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Atrial fibrillation (AF)

What is atrial fibrillation? 1

Atrial fibrillation (AF) is a heart condition that causes an irregular and often abnormally fast heart rate. AF can increase your risk of stroke, heart failure and other heart-related complication. 1

 

There are 2 types of atrial fibrillation:

  • Valvular atrial fibrillation- when valvular disease, mostly rheumatic in origin, increases the risk of thromboembolism
  • Nonvalvular atrial fibrillation, known as NVAF- not associated with valvular diseases
Atrial fibrillation (AF)

A normal beating heart

The chambers of the heart contracts smoothly and regularly, meaning the blood flow is well coordinated

   
Atrial fibrillation (AF)

A heart with atrial fibrillation

The upper chambers of your heart contract rapidly but partially, making the blood flow through your heart chaotically

 

 

What are the causes for AF? 2

The cause of AF is not fully understood and men and women are equally susceptible to the disease. However, it is noted that AF is more likely to occur in patients who have other heart conditions 2 , such as:

  • High blood pressure
  • Heart attacks
  • Coronary artery disease
  • Abnormal heart valves
  • Mitral heart valve disease (caused by rheumatic heart disease, valve problems at birth, or infection)
  • Congenital heart disease (abnormality of the heart since birth)
  • Thyroid gland disorders
  • Pneumonia
  • Alcohol or drug abuse or misuse

 

What might you experience with AF? 3,4

Atrial fibrillation affects different people in different ways. Some people with atrial fibrillation have no symptoms and are unaware of their condition until it's discovered during a physical examination. Those who do have atrial fibrillation symptoms may experience signs and symptoms such as:

  • Palpitation (heart is racing)
  • Shortness of breath
  • Reduced ability to exercise
  • Fatigued or lacking in energy
  • Chest pain
  • Lightheaded
  • Dizziness
  • Confusion

 

Are you aware that AF increases your risk of stroke?

The irregular, turbulent blood flow through your heart due to atrial fibrillation creates the sort of environment that encourages blood clots to form. Blood clots increase the risk of stroke. A stroke is a serious medical condition, which occurs when the blood supply to a part of the brain is cut off by a blood clot. 5

 

Atrial fibrillation (AF)

 

How a blood clot can cause a stroke: 6

  • In atrial fibrillation, blood clots may form in the chambers of the heart
  • If the clot gets stuck in the blood vessels supplying the brain, it can form a blockage and prevent blood from reaching an area of the brain-resulting in a stroke
  • Sometimes these clots become dislodged and travel in the blood around the rest of the body where they stick in smaller blood vessels

 

How can you reduce your risk of stroke? 7

Maintaining a healthy lifestyle can help reduce your risk of suffering from a stroke.

 

Stop smoking is a good idea

  • Smoking damages your blood vessels and makes blood clots more easily. It is a good idea to quit smoking, ask your doctor or pharmacist for advice in smoking cessation.

 

It's best to drink alcohol in moderation

  • Excess amount of alcohol increases your blood pressure, which is one of the risk factors for stroke.

 

Eat a healthy diet

  • Eat at least 5 portions of fruit and vegetables each day
  • Choose oily fish, e.g. salmon and mackerel, a couple of times a week
  • Avoid high fat content foods and saturated fats
  • Reduce amount of salt intake

 

Get active

  • Take regular exercise to lower your blood pressure
  • Lose excess weight

 

What are the treatments for AF? 8,9

There are three main types of atrial fibrillation treatments :

  • Treatment to slow down heart rate
  • Treatment to control heart rhythm
  • Treatment to prevention blood clot and stroke

 

Slow down heart rate

Doctor may be able to reset heart beat to its regular rhythm (sinus rhythm) using a procedure called cardioversion, depending on the underlying cause of atrial fibrillation and how long you’ve had it

 

Cardioversion can be conducted in two ways:

  • Electrical cardioversion: an electrical shock is delivered to your heart through paddles or patches placed on your chest. The shock stops your heart's electrical activity momentarily.
  • Cardioversion with anti-arrhythmic drugs: help to restore normal sinus rhythm e.g. Amiodarone
  • If medication doesn’t work, we will need to perform catheter ablation, surgical maze procedures and atrioventricular (AV) node ablation

 

Control heart rhythm

Maintenance of sinus rhythm requires treatment of cardiovascular risk factors and any underlying disorder (ie, hyperthyroidism) that may have triggered AF.

 

Common antiarrhythmic drugs

  • Flecainide
  • Propafenone
  • Amiodarone
  • Dronedarone

 

Preventing blood clot and stroke

The goal of long-term anticoagulation in atrial fibrillation is to reduce the risk of thromboembolism. Patients withs AF have a risk of stroke or peripheral embolism that is approximately 5 times that of individuals in sinus rhythm.

 

Common oral anticoagulant agents

  • Warfarin
  • Lixiana (Edoxaban)
  • Dabigatran
  • Rivaroxaban
  • Apixaban

 

References

1. Atrial Fibrillation Introduction. NHS Choices. Available at: http://www.nhs.uk/Conditions/Atrial-fibrillation/Pages/Introduction.aspx.  Last accessed: June 2016

 

 2. AF Information & Advise for Patients, AF Association Website: What is Atrial Fibrillation? Available at: http://atrialfibrillation.org.uk/. Last accessed: June 2016

 

 3. Atrial Fibrillation, Symptoms and Causes, Mayo Clinic. Available at: http://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/dxc-20164936.  Last accessed: June 2016

 

4. Symptoms of Atrial Fibrillation. WebMD. Available at: http://webmd.com/heart/atrial-fibrillation-stroke-11/symptom-guide.  Last accessed: June 2016

 

5. Stroke. Introduction, NHS Choices. Available at: http://www.nhs.uk/conditions/Stroke/Pages/Introduction.aspx. Last accessed: June, 2016

 

6. Diseases and Conditions, Stroke, Cleveland Clinic. Available at: http://my.clevelandclinic.org/disorders/stroke. Last accessed: June 2016

 

7. The Stroke Association UK. Preventing Stroke. Available at: https://www.stroke.org.uk/what-stroke/what-can-i-do-reduce-my-risk. Last accessed: June 2016
 

8. Atrial Fibrillation Treatment & Management. E Medicine Medscape. Available at: http://emedicine.medscape.com/article/151066-treatment. Last accessed: June 2016

 

9. Atrial Fibrillation, Diagnosis & Treatment, Mayo Clinic, Available at: http://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/treatment/txc-20164944. Last accessed: June, 2016

 

10. Lixiana Prescribing Information. Daiichi Sankyo HK Limited Sept 2016

 

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