Atrial Fibrillation is an abnormality of electrical conduction affecting the atrial chambers of the heart, which rather than beating in a coordinated and purposeful manner, contract in a haphazard and ineffective way. In its early form, Atrial Fibrillation may occur in a spontaneous manner for short periods. This is known as “Paroxysmal Atrial Fibrillation”. As the disease progresses, it becomes more “Persistent” requiring therapeutic interventions such as cardioversion (a shock across the heart) to revert the heart to regular rhythm. Ultimately Atrial Fibrillation becomes ”Permanent”.
Atrial Fibrillation is a very common abnormality of heart rhythm that occurs in about 1% of people under 60 years of age and as many as 10% of the population over the age of 80 years suffer from Atrial Fibrillation. For many years Atrial Fibrillation was regarded as a benign arrhythmia. Nowadays, it is recognized as a sinister rhythm abnormality because it is associated with serious complications (heart failure, heart dilatation, and stroke) and increased risk of death.
All patients with Atrial Fibrillation should be investigated thoroughly to look for potential causes. Blood tests and an echocardiogram are essential tests. Patients with an overactive thyroid gland can develop Atrial Fibrillation. Mitral valve disease is also associated with Atrial Fibrillation.
Paroxysmal Atrial Fibrillation can produce a variety of symptoms such as palpitations, shortness of breath, and general feeling of ill health. Paradoxically, by the time permanent Atrial Fibrillation develops, patients have become tolerant of their arrhythmia and the associated reduction in cardiac function.
“Atrial Fibrillation can promote clot formation within the heart that can dislodge (embolise) anywhere into the circulation. If clot embolises to the brain, a stroke is the result.”
Antiarrhythmic drugs can be used in an attempt to revert the heart back to regular rhythm in the early phase of the disease. As the Atrial Fibrillation becomes more persistent, cardioversion may be required. In patients with permanent Atrial Fibrillation, controlling the heart rate with Antiarrhythmic drugs such as Digoxin can help to control symptoms.
All patients with Atrial Fibrillation should be started on Warfarin to thin the blood in order to reduce the risk of intracardiac clot formation. The only exception, are those patients in whom Warfarin therapy is contraindicated (e.g. previous history of bleeding disorder).