- Improving Your Atrial Fibrillation Prognosis
- Lone Atrial Fibrillation
- 8 Atrial Fibrillation Myths, Debunked
- Can a Person Live with Atrial Fibrillation?
- Catheter ablation helps atrial fibrillation patients live longer
- Catheter ablation led to 60% lower rate of deaths from cardiovascular events
- Even older patients, and those with other conditions benefited
Improving Your Atrial Fibrillation Prognosis
Many treatments are available for AFib, ranging from oral medications to surgery.
First, it’s important to determine what’s causing your AFib. For example, conditions like sleep apnea or thyroid disorders can cause AFib. If your doctor can prescribe treatments to correct the underlying disorder, your AFib may go away as a result.
Your doctor may prescribe medications that help the heart maintain a normal heart rate and rhythm. Examples include:
- amiodarone (Cordarone)
- digoxin (Lanoxin)
- dofetilide (Tikosyn)
- propafenone (Rythmol)
- sotalol (Betapace)
Your doctor may also prescribe blood-thinning medications to reduce your risk of developing a clot that could cause a stroke. Examples of these medications include:
- apixaban (Eliquis)
- dabigatran (Pradaxa)
- rivaroxaban (Xarelto)
- edoxaban (Savaysa)
- warfarin (Coumadin, Jantoven)
The first four medications listed above are also known as non-vitamin K oral anticoagulants (NOACs). NOACs are now recommended over warfarin unless you have moderate to severe mitral stenosis or an artificial heart valve.
You doctor may prescribe medications to ideally cardiovert your heart (restore your heart to normal rhythm). Some of these medications are administered intravenously, while others are taken by mouth.
If your heart starts beating very rapidly, your doctor may admit you to the hospital until the medications are able to stabilize your heart rate.
The cause of your AFib may be unknown or related to conditions that directly weaken the heart. If you’re healthy enough, your doctor may recommend a procedure called electrical cardioversion. This involves delivering an electric shock to your heart to reset its rhythm.
During this procedure, you’re given sedative medications, so you most likely won’t be aware of the shock.
In certain instances, your doctor will prescribe blood-thinning medications or perform a procedure called a transesophageal echocardiogram (TEE) before cardioversion to ensure there aren’t any blood clots in your heart that could lead to stroke.
If cardioversion or taking medications doesn’t control your AFib, your doctor may recommend other procedures. They may include a catheter ablation, where a catheter is threaded through an artery in the wrist or groin.
The catheter can be directed toward areas of your heart that are disturbing electrical activity. Your doctor can ablate, or destroy, the small area of tissue that’s causing the irregular signals.
Another procedure called the maze procedure can be performed in conjunction with open-heart surgery, such as a heart bypass or valve replacement. This procedure involves creating scar tissue in the heart so irregular electrical impulses can’t transmit.
You may also require a pacemaker to help your heart stay in rhythm. Your doctors may implant a pacemaker after an AV node ablation.
The AV node is the heart’s main pacemaker, but it can transmit irregular signals when you have AFib.
You doctor will create scar tissue where the AV node is located to prevent irregular signals from being transmitted. He will then implant the pacemaker to transmit the correct heart-rhythm signals.
Your heart is amazing. It is a muscle that beats regularly every minute of each day, keeping you alive.
But sometimes that beating is not as regular as it should be. An irregular heartbeat is common. In fact, about three million people each year may be diagnosed with what is known as a heart rhythm disorder.
One of the most common rhythm disorders is atrial fibrillation, or AFib for short. It is a serious condition that requires medical care.
What is AFib?
Your heart runs on a kind of electrical system that makes it beat. When that system does not signal the heart correctly, it can cause an irregular heartbeat. With AFib, there is an abnormal electrical signal in the top chambers of the heart, known as the atria.
How serious is it?
AFib itself is not life-threatening. If left untreated, however, the irregular heartbeat can cause serious complications. Those include:
- increased risk of blood clots leading to stroke
- damage to the function of the heart
- congestive heart failure
Sometimes, people with AFib have no signs of their condition. If you experience a feeling like your heart is racing for a period of time, it could be a sign of atrial fibrillation. Other signs may include pain in the chest, shortness of breath, or dizziness, which could be signs of AFib or other serious conditions. If you experience any of those symptoms, it is important to seek medical attention quickly.
- Medications: With an irregular heartbeat, blood cannot flow as freely as it should throughout your body. As a result, this increases the chances of a blood clot. This increased stroke risk is often treated with blood thinning medications, known as anticoagulants. If you are taking anticoagulants like Warfarin or Coumadin, regular blood monitoring is necessary. Also, these medications cause a bleeding risk, so anyone taking these should be careful to avoid cuts or injuries.
- WATCHMAN Implantable Device: While blood thinners reduce the risk of stroke, they also have the potential to cause excessive bleeding. That is why implantable devices may be a better option for some patients. One device, approved by the FDA in 2015, is the WATCHMAN. This implant is placed permanently using a catheter-based procedure. This can help to prevent clots from forming to protect patients with atrial fibrillation from strokes without the long-term use of blood thinners. You can learn more about other innovative procedures here.
A variety of conditions may increase your risk for atrial fibrillation. Those include heart valve issues or heart defects you may be born with. Other factors that can contribute to AFib development include high blood pressure, obesity, and sleep apnea. These conditions, however, can often be managed through lifestyle changes and weight management. Learn more about seven steps to a healthier heart.
Any heart condition is a concern. The good news is that AFib can be treated so you can continue to enjoy life.
If you have AFib, be sure to seek the advice of medical experts who specialize in atrial fibrillation, including cardiologists and cardiac electrophysiologists. Learn more about our team and how we can help you here.
Lone Atrial Fibrillation
The term lone auricular fibrillation was introduced by Evans and Swann1 in 1953. Lone atrial fibrillation has not been defined with any consistency, mainly because of the introduction of echocardiography and changes in criteria for hypertension. Currently, lone atrial fibrillation is considered a nosographic entity, only when clinical and echocardiographic evidence of cardiovascular or pulmonary disease has been ruled out. Conditions such as hypertension, diabetes, hyperthyroidism, acute infections, recent cardiothoracic or abdominal surgery, and systemic inflammatory diseases should be excluded also. There is no consensus as to whether atrial fibrillation occurring in patients with sick sinus syndrome should be considered lone atrial fibrillation.
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Cardiologists with strong political influence have suggested that a diagnosis of lone atrial fibrillation should be restricted to patients <60 years of age,2 although there is no evidence of any threshold values by age regarding the risk of stroke in patients with atrial fibrillation3—or in any other medical condition for that matter.4
Several other problems are associated with “threshold decision making.” Should we consider atrial fibrillation caused by overweight or obesity5,6 as lone atrial fibrillation? How little alcohol has to be consumed7–9 before we call the patient a “lone atrial fibrillator”? How much exercise must be performed before we think atrial fibrillation may be caused by excessive sporting activities10 and therefore should not be classified as true lone atrial fibrillation? And what about those individuals who experience exercise-induced atrial fibrillation11?
Perhaps we should stop using terms such as idiopathic or lone because in the end we will find a cause. Increasing knowledge is accumulating on genetics of atrial fibrillation. Should we classify patients with a strong family history of atrial fibrillation as patients with lone atrial fibrillation? There may also be gene-environment interactions that may explain some cases of so-called lone atrial fibrillation, but we have not yet discovered them, presumably because familial atrial fibrillation is a heterogenetically disorder caused by >1 gene. Thus, the diagnosis of lone atrial fibrillation seems a disintegrating clinical entity with an increasing number of subtypes of lone atrial fibrillation as our knowledge of causes of atrial fibrillation accumulates.11 So, is there anything left for a go-home message?
Scientists from the Mayo Clinic (Rochester, Minn) have for >5 decades examined and followed up patients with lone atrial fibrillation,12–18 and in this issue of Circulation, they present new data on long-term progression and outcomes with aging in patients with lone atrial fibrillation.19 These studies from the Mayo Clinic represent excellent and unique studies that will be difficult to replicate because the mean follow-up now exceeds 25 years.
Patients included in the Mayo Clinic study had a first episode of atrial fibrillation between 1950 and 1980 and had no concomitant heart disease, hypertension, hyperthyroidism, chronic obstructive pulmonary disease, or noncardiac disease that potentially could shorten life expectancy. Patients with atrial fibrillation related to surgery, trauma, or acute medical diseases also were excluded, and patients had to be <60 years of age to be included.
What are the important messages from this study? First, surprisingly few patients were classified as having lone atrial fibrillation. According to the Mayo Clinic, we are dealing with ≈2% (76 of 3623) of the total population of patients with atrial fibrillation. However, a very low proportion of lone atrial fibrillation in the total population of patients with atrial fibrillation also was observed by others.20 Patients with lone atrial fibrillation were predominantly male (78%), and young, with a mean age of 44.2 years when diagnosed. Very few patients were in permanent atrial fibrillation, and the 30-year cumulative probability of progression to permanent atrial fibrillation was as low as 29% among those who had paroxysmal or persistent atrial fibrillation at baseline.
Second, the overall survival was similar to that of the age- and sex-matched Minnesota population. Most important, all patients who subsequently had a cerebral event developed ≥1 risk factors for stroke during follow-up before the occurrence of stroke. However, the only independent risk factor for stroke identified in the present study was increasing age. But, if the study power had matched the study ambitions, we would have seen a confirmation of what is already known for the population at large: Increasing age, development of hypertension, congestive heart failure, and diabetes are risk factors for stroke also among patients with lone atrial fibrillation.
Thus, there are 2 very important lessons to be learned. Patients with lone atrial fibrillation have a normal life expectancy, and they should be offered regular follow-up examinations to evaluate if and when they might be appropriate candidates for aspirin or oral anticoagulation according to current clinical guidelines.2
The excellent survival in patients with lone atrial fibrillation implies that any treatments associated with risk of serious adverse events such as long-term antiarrhythmic drug treatment or ablation should be offered only after a careful medical history is obtained and after the patient is informed about the superb prognosis without and any risk associated with such treatment.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
The author thanks Søren Paaske Johnsen, MD, PhD, research consultant and associate professor, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, and John Godtfredsen, MD, DMSC, consultant emeritus and senior scientific associate, Department of Cardiology, Herlev University Hospital, Copenhagen, Denmark, for their helpful comments.
Dr Frost has been a consultant for AstraZeneca, Nycomed Group, and Pfizer.
Correspondence to Lars Frost, MD, PhD, Head of Cardiology, Associate Professor, Department of Medicine, Silkeborg Hospital and Clinical Institute, Aarhus University Hospital, Falkevej 1–3, DK-8600 Silkeborg, Denmark. E-mail
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Atrial fibrillation, commonly referred to as AF or a-Fib, is the most commonly occurring arrhythmia, or heart rhythm problem. AF is characterized by an abnormal or irregular heart rhythm that causes a rapid heart rate. The irregular rhythm is due to abnormal electrical impulses in the atria (the upper chambers of the heart) that cause the heart to beat irregularly and too fast.1-4
According to the American Heart Association, an estimated 2.7 million individuals in the United States have AF. The incidence of AF increases with age and occurs commonly in those older than 60 years. Although AF is not considered life threatening, if left untreated it can lead to various complications such as blood clots, stroke, and heart failure. The American Heart Association also reports that more men than women are diagnosed with AF, but women have a greater incidence of stroke-related deaths resulting from AF (Table 1).4
Causes and Symptoms of Atrial Fibrillation
The most common causes of AF include heart abnormalities or damage to the heart structure (Table 2).1-4 Some individuals who have AF are symptom free and the condition may be discovered during a physical examination, but many others experience 1 or more symptoms that vary in frequency and severity. The following are the most common symptoms1-4:
• General feeling of fatigue
• Rapid or irregular heartbeat or palpitations and/or sudden pounding, fluttering, or racing sensation in the chest
• Anxiety or shortness of breath
• Confusion or faintness
• Chest pain
Diagnosing Atrial Fibrillation
If you have symptoms of AF, you should see your physician for further evaluation. He or she may order an electrocardiogram, a Holter monitor, an echocardiogram, or a blood test to confirm a diagnosis. According to the National Institutes of Health/ National Heart, Lung and Blood Institute, AF may be classified as occasional, persistent, or permanent.2
Treating Atrial Fibrillation
Left untreated, AF can weaken the heart and may eventually cause congestive heart failure and/or a stroke. Your physician will determine the best treatment for you based on the severity of your AF, your symptoms, and the underlying cause. In general, therapeutic goals include controlling heart rhythm and rate, preventing blood clots, and decreasing the risk for stroke. Medications commonly used to treat AF include rhythm control medications (also known as antiarrhythmic drugs), rate control medications, and anticoagulant and antiplatelet medications. According to the National Heart, Lung and Blood Institute, individuals with permanent AF typically require the use of blood thinners to prevent clots.2 If medications are not effective in controlling your AF, your physician may suggest a procedure such as electrocardioversion, catheter ablation, or insertion of a pacemaker.2 Your physician will discuss the potential therapies with you to determine the best option.
Living with Atrial Fibrillation
With proper treatment, individuals with AF can live normal and active lives. It is imperative that you adhere to your prescribed therapy and maintain routine checkups with your physician. You should always discuss with your physician any concerns about your condition or medications and seek immediate medical care if your symptoms worsen. Your physician may also recommend various lifestyle measures to improve your overall health, such as:
• Quitting smoking
• Engaging in routine exercise when appropriate
• Maintaining a healthy weight
• Eating a heart-healthy diet
• Managing blood pressure and cholesterol levels
• Controlling blood glucose levels if you have diabetes
• Eliminating alcohol or reducing consumption to a moderate level
• Reducing stress and practicing relaxation techniques
Other important points to keep in mind if you have AF include the following:
• If you are on blood thinners, always inform your dentist, pharmacist, and other health care professionals that you are taking these medications, and inform your physician of unusual bleeding or bruising.
• Always ask your physician or pharmacist before using any OTC medication, including nutritional supplements and alternative remedies, because some products may contain stimulants that can affect your heart rate or cause serious drug interactions.
• Keep a current list of all medications you take, and bring the list to all checkups.
If you have AF, take a proactive role in your health and talk with your primary health care provider about the available treatments so that you can make informed decisions about your health. A number of educational resources are available for patients with AF (Online Table 3).
TABLE 3: EDUCATIONAL RESOURCES
· American Heart Association website—Atrial Fibrillation: www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Atrial-Fibrillation-AF-or-AFib_UCM_302027_Article.jsp
· National Institutes of Health National Heart, Lung and Blood Institute website—What Is Atrial Fibrillation?: www.nhlbi.nih.gov/health/health-topics/topics/af/
· National Stroke Association website—Preventing a Stroke: http://www.stroke.org/understand-stroke/
Ms Terrie is a clinical pharmacist and medical writer based in Haymarket, Virginia.
References: 1. Afib-stroke connection. National Stroke Association website. www.stroke.org/understand-stroke/preventing-stroke/afib-stroke-connection. Accessed November 5, 2014.
2. Who is at risk for atrial fibrillation? National Institutes of Health National Heart, Lung and Blood Institute website. www.nhlbi.nih.gov/health/health-topics/topics/af/atrisk.html. Published September 18, 2014. Accessed November 5, 2014.
3. Atrial fibrillation. Medline Plus website. www.nlm.nih.gov/medlineplus/atrialfibrillation.html#cat5. Reviewed June 25, 2014. Accessed November 5, 2014.
4. FAQs of atrial fibrillation. American Heart Association website. www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_424424.pdf. Accessed November 5, 2014.
8 Atrial Fibrillation Myths, Debunked
Atrial fibrillation, also known as Afib, is the most common type of arrhythmia, and it currently affects almost 2.5 million Americans. And, as with many health issues, there’s a lot of misinformation circulating about Afib. Get the truth behind these common atrial fibrillation myths so you can better understand this form of irregular heartbeat.
Myth: Atrial fibrillation only affects the elderly.
Fact: Yes, Afib is more common in people over 70, and the greatest number of cases is in people 80 and older — but it can occur at any age. Among adults younger than 55, fewer than one in 1,000 have atrial fibrillation. However, the risk of developing Afib over a person’s entire life is considered to be between 18 and 25 percent. The causes vary, and can include everything from trauma to medications to heart attack.
Myth: You can tell when you’re having atrial fibrillation symptoms.
Fact: The symptoms of Afib may be barely noticeable or even nonexistent. Atrial fibrillation symptoms are not always noticeable because the chamber that is fibrillating, or quivering, is the small upper chamber, which doesn’t do the bulk of the work in pumping blood. “If a healthy or near-normal heart goes into Afib, there’s still normal pump function from the lower chamber, which helps the blood flow passively through the upper chamber that is fibrillating,” says Thomas Togioka, MD, a cardiologist at Marina Del Rey Hospital in Marina del Rey, Calif. “There is a small loss of efficiency that, in a normal heart, may not be noticed.”
Myth: You can’t exercise when you have atrial fibrillation.
Fact: For most people, this is false. “Exercise is typically fine for people with atrial fibrillation, as long as their heart rate does not get too fast,” says Sarah Samaan, MD, a cardiologist at Legacy Heart Center; a physician partner at the Baylor Heart Hospital in Plano, Texas; and author of Best Practices for a Healthy Heart: How to Stop Heart Disease Before or After It Starts. “Some people who are in atrial fibrillation may notice poor endurance and shortness of breath while exercising. And exercise may provoke an Afib episode in people with paroxysmal atrial fibrillation (meaning the symptoms start and stop on their own). But generally, instead of discouraging people from working out, we work to find a treatment that controls the problem and allows them to stay active.”
Before you start exercising, it’s important to talk to your doctor or cardiologist about which exercises are best for you, and whether or not you should use a heart rate monitor during your workouts.
Myth: Diet doesn’t affect atrial fibrillation.
Fact: Caffeine and alcohol, along with other stimulants, can trigger atrial fibrillation symptoms. In addition, very rich foods may be a problem for some people. And salty foods can raise blood pressure, which in turn could provoke an Afib episode.
Myth: The biggest risk of atrial fibrillation is having a heart attack.
Fact: With atrial fibrillation symptoms like heart palpitations, it’s easy to see why people think this. In reality, the largest risk of atrial fibrillation is an embolic stroke, which occurs when a blood clot forms, commonly in the heart, and is swept through the bloodstreams to the brain. “Not everyone with Afib is at a high risk of a stroke, but many are,” says Dr. Togioka. However, certain types of atrial fibrillation treatment such as anti-clotting drugs, can help prevent stroke.
Myth: Atrial fibrillation affects life expectancy.
Fact: It depends. Younger, generally healthy people who keep symptoms under control and take medications to prevent stroke typically do not have an increased risk of death from Afib. However, the underlying cause is usually the determining factor. Someone who developed atrial fibrillation after a heart attack that caused significant heart muscle damage may have a worse prognosis than someone with treatable high blood pressure and a normal heart.
Myth: Electrically shocking the heart fixes atrial fibrillation.
Fact: “Although an electrical cardioversion procedure resets the heart rhythm back to normal for most people, it has no impact on whether or not atrial fibrillation will return,” says Dr. Samaan. The low-energy shocks of electrical cardioversion succeed about 75 percent of the time, but the procedure often has to be repeated because the arrhythmia returns.
Myth: Atrial fibrillation can be cured.
Fact: It depends on the cause. Thyroid disorders and binge drinking, for example, can both lead to Afib, but if those conditions are treated, the Afib should resolve. On the other hand, causes such as high blood pressure and coronary artery disease generally result in cases of Afib that are not curable — but they are manageable.
If you have questions about Afib and the best ways to manage it, talk to your doctor.
Can a Person Live with Atrial Fibrillation?
In general, the outlook for most individuals with AFib is good to fair, depending on the cause of the disease and how well the patient responds to treatment. The most dangerous complication of atrial fibrillation is stroke.
- Someone with atrial fibrillation is about 3-5 times more likely to have a stroke than someone who does not have atrial fibrillation.
- The risk of stroke from atrial fibrillation for people aged 50-59 years is about 1.5%. For those aged 80-89 years, the risk is about 30%.
- Warfarin (Coumadin), when taken in appropriate doses and monitored carefully, reduces this risk of stroke by over two-thirds.
- It is important to know that clinical trial data have shown that individuals can live just as long with atrial fibrillation with a controlled heart rate — for example, with medications plus Coumadin — as other people in normal sinus rhythm (AFFIRM trial).
Another complication of atrial fibrillation is heart failure.
- In heart failure, the heart no longer contracts and pumps as strongly as it should.
- The very rapid contraction of the ventricles in atrial fibrillation can gradually weaken the muscle walls of the ventricles.
- This is uncommon, however, because most people seek treatment for atrial fibrillation before the heart begins to fail.
Patients with complications of stroke or heart failure have a more guarded outcome than those without complications. However, for most people with atrial fibrillation,relatively simple treatment dramatically lowers the risk of serious outcomes. Those who have infrequent and brief episodes of atrial fibrillation may need no further treatment other than learning to avoid the triggers of their episodes, such as caffeine, alcohol, or overeating.
For more information, read our full medical article on atrial fibrillation.
Catheter ablation helps atrial fibrillation patients live longer
A new long-term study suggests that adult patients with atrial fibrillation whose heart rhythm is successfully restored with a minimally invasive procedure called catheter ablation, have a significantly reduced chance of early death from a heart attack or heart failure.
Share on Pinterest”The study findings show the benefit of catheter ablation extends beyond improving quality of life for adults with atrial fibrillation,” say the researchers.
The team, from the University of Michigan (U-M) at Ann Arbor, reports the findings in the journal Heart Rhythm.
Atrial fibrillation is an age-related heart rhythm disorder caused by electrical “short-circuits” in the heart that impair its ability to pump blood efficiently and cause fluttering sensations in the chest.
People with atrial fibrillation have a higher risk of stroke and heart attacks, and they also suffer a considerably poorer quality of life.
According to the World Heart Federation, who describe the condition as a “growing and urgent public health concern,” atrial fibrillation is the most common sustained abnormal heart rhythm condition worldwide.
In Europe and the US, there are currently estimated to be about 9 million people with atrial fibrillation, and numbers are set to increase.
Catheter ablation led to 60% lower rate of deaths from cardiovascular events
Catheter ablation is a minimally invasive procedure where an electrophysiologist delivers radiofrequency energy to the heart muscle through a specially designed catheter inserted into the left atrium or chamber of the heart.
The intention is to disrupt the short-circuits that are causing the irregular heart rhythm.
The catheter is inserted with a needle into a vein that runs up to the heart from the groin. A three-dimensional mapping system on a computer helps the doctor guide the catheter precisely to the correct location in the heart.
In this latest study, the U-M researchers showed that death from cardiovascular events dropped by 60% among adults who had their normal heart rhythm successfully restored with catheter ablation.
Lead author Dr. Hamid Ghanbari, an electrophysiologist at U-M’s Frankel Cardiovascular Center, says:
“The study findings show the benefit of catheter ablation extends beyond improving quality of life for adults with atrial fibrillation. If successful, ablation improves life span.”
Even older patients, and those with other conditions benefited
He and his colleagues found that even older patients gained the cardiovascular survival benefits of the procedure, as did those with diabetes or a history of stroke, or who had sleep apnea, or a condition known as low-ejection fraction – an early sign of heart failure where the heart does not pump enough blood.
In an accompanying editorial, that characterizes catheter ablation of atrial fibrillation as “a death-defying endeavor,” the authors describe the study results as encouraging for those involved in treating the debilitating heart condition.
For their investigation, Dr. Ghanbari and colleagues examined 10 years of follow-up medical data on over 3,000 adults who had received catheter ablation as a treatment for paroxysmal atrial fibrillation – where the condition comes and goes on its own. Most of the participants, whose average age was 58 when they received the treatment, were men.
The study is thought to be the first and longest to examine the clinical outcomes of catheter ablation.
Meanwhile, Medical News Today recently learned how another new study found light may treat atrial fibrillation painlessly. Presenting at a conference in Spain, researchers explained how rather than relying on painful electric shocks, they are studying a new “optogenetic” treatment that uses light to achieve defibrillation in patients with atrial fibrillation.