By Dr. Dionyssios Robotis
February is American Heart Month, and it is important to keep your heart healthy. This week, Dionyssios Robotis, MD, talks about atrial fibrillation.
Atrial fibrillation (AFib or AF) is an abnormal, irregular heart rhythm coming from the upper chambers of the heart. It is a common problem, particularly among the elderly and people with existing heart conditions. While some have minimal (or no) symptoms, others are completely incapacitated by it. Symptoms of atrial fibrillation include:
* Irregular or rapid heartbeat
* Extreme fatigue
* Shortness of breath
* Chest pain
However, people with atrial fibrillation do not always experience symptoms. Untreated atrial fibrillation doubles the risk of heart-related deaths and significantly increases the risk for stroke. An electrocardiogram (EKG) can diagnose atrial fibrillation.
Stroke and heart failure are the two most common complications of atrial fibrillation. Atrial fibrillation is responsible for 15-20 percent of ischemic strokes. During an ischemic stroke, blood flow to the brain is blocked by blood clots or fatty deposits called plaque in blood vessel linings. People with atrial fibrillation are five times more likely to suffer an ischemic stroke than people without. The risk for developing atrial fibrillation increases with age.
Since there is a significant risk for stroke with atrial fibrillation, early recognition and management is critically important.
Electrical cardioversion is performed in a hospital setting under moderate sedation. An electrical shock delivered across the chest will often restore normal heart rhythm. This may be sufficient for a number of years. More often than not, an antiarrhythmic agent (rhythm-regulating medication) will be required as well. There are a number of antiarrhythmic agents available, and the particular one chosen will depend on the patient's overall condition and the presence (or not) of other heart problems. Some of these medications can be started as an outpatient, but some require hospitalization for a few days for cardiac monitoring as the dosage is adjusted.
At some point in the course of the disease, the physician may decide to refer the patient for more invasive procedures, namely, ablation and/or implantation of a pacemaker. Ablation is a procedure done in a specially equipped electrophysiology lab. There are two kinds of ablation procedures widely available: radiofrequency ablation and cryoablation. During ablation, energy is delivered to specific areas of the heart muscle that are responsible for the atrial fibrillation. Occasionally, eliminating atrial fibrillation requires ablation of an area along the normal wiring of the heart, and if this is the case, the patient will require implantation of a permanent pacemaker during the procedure.
The fundamentals of atrial fibrillation management are symptom reduction, control of the heart rate and stroke prevention. Most importantly, atrial fibrillation needs to be identified and treated before complications arise. Regular visits to the doctor with periodic EKGs, EKGs if/when symptoms occur, and following the prescribed treatment plan can greatly reduce the risk of suffering complications of atrial fibrillation.
Dionyssios Robotis, MD can be reached at: HealthAlliance Hospital, 100 Hospital Road, 978-534-3179. Please contact your physician if you are experiencing any health concerns. If you are looking for a doctor, please call our physician referral line at 888-840-DOCS (3627). If you would like to submit a health topic, email askadoc@health alliance.com.