The heart pumps blood constantly toward the entire body by squeezing its different parts in a special way. The top part, called the atria, squeezes first then the bottom part of the heart, called the ventricles, squeezes next. Atrial fibrillation is an abnormal heart rhythm that causes a fast and irregular pulse. In atrial fibrillation parts of the atria send disorganized electrical impulses into the top of the heart. These abnormal discharges cause the atria to shake like jelly. This activity takes over the heart’s normal beats and the body is not able to control how fast the heart is beating.
This causes the most common symptom of atrial fibrillation: fatigue. Atrial fibrillation is the most common type of abnormal heart rhythm. An estimated 3 to 6 million Americans have it. In fact, it happens so commonly doctors have a nickname for it: “a-fib”. Most often the risk of air increases as we get older. As people age so does their heart and age is the biggest risk factor for developing afib.
Just 2% of people under the age of 65 have atrial fibrillation but as high as 9% of those over the age of 65 have it. Age is not the only thing that brings on-air, other things can cause it too. Problems like obesity, thyroid disorders, too much alcohol, caffeine and energy drinks, high blood pressure, lung problems like COPD, and even sleep apnea can trigger this arrhythmia. Also being very sick like with a serious infection can throw the heart into this abnormal rhythm.
Atrial fibrillation causes two main problems: the symptoms it can cause, and the increased chances of stroke. To understand how atrial fibrillation causes strokes we need to look at a part of the heart called the left atrial appendage. This part of the heart is kind of like the heart’s tail. When afib starts, the atria shakes like jelly. This type of movement does a bad job of pushing blood out of the top part of the heart and into the bottom.
Because of this, some of the blood pools inside the heart’s little tail where it settles and can form blood clots. In afib, some of these formed clots inside the appendage can detach. If the heartbreaks out of the air and starts squeezing normally again the tail appendage can squeeze the clots out. The clots can then be launched into the body. The most commonplace of blood clot goes after it leaves the heart is the brain. If a clot lands in your brain it can obstruct the blood flow and cause a stroke.
A stroke can have a huge impact on a person’s life, even taking away their ability to talk and move independently. If you have afib it is important to find out your chance of having a stroke so you can decide if you need to protect yourself from one. Fortunately, there is a tool that can help you and your doctor quickly determine your risk. This tool is called the CHADS VASC2 score.
This score looks at all the factors that increase the chances of stroke in people with afib. If your score adds up to zero or one then your chance of having a stroke is low. For any score over two: protection with a blood thinner or what is called an “occlusion device” is recommended.
Until recently coumadin was the only choice of blood thinner available for patients with acid. Coumadin can protect from a stroke but it is a very difficult drug to take as it requires frequent testing. Fortunately, there are now four new oral blood thinners that do not need regular blood draws for monitoring and have minor interactions with food and other medications. If a patient is bleeding or is at high risk of bleeding because of frequent falls, job activities or sports or has had head trauma an occlusion device is recommended. An occlusion device may also be used if the patient has a history of not taking their prescribed medications. Doctors in the U.K offer two occlusion devices that can protect you permanently from a stroke.
The first of these devices is called the Watchman device: a plug is placed inside the heart’s tail so that clots will not settle inside of it. The second device option ties off the heart’s tail altogether so it can no longer cause the problem. Symptoms of acid can be different for everyone. The same irregular heart rhythm can cause severe symptoms in one person and nothing in others.
The most common symptom of acid is fatigue but people with afib can also feel their heart racing or palpitations, shortness of breath, chest pain and even anxiety. There are medications available that can help treat the heart so that afib happens much less often. This can lead to an improvement in symptoms.
These medications are called “antiarrhythmics.” Antiarrhythmics have a limited ability to control air and can cause side effects. The most common and powerful of these medications is called amiodarone. Amiodarone is effective at controlling atrial fibrillation but it can affect the thyroid gland making it either over-active or under-active. Also taking amiodarone for a long time can change the skin’s color and cause permanent lung scarring. Over the last two decades, atrial fibrillation has also been treated with a procedure called an “ablation”.
The ablation procedure was invented in the 1990s and has been dramatically improved over time. It can help reduce the patient’s symptoms and mortality while reducing the need for medications and their side effects. With an ablation, doctors can target the root of the problem that causes afib. They do this by tracing the abnormal electrical discharges that cause an irregular heartbeat and locating the parts of the heart where they occur. Up to 85% of these discharges happen in the part of the heart that receives blood from the lungs: the pulmonary veins.
Once they locate these trigger areas doctors then enter the heart using a minimally invasive approach. Inside the atrium, they target and zap or “ablate” these abnormal trigger areas while leaving the normal parts alone. The earlier the problem is treated the more effective an ablation will be. Ablations are successful at treating afib that comes and goes called “paroxysmal” up to 90% of the time.
The procedure can be up to 80% effective for those with persistent air that has been occurring for less than one year and as high as 60% effective at treating it if it has been happening for over a year. Since 2016 the procedure of afib ablation has begun to expand to include the left atrial appendage. When the left atrial appendage is ablated in addition to the ablation around the pulmonary veins the procedure’s effectiveness improves by approximately 20%. Many studies have shown that this updated ablation procedure is safe and does not increase the risks related to ablation. Regardless of how long a thief has been going on it is never too late for treatment.
Even in those who have had it for a long time, reducing the amount of time the heart stays in the air can lead to an improvement in symptoms..