Atrial Fibrillation (AF)

Dr John Hayes discusses Atrial Fibrillation (AF)

Watch Dr John Hayes discuss atrial fibrillation – how it develops, what symptoms to look out for, and some of the treatment options that he offers that may not be available anywhere else in Australia. This is where to start if you’re seeking a diagnosis.

For more information on Atrial Fibrillation, visit QCG’s Atrial Fibrillation Institute website:

Atrial Fibrillation Institute: Browse Treatments & Locations (afibinstitute.com.au)

What is Atrial Fibrillation (AFib or AF)

Atrial Fibrillation (AF) is an irregular heartbeat caused by an abnormal electrical signal in part of the heart. Some patients may not even know they have AF, while others may experience symptoms and complications.

AF is characterised by an abnormal heart rhythm (arrhythmia) where rapid and irregular rhythm disturbances of the upper chambers of the heart (atria) override the normal regular heart beat. The normal heart beat for an adult is usually between 60 and 100 beats per minute (bpm). When the heart is in AF, the atria can beat in excess of 300 bpm. The lower chambers (ventricles) try to keep up with the upper chambers, but are irregular and often in the range of 100-200 bpm. The rate in the lower chambers is often slowed when patients are on medications, but the upper chambers remain rapid.

AF itself is not a life-threatening heart rhythm, but in some people it can cause distressing symptoms, and it can increase your risk of other dangerous consequences. AF is associated with a much higher risk of stroke – people with AF have up to 5X the risk of stroke than those who do not. Long-term AF can also be associated with heart failure if not adequately managed. Effective treatment for AF returns the heart to a normal rhythm or controls the heart rate, and reduces the risk of blood clots and strokes.

AF is the most common abnormal heart rhythm. Eight out of every 100 people over the age of 65 are diagnosed with AF.

Symptoms of Atrial Fibrillation

The symptoms of AF vary greatly for each person. AF can be free of any symptoms in some people, but can cause uncomfortable symptoms in other people. Possible symptoms include:
  • Palpitations – An awareness of the heart beating differently to normal. It can feel like a bump, or a flutter or a flop in the chest.
  • Irregular Pulse – A pulse that is faster than normal, or varying between fast and slow.
  • Shortness of Breath – Difficulty catching your breath, especially on exertion .
  • Fatigue or Tiredness – Fatigue is often felt during or after an AF episode, though can also be a side effect of some medications used to manage it.
  • Chest Discomfort or Pain – Due to the heart not beating as efficiently.
  • Dizziness or Feeling Light-headed – Especially during more rapid episodes of AF.
  • Syncope – Passing out or fainting.
  • Urinary Frequently – Needing to pass urine more frequently due to a hormone released by the heart when it is in AF.

Atrial Fibrillation Risk Factors

A wide range of risk factors may contribute to the AF such as:

  • Older than 60 years of age.
  • Diabetes.
  • High blood pressure.
  • Coronary heart disease.
  • Congestive heart failure.
  • Heart valve disease.
  • Prior open heart surgery.
  • Thyroid disease.
  • Chronic lung disease.
  • Obstructive sleep apnoea.
  • Serious illness, infection or non-cardiac surgery.
  • Excessive alcohol consumption.
  • Inherited (genetic) AF.

Sometimes, there is no obvious cause for the AF to develop. It is more common for younger people to have no evidence of any other heart disease on testing, such as an echocardiogram or exercise stress test . This is often called “Lone AF”. AF increases in frequency with advancing age.

Three Different Types of Atrial Fibrillation

Episodes come and go on their own. The AF may last for seconds, minutes, hours or days before the heart returns to its normal rhythm. As the heart goes in and out of AF, the pulse rate may change from slow to fast and back again. People with this type of AF are often most symptomatic.

Episodes come and usually last until the person is put back into normal rhythm, either with medications or by an electrical shock (cardioversion, direct current counter shock (DCCS). It is unknown how long the heart will then stay in rhythm. Certain medications may reduce the recurrence of AF.

The heart stays in AF despite efforts to convert it back to normal rhythm with medications, cardioversion or ablation procedures.

Atrial Fibrillation Treatment Goals

AF can be associated with a high risk of stroke. The foundation for managing AF is to reduce the risk of clots forming that may cause a stroke in the brain. This involves assessing other stroke risk factors, and if indicated, starting anti-coagulation therapy.

If AF is not treated, it can eventually weaken the heart muscle and cause permanent damage. Restoring the heart’s regular rhythm can relieve the symptoms of AF and prevent dangerous blood clots from forming.

Controlling rapid heart rates allows the heart to pump oxygen-rich blood efficiently, relieves some or all symptoms and protects against a weakening of the heart muscle. Controlling the rapid heart rates, however, does not address the underlying arrhythmia or the risk of clots and strokes.

To reduce the frequency of the AF and the likelihood that it will progress over time. Treatment of blood pressure, weight and sleep apnoea are essential.

Treatment Options

A number of treatment options are available, including:

Medication

Managing AF may involve different medication strategies, which include:

  • Blood thinning medications (anticoagulants) to reduce risk of stroke.
  • Medication intended to restore the heart’s normal rhythm and try to prevent the recurrence of AF.
  • Medication to help control the pulse (ventricular) rate.

Electrical Cardioversion

When medication fails to restore the heart’s normal rhythm, an electric shock can be delivered to the chest wall to restore a normal rhythm. Find out more about Electrical Cardioversion. 

Cardiac Catheter Ablation

Cardiac catheter ablation is a minimally invasive procedure that uses long, thin ‘catheters’ along wires that are passed up into the heart via the leg veins. The end of the catheter has a device that uses either cooling energy (cryoablation) or heating energy (radiofrequency ablation) to burn small precise areas of heart tissue that are causing the arrhythmia.

New catheter ablation technologies and techniques are evolving all the time.

Find out more about Catheter Ablation here, or on the Atrial Fibrillation Institute website.

For more specific information about AFib, please visit the QCG Atrial Fibrillation Institute website , which is dedicated to supporting patients with AFib with the latest information on diagnostics, treatments and management.
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