Atrial fibrillation is the most common abnormal rhythm of the heart. Atrial refers to the two upper chambers of the heart, the left and right atria. Fibrillation means rapid inefficient beating. Atrial fibrillation occurs when the normal electrical conduction system of the atria malfunctions. This causes multiple inefficient contractions or fibrillation within the atrium. This inefficient beating of the atrium leads to the inefficient beating of the lower chambers of the heart or the ventricles which are responsible for sending blood to the lungs or the rest of the body. The fibrillation also results in swirling of blood within the atrium, increasing the risk for clot formation. If a clot forms in the heart, there is a risk that it will travel to the lungs causing a life threatening pulmonary embolus, or to the brain causing a stroke.
- Increased age
- Coronary heart disease
- High blood pressure
- Abnormal heart muscle function (including congestive heart failure)
- Mitral valve disease
- Hyperthyroidism or overdose of thyroid medication
- Insufficient oxygen in the blood caused by chronic lung diseases such as emphysema or chronic obstructive pulmonary disease (COPD)
- Inflammation of the lining surrounding the heart
- Blood clots in the lung
- Excessive alcohol intake
- Stimulant drug use
- Recent heart or lung surgery
- Abnormal heart structure from the time of birth (congenital heart disease)
Patients with atrial fibrillation may experience a number of symptoms associated with the disease including:
- Palpitations (fluttering in the chest)
- Shortness of breath
- Possibly swelling in the legs.
Fortunately physicians today have many tools at their disposal to help accurately diagnose and treat atrial fibrillation. The first and most important begins with a thorough history and physical. Physicians may detect an irregular heart rate.
Common tests include:
- Electrocardiogram records electrical activity of the heart and makes a definitive diagnosis of atrial fibrillation if it exists during the time of the tes.
- Echocardiogram is an ultrasound of the heart that can help determine if one is in atrial fibrillation.
- Holter monitor is a portable device that continuously monitors the electrical activity of the heart for 24 hours. This may be worn by a patient at home and may be required to identify intermittent atrial fibrillation.
The initial mode of therapy for atrial fibrillation involves medications. If medications are unsuccessful, a cardiologist may perform an ablation in which a catheter is placed through a patient’s vein in their leg up to their heart. An energy source is used to interrupt abnormal electrical pathways responsible for atrial fibrillation.
Atrial Fibrillation Surgery
When medications and percutaneous techniques are either not appropriate or unsuccessful, a patient may be a candidate for surgical atrial ablation. Atrial ablation for atrial fibrillation may be performed as an isolated surgical procedure or combined with coronary artery bypass grafting or valve surgery. An energy source is utilized to ablate electrical pathways that exist within the heart responsible for atrial fibrillation. When combined with additional heart surgery, atrial ablation adds minimal time and risk to the surgical procedure. Some patients may be candidates for minimally invasive atrial ablation. This involves a technique where small incisions are made on the chest to enable placement of specialized instruments and energy sources that perform the ablation. Once a patient is found to no longer be in atrial fibrillation, it may be possible for their Coumadin to be discontinued. When no longer in atrial fibrillation, patients can expect to have an improved quality of life.
1. What caused my atrial fibrillation?
That is very difficult to know. Please refer to the section on causes. However many cases of atrial fibrillation have no definitive cause.
2. Is an episode of atrial fibrillation life-threatening?
Most episodes are not life-threatening. The biggest concern is the risk of stroke. Patinets with atrial fibrillation require blood thinners like Coumadin to prevent clot formation in the heart. If atrial fibrillation has been present for a long time, it can weaken teh heart and make on emore prone to heart failure.
3. Can my atrial fibrillation go away on its own?
Occasionally, spontaneous remission can occur. The longer atrial fibrillation is present, the less likely it will resolve without treatment.