, are attached to
your arms and legs and connected by wires to an
ECG machine. If you have the test during an
attack of atrial fibrillation, the ECG will record
your abnormal heart rate and a diagnosis of atrial
fibrillation can be confirmed.
Complications of atrial fibrillation
Stroke
When the atria (upper chambers of the heart) are
not pumping efficiently, as in atrial fibrillation,
there is a risk of blood clots forming.
These blood clots may move into the ventricles
(lower chambers of the heart) and get pumped
into the lungs or the general blood circulation.
Clots in the general circulation can block arteries
in the brain, causing a stroke.
The risk of stroke in people with atrial fibrillation
is about double that of the general population.
However, the risk depends on a number of
factors, including age and whether you have high
blood pressure, heart failure, diabetes and a
previous history of embolism (blood clots).
Heart failure
If your atrial fibrillation is persistent, it may start
to weaken your heart. In extreme cases, it can lead
to heart failure (where your heart cannot pump
blood around your body efficiently).
Treatment
The aim of treatment for AF is to control the heart
rate (how fast it beats) and the heart rhythm (how
regularly it beats). Medication can help control
both the rate and rhythm of the heart. Sometimes
people also need treatment called cardioversion to
return their heart to its normal rhythm. Many
people with AF need treatment called
anticoagulation to reduce the risk of blood clots
and stroke.
Because of the risk of blood clot and stroke, all
people with persistent AF (or atrial flutter) should
be offered anticoagulation treatment where this is
appropriate, and on a long-term basis if necessary
(NICE Guidance, June 2006).
For more information visit:
www.anticoagulationeurope.org
www.arrhythmiaalliance.org.uk
www.stroke.org.uk
www.bhf.org.uk
www.nhs.uk/conditions/Atrial-
fibrillation/Pages/Introduction.aspx