OTHER SYMPTOMS & DIAGNOSIS

Atrial fibrillation (AF)

What is atrial fibrillation?

This is a common cause of palpitation and occurs in around 4% of patients in their sixties and 11-12% of patients in their eighties. It results from a change in the normal cardiac rhythm (sinus rhythm) to a chaotic electrical activation of the two small chambers of the heart (the atria) resulting in an irregular and often rapid heartbeat. Atrial fibrillation is caused by high blood pressure, coronary artery disease, heart valve disease, a problem with the thyroid gland or an infection. It is often an incidental finding and may also result in breathlessness, light-headedness or chest discomfort/angina.

Are there different types of AF?

Yes.

AF may come and go lasting from a few hours to days (paroxysmal) or may last longer and if for greater than 7 days is know as persistent AF. If it does not go away then it is called permanent AF.

How is it treated?

The treatment of patients with paroxysmal, persistent and permanent atrial fibrillation varies.

In paroxysmal AF the main approach is to use medication to regulate the heart rhythm. This may require the use of a number of different drugs. If unsuccessful then often patients are referred for ablation therapy. This requires the placement of a number of electrodes inside the heart and part of the lining of the heart is burnt to prevent the atrial fibrillation occurring.

Patients with persistent atrial fibrillation may be put on medication to try and slow the heart as well as restoring the normal heart rhythm. It may not be possible to achieve this with tablets. In such circumstances an electrical shock (DC cardioversion) may be required and this is a procedure carried out under general anaesthetic.

Permanent atrial fibrillation may result in the patient needing some medication to slow the rate of the heart.

Is there a risk of stroke and do patients with AF have to take Warfarin?

Patients with AF may be at risk of a stroke and either their GP or Cardiologist will assess this using the CHA2DS2Vasc score. It may be recommended that patients with AF be treated with Warfarin or one of the newer anticoagulants (Direct Oral Anticoagulants) such as Dabigatran, Rivaroxaban and Apixaban to reduce this risk.