stress ECG

Atrial Fibrillation

What is it Atrial Fibrillation?

AF is a condition where Heart is beating “out of rhythm.” Imagine your clock or watch instead of moving forward regularly, second by second, moving forward erratically. Sometimes one second, another time 2 seconds and other times 4 seconds forward without any order, completely random. So AF is “your heart beating irregular and out of rhythm.” 

Will I remain in AF forever or is it gonna go away?

Once you have AF, you will have further episodes in the future. Unfortunately, it’s there to stay with you. You might have it periodically, which is called Paroxysmal AF or permanently (Permanent AF). It might start as an episodic event initially, but down the track, you will have more of it.

What usually causes Atrial Fibrillation?

As we age, our body goes through significant changes in every single organ, including the Heart.  When we are born, the chambers inside the Heart and electrical circuits are in pristine condition. With aging, this starts to change. The chambers (esp. the top chambers which are called atria) can enlarge (dilate), and this change of structure cause distortion of the electrical circuits which run inside the chamber walls, raising the likelihood of Atrial Fibrillation. Many conditions can expedite this “structural change,” including uncontrolled hypertension, diabetes, myocardial infarction (Heart attack), sedentary lifestyle, obesity, obstructive sleep apnea (OSA), smoking, and genetic background. The older we get, the higher the likelihood of Atrial Fibrillation  to the point of inevitability. Certainly controlling other medical conditions, mentioned above, will reduce the risk, but never to nil.

How is Atrial Fibrillation gonna affect me?

Well, in many ways. Some people are not even aware that their heart is beating irregularly and continue a normal life as if nothing has changed. Others do experience symptoms that could be different from person to person. Some report palpitations and some fatigue. Some would report shortness of breath with the exertion of any sort. Very few cannot live a normal life when in fibrillation (fortunately not that common) while others are not even aware.

So Is it just about symptoms? I mean, can it cause any serious harm?

Irregular heartbeat, per se, is not lethal, but when the heart beats irregularly, the chance of blood clots forming in the heart is quite high. If a large enough clot forms in the heart, it can move with the blood flow out of the heart. Where it goes usually? BRAIN, and if the clot is large enough to block a major artery, STROKE happens. Depending on how big the clot has been, the stroke could be trivial and temporary (TIA or Transient Ischemic Attack or “Mini-stroke”) or large and devastating or even lethal. But, the good news is that these days we have excellent medications to reduce the risk of stroke significantly.

So is managing AF is all about preventing stroke?

Of course NOT, but that is the most crucial aspect of management. The other important issue is to stop your heart from beating fast when in atrial fibrillation. The usual heart rate is 60 to 70 beats per minute. In AF, this could go up to anywhere from 80 to 170 beats per minute. If this continues for a long time, “heart fatigue” could happen, which is actually heart giving up, and that’s when heart failure comes into the picture. Heart rate control can usually be achieved by medications. So the two parts of managing AF are 1) Preventing stroke and 2) Controlling your heart rate.

I was told that my heartbeat should be regular, as that’s how it’s meant to be.

Well, that’s sort of true. The normal/regular heartbeat or “Sinus rhythm” can be achieved in two ways. Either with medications or via electrical interventions. The problem is that neither way is perfect. Unless you are complaining of some symptoms which could be linked to AF, there is no significant point in reverting you to sinus rhythm as long as 1. you are protected against stroke and 2. your heart rate is within normal range and not fast.

What initial tests are usually required?

That largely depends on your complaints and symptoms. The routine initial tests, of course, after a physical exam, are ECG (Electrocardiogram) and an Echocardiogram. ECG shows how fast your heart is beating and establishes the diagnosis of Atrial Fibrillation and Echocardiogram shows how the heart is functioning and whether there is any underlying valvular disease, causing the fibrillation. 

Two electrocardiograms showing 1. Sinus rhythm and 2. Atrial Fibrillation. Click on the images for larger picture.

1. Sinus Rhythm
2. Atrial Fibrillation

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