When the Heart Gets Out of Control: What is Atrial Fibrillation and How Can You Cope With It?
It’s the most common heart arrhythmia disorder in the world but remains very difficult to diagnose. This is what you can do to reduce your risk.

Atrial Fibrillation (AFib) is the most common heart rhythm disorder in the world. Annually, 4.7 million patients are diagnosed with AFib and a total of over 33 million people around the world suffer from the condition. For example, Atrial Fibrillation affects 0.9% of Singapore’s general population and 0.8% of the general population in Hong Kong. It may present itself differently for different people, but the most common symptoms include a rapid heartbeat and chest pain. However, some cases don’t present any noticeable or unusual symptoms.

When the heart functions normally, it pumps blood into the lungs and other parts of the body a specific rhythm, or “beats”. Heartrate changes frequency according to the body’s needs. During atrial fibrillation, however, the upper (atrial) parts of the heart beat rapidly, regardless of the body’s true needs. This results in increased and uncoordinated contractions, known as fibrillations. While a normal heartrate is 60-100 beats per minute, during an episode of Atrial Fibrillation, it reaches between 101 to 175 beats per minute.

Atrial Fibrillation causes improper blood flow from the heart. This results in a lack of oxygen in the body cells, which causes dizziness, weakness, shortness of breath and, in some cases, fainting. The duration and frequency of the “episode” may vary between patients, depending on the type of fibrillation. Moreover, the rapid fibrillations only allow partial atrial contraction, meaning that the atria do not fully drain, leaving excess blood in the heart instead of pumping it to the different body parts. This increases the chances of blood clotting within the heart. These blood clots might then travel to the brain, block the small vessels in it and eventually cause a stroke.

When the Heart Goes Out of Sync

So, we understand the meaning of AFib, but why does it occur in the first place?

Inside the heart, a specialised group of cells called the sinus node functions as the body’s natural pacemaker. By producing and timing electrical signals to the various parts of the heart, the sinus node causes the heart muscle to contract in a synchronised and coordinated manner. Different illnesses can overload the heart, placing strain on the sinus node, which in turn impairs their activity. For example, high blood pressure or Chronic Obstructive Pulmonary Disease (COPD) make it difficult for the heart to regularly pump blood, so the sinus node increases its function and may erode. Certain drugs can also interfere with the sinus node’s activity. In such cases, the heart may get “out of sync” and cause fibrillation. In one third of all AFib cases, sinus node damage occurs without prior illnesses and is caused by trauma, electrolyte imbalance or excessive alcohol consumption.

Although Atrial Fibrillation is not considered life-threatening in itself, if it goes untreated, it increases the risk of heart attack (15% to 20% of heart attacks occur in patients with history of Atrial Fibrillation), cardiac failure or stroke. Cardiologists estimate that untreated AFib doubles the chance of death from cardiovascular disease.

Nevertheless, global awareness of these dangers and of the importance of treatment is at a low. According to a survey by the American Heart Association among patients with Atrial Fibrillation, less than half reported being aware of having an increased risk of heart disease and death. Only one-third of those surveyed considered the diagnosis a serious medical condition.

The Diagnosis May Take Time

There are several types of Atrial Fibrillation: Paroxysmal AFib, which spontaneously returns to a normal heartbeat after a few minutes or hours; Persistent AFib, which requires external intervention in order to restore a normal heartbeat; and Chronic Atrial Fibrillation, which does not respond to drugs or devices that encourage electrical normalisation of the heart rate.

Since not all types of fibrillation occur continuously, the diagnosis may take time and the appropriate tests must be conducted by a cardiologist who specialises in arrhythmia. In order to reach a diagnosis, an ECG (electrocardiogram) device is attached non-invasively to the patient’s body and records the cardiac activity. The monitoring can be done at a clinic or via a mobile device known as a Holter Monitor, which allows the patient to walk around and go about his or her daily routine while heart activity is monitored for 24 hours or longer.

In certain cases, in order to reach a diagnosis, Atrial Fibrillation is induced in controlled conditions and under medical supervision, for example, through strenuous physical activity. In other cases, the doctor may need to conduct an invasive, electrophysiological examination to determine the source of the arrhythmia. Blood tests may also be needed to examine background factors that might cause the heart problem.

How is it Treated?

Treatment options for atrial fibrillation depend on the fibrillation’s type and frequency. In some cases, the cardiologist will offer pharmacological treatment, such as beta blockers which reduce the chance of arrhythmia. Alternatively, a doctor may recommend taking anticoagulants (blood thinners) in order to reduce the chance that the fibrillation will result in harmful blood clots. If the Atrial Fibrillation persists despite drug treatment, or if it is a severe fibrillation, an electrical inversion (Cardioversion) may be required. Such a procedure is performed with a defibrillator under the supervision of trained doctors.

In situations where the fibrillation returns despite the mentioned treatments, surgical procedures may be required. During surgery, areas of the cardiac tissue identified as stimulating the fibrillation are ablated, or alternatively, an external pacemaker is implanted in order to monitor regular heart contraction, replacing the body’s natural pacemaker, the sinus node.

What Each of us Can Do?

Researchers are still attempting to fully understand the reasons why the sinus node’s function is disrupted in such a way as to lead to Atrial Fibrillation. Until conclusive findings are obtained, however, the primary recommendation to those wishing to maintain heart health is to sustain a healthy lifestyle: keeping a healthy weight, avoiding smoking, moderating alcohol and caffeine consumption and reducing stress factors can help avoid cardiac disease.

If you believe that you may have any cardiac symptoms, even if they do not match the typical symptoms of a heart attack, you should urgently consult with a doctor or go to the emergency room and check for Atrial Fibrillation or other heart conditions, as early diagnosis saves lives.

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