Manawa tukituki Atrial fibrillation
Atrial fibrillation (AF or AFib) is a problem with the heart's electrical system. It causes heart rhythm changes. Instead of a normal steady beat, the heartbeat is fast and varies in speed (irregular). Atrial fibrillation is the most common heart rhythm problem, especially in older people.
Causes of atrial fibrillation
The cause of atrial fibrillation is often unclear.
However, several things make you more likely to have atrial fibrillation. These include:
- older age
- high blood pressure
- heart disease
- being overweight
- drinking alcohol
- sleep apnoea — where your breathing stops and restarts many times during sleep.
Symptoms of atrial fibrillation
Many people with atrial fibrillation do not have any symptoms and it is only picked up when their pulse is checked.
If you have symptoms due to atrial fibrillation, you may feel:
- your heart is racing
- your heart is having extra beats (palpitations)
- short of breath, dizzy or weak.
Your symptoms may come and go (paroxysmal atrial fibrillation).
If you have any of these symptoms, make an appointment with your healthcare provider.
Diagnosing atrial fibrillation
Atrial fibrillation is diagnosed by checking your pulse to feel if it is beating regularly. Your healthcare provider can do this or you can learn to do it yourself.
If your heartbeat is abnormal, you will have an electrocardiogram (ECG) test to check for atrial fibrillation.
Electrocardiograph — Heart Foundation (external link)
If your atrial fibrillation comes and goes, you may have a test that involves wearing a Holter monitor. This is a device that records your heartbeat for 24 to 48 hours.
Atrial flutter is similar to atrial fibrillation and is diagnosed and treated in the same way.
Treating atrial fibrillation
The treatment for atrial fibrillation varies from person to person depending on several factors. These include:
- how severe your symptoms are
- the cause of your atrial fibrillation
- how long you have had atrial fibrillation
- any other underlying health problems.
There are different treatment options for atrial fibrillation.
Rate control medicines slow your heart rate. Your healthcare provider may prescribe these to slow down the rate at which the lower chambers (ventricles) in your heart are beating, to bring your heart rate to a normal level.
Rate control medicines include groups of medicines called beta blockers (for example, metoprolol, bisoprolol and carvedilol) or calcium channel blockers (for example, diltiazem and verapamil).
If your heart rate is still not at a normal level with beta blockers and calcium channel blockers, your healthcare provider may also add a medicine called digoxin.
If rate control medicines are not working well for you, your healthcare provider may prescribe medicines or recommend procedures to control the rhythm of your heart.
Medicines used to control the rhythm of your heart include:
- amiodarone
- sotalol
- flecainide
- propafenone
- disopyramide.
These are usually prescribed by a heart specialist (cardiologist).
Having atrial fibrillation puts you at a high risk of blood clots forming in the heart. These clots can cause a stroke if they break away from the heart. Preventing blood clots is one of the most important parts of treating atrial fibrillation.
To prevent blood clots, you may be prescribed blood-thinning medicines (anticoagulants), for example:
- warfarin
- dabigatran
- rivaroxaban.
Because anticoagulants stop blood clots, they may also cause bleeding. Your healthcare provider will consider your risk of bleeding and whether anticoagulants are suitable for you.
Healthcare providers no longer recommend aspirin for preventing blood clots in people with atrial fibrillation.
Electrical cardioversion
Electrical cardioversion is sometimes recommended to treat a fast or irregular heartbeat. It uses low-energy electrical shocks to trigger your heart into a normal rhythm. It is done under a general anaesthetic.
Catheter ablation
Catheter ablation is a more invasive method to restore a normal heart rhythm. In this procedure, a catheter (a long, thin tube) is inserted into a vein in your leg or arm and threaded all the way to your heart. Radiowave energy is used to damage the small portion of heart tissue responsible for the abnormal electrical signals causing atrial fibrillation.
Pacemaker
Implanted pacemaker devices help to maintain a normal heart rhythm. They are used for people with atrial fibrillation that has not been effectively treated with other less invasive treatments.
Before inserting a pacemaker, catheter ablation is used to destroy the atrioventricular (AV) node area of your heart. The AV node is a part of the electrical control system of the heart.
The pacemaker device takes over the role of the AV node to maintain a normal heart rhythm.
Surgery
Heart surgery is very rarely needed for atrial fibrillation.
The most common operation performed is known as the maze procedure. Areas of scar tissue are created in the heart to prevent the abnormal electrical signals that cause atrial fibrillation from spreading and causing an abnormal heartbeat.
Self care for atrial fibrillation
Following the advice on preventing angina and heart attacks will reduce your chance of getting atrial fibrillation and help if you have it.
Lower your risk of heart disease — Heart Foundation (external link)
General things you can do that will also help include:
- maintaining a healthy body weight
- limiting how much alcohol you consume
- getting help for sleep apnoea.