Lesson 1: What is atrial fibrillation?
Atrial fibrillation is an abnormal heart rhythm that causes a fast and irregular pulse. In atrial fibrillation, parts of the atria send disorganized electrical impulses into the top of the heart. These abnormal discharges cause the atria to shake like jelly. This activity takes over the heart's normal beats, and the body is not able to control how fast the heart is beating. This causes the most common symptom of atrial fibrillation: fatigue.
The most common symptom of afib is fatigue
Atrial fibrillation is the most common type of abnormal heart rhythm. An estimated three to six million Americans have it. In fact, it happens so commonly, doctors have a nickname for it — “a fib." Most often, the risk of a fib increases as we get older. As people age, so does their heart, and age is the biggest risk factor for developing a fib. Just 2% of people under the age of 65 have atrial fibrillation, but as high as 9% of those over the age of 65 have it.
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2% of people under the age of 65 have a fib, but as high as 9% of those over the age of 65 have it
What causes afib?
Advanced age
This is the most important risk factor.
Obesity
Thyroid problems
Too much alcohol, caffeine or energy drinks
Lung problems like COPD
Sleep apnea
Severe illness
Afib causes two main problems:
Afib can cause symptoms
Afib increases your chances of having a stroke
Lesson 2: Atrial Fibrillation and the Risk of Stroke
Strokes caused by afib
To understand how are strokes caused by afib, we need to look at a part of the heart called the left atrial appendage. This part of the heart is kind of like the heart's tail. When afib starts, the atria shakes like jelly. This type of movement does a bad job at pushing blood out of the top part of the heart and into the bottom. Because of this, some of the blood pools inside the heart’s little tail, where it settles and can form blood clots.
The left atrial appendage can squeeze the clots out into the body. The most common place a blood clot goes after it leaves the heart is the brain.
In afib, some of these formed clots inside the left atrial appendage can detach. If the heart breaks out of afib and starts squeezing normally again, the tail appendage can squeeze the clots out. The clots can then be launched into the body. The most common place a blood clot goes after it leaves the heart is the brain. If a clot lands in your brain, it can obstruct the blood flow and cause a stroke. A stroke can have a huge impact on a person’s life, even taking away their ability to talk and move independently.
Calculating Your Stroke Risk
If you have afib, it is important to find out your stroke risk so you can decide if you need to protect yourself from one. Fortunately there is a tool that can help you and your doctor quickly determine your risk. This tool is called the CHADS VASc score. This score looks at all the factors that increase stroke risk in people with afib.
The CHADS VASc score looks at all the factors that increase your stroke risk if you have afib.
If your score adds up to 0 or 1, then your stroke risk is low.
For any score over 2, protection with a blood thinner or what is called an occlusion device is recommended.
Calculate your CHADS VASc Score here by adding all the conditions that apply to you:
Stroke Prevention in Atrial Fibrillation
Until recently, Coumadin, also known as Warfarin, was the only choice of blood thinner available for patients with afib. Coumadin can protect from a stroke but it is a very difficult drug to take as it requires frequent testing. Fortunately, there are now four new oral blood thinners that do not need regular blood draws for monitoring and have minor interactions with food and other medications.
If a patient is bleeding or is at high risk of bleeding because of frequent falls, job activities or sports, or has had head trauma, an occluding device for the left atrial appendage is recommended. An occluding device may also be used if the patient has a history of not taking their prescribed medications.
Doctors in the US offer two occlusion devices that can protect you permanently from a stroke:
The Watchman® Device:
A plug is placed inside the left atrial appendage so clots cannot settle inside of it.
The Lariat® Device:
Ties off the left atrial appendage altogether so it can no longer cause the problem.
Lesson 3: Atrial Fibrillation and its Symptoms
What are afib symptoms?
Afib can feel like
Symptoms of atrial fibrillation (afib) can be different for everyone. The same irregular heart rhythm can cause severe symptoms in one person and literally nothing in others. The most common symptom of afib is fatigue, but people with afib can also feel their heart racing (palpitations), shortness of breath, chest pain, and even anxiety.
The most common symptom of atrial fibrillation is fatigue.
Afib treatments
There are medications available that can help treat the heart so that afib happens much less often; this can lead to an improvement in symptoms. These medications are called “antiarrythmics”, and as a group have only a modest ability to help and several potential side effect. The most common and powerful of these medications is called Amiodarone.
Although amiodarone is very effective at controlling atrial fibrillation, its down side is that it can potentially cause serious side effects. Amidorone can affect the thyroid gland, making it either over-or underactive. Also, taking amiodarone for a long time can lead to changes in skin coloration and lead to an untreatable condition that scars the lungs permanently.
Over the last two decades, atrial fibrillation has also been treated with a procedure called an ablation. The ablation procedure was invented in the 1990s and has been dramatically improved over time. It can offer patients improvement in symptoms and mortality while reducing the need for medications and their side effects.
Atrial fibrillation ablations can improve symptoms and reduce mortality while at the same time reducing the need for medications and their side effects.
With an ablation, doctors can precisely target the root of the problem that causes afib. Using space age technology, doctors trace the abnormal electrical discharges that provoke the irregular heart beat and locate the parts of the heart where they occur. Up to 85% of these happen in the part of the heart that receives blood from the lungs: the pulmonary veins . Once they locate these trigger areas, doctors then enter the heart using a minimally invasive approach. Inside the atrium they target and zap or “ablate” these abnormal trigger areas while leaving the normal parts alone.
How effective are atrial fibrillation ablations?
The earlier the problem is treated the more effective an ablation will be.
90% effective at treating afib that comes and goes, called “paroxysmal”.
70-80% effective at treating "persistent" afib that has been occurring for less than one year.
60% effective at treating afib that has been happening for over a year.
Since 2016, the procedure of afib ablation has begun to expand to include the left atrial appendage. When the left atrial appendage is ablated in addition to the ablation around the pulmonary veins, the procedure’s effectiveness improves by approximately 20%. Many studies have shown that this updated ablation procedure is safe and does not increase the risks related to ablation.
Regardless of how long afib has been going on, it is never too late for treatment. Even in those who have had it for a long time, reducing the amount of time the heart stays in afib can lead to an improvement in symptoms.
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