Treating and Preventing Atrial Fibrillation

By John D Day MD

Atrial fibrillation, also known as A-fib, is the most common heart rhythm abnormality. Up to one in four adults will have an episode of A-fib at some point during their life. Fortunately, there are ways we can treat and prevent A-fib - find out how.

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Atrial fibrillation, also known as A-fib, is the most common heart rhythm abnormality. Up to one in four adults will have an episode of A-fib at some point during their life. Many famous people have developed A-fib including President George W. bush, Vice Presidents Dick Cheney and Joe Biden, and Barry Manilow - just to name a few.

While many people may have felt their heart skip a beat or even beat fast with their first kiss or during a stressful conflict with a family member, this likely is not A-fib. The only way to know whether or not you have A-fib is to capture it on an EKG. Unfortunately, when most patients see their doctor for an abnormal heart rhythm, their hearts are usually beating normally on the day of the visit. For this reason, we often prescribe a 30-day heart monitor that people can take home with them to record when these uncomfortable heart rhythm abnormalities occur.

The typical symptoms of A-fib are chest discomfort, palpitations, shortness of breath, fatigue, dizziness, or lightheadedness. If you take the pulse of someone in atrial fibrillation, you will generally feel a rapid and irregular pulse. A-fib can affect any adult at any age. While most patients develop it in their 60s, 70s, or 80s, I also see some young adults in their 20s or 30s with this condition. In fact, I recently saw a young woman who was diagnosed with A-fib while she was pregnant at age 21. This caused her to have a very difficult pregnancy because we worried about the effects of the A-fib medications on her baby. Fortunately, we were able to cure her of her A-fib shortly after her pregnancy with a procedure called catheter ablation.

Is atrial fibrillation something you should worry about?

Unfortunately, A-fib increases the risk of stroke, heart failure, and dementia or Alzheimer’s disease. In A-fib, the upper chambers of the heart are beating so fast and chaotically, that they can’t pump blood. As a result, the stagnant blood in the upper chambers can cause blood clots, which lead to strokes. The symptoms from A-fib usually come from either the upper chambers of the heart not beating or from the rapid and chaotic pulse of A-fib.

Amazingly, some patients may not have any symptoms. In my experience, it is typically the elderly or inactive patients who may not have any symptoms from their atrial fibrillation. I suspect this is because these patients typically do not push their hearts hard enough to experience symptoms. Such was the case with my grandmother. She had unknowingly developed A-fib, and although she lived a very fulfilling life, we tragically found her unconscious on her floor, possibly for days, from a massive stroke as a result of her previously undiagnosed A-fib. It was tragic that an earlier diagnosis of A-fib may have prevented the stroke.

How is atrial fibrillation treated?

For patients at low risk of a stroke, we may just prescribe a daily aspirin regimen. For patients at higher risk, we may prescribe a stronger blood thinner such as warfarin (Coumadin©), dabigatran (pradaxa©), or rivaroxaban (Xarelto©). For patients who do not have any symptoms from A-fib, we generally also prescribe a medicine to slow their heart down to prolong its health.

Most of the patients that we see in our clinic have symptoms from their A-fib. In these patients, we get their heart back in rhythm either by shocking it or by starting them on a rhythm medication. Unfortunately, over time these medications generally stop working or may cause intolerable side effects. Many patients can also be cured using a procedure called catheter ablation.

What is a catheter ablation procedure?

During a catheter ablation, catheters are inserted into the heart to map the source of atrial fibrillation. The abnormal nerves of cells causing the A-fib are then cauterized. Patients spend a night in the hospital following the procedure and leave the next morning with just a bandage on their neck and in the groin area. There is no cutting, and no stitches are required. Sometimes a patient may need a second or rarely even a third procedure to cauterize any remaining areas that may be causing the A-fib. As with any procedure, complications can occur, but your doctor will discuss these with you.

What can you do to prevent atrial fibrillation?

You can avoid A-fib by participating in daily exercise, getting enough sleep, keeping your blood pressure controlled, and maintaining an ideal body weight. While none of us can prevent the aging process, if we actively take care of our bodies, we can dramatically reduce the risk of developing A-fib. I also recommend that people older than age 60 check their pulse daily. If you detect a rapid or irregular pulse, it is time to notify your doctor.

We truly live in a remarkable age. While our parents or grandparents had to cope with the ravages of atrial fibrillation, with modern medications or new heart procedures, we can help prevent this condition or the devastating consequences of stroke.