Atrial Fibrillation

Atrial fibrillation is caused by abnormal electrical activity in the upper chambers which causes an irregular and rapid rhythm in the lower chambers.

Atrial fibrillation (AF) is an abnormal heart rhythm (arrhythmia) characterised by rapid and irregular beating. This is caused by unusual electrical activity in the upper chambers (atria) of the heart which causes the lower chambers (ventricles) to beat quickly and irregularly. It is the most common heart rhythm problem and can occur in patients of any age though it is more commonly seen in older patients. AF is not immediately life-threatening but may result in heart failure in acute and chronic settings. AF also predisposes a patient to blood clot formation in the atria, particularly the left atrial appendage. In an event of clot embolisation from the heart to the brain, a stroke occurs.

Understanding Atrial Fibrillation

Types of Atrial Fibrillation

Atrial fibrillation (AF) can be classified into four categories based on severity.

1. Paroxysmal atrial fibrillation (occasional): The AF comes and goes spontaneously, and usually last for a few minutes to hours. Patients may feel intermittent palpitations with this. 
2. Persistent: The AF might last for more than seven days and require treatment with medication to restore a normal heart rhythm.
3. Long-standing persistent: The AF occurs often for a period of more than a year.
4. Permanent: AF is continuously occurring and the patient accepts that this will be long-term.

Possible complications of Atrial Fibrillation

If atrial fibrillation (AF) is left untreated, it can lead to life-threatening complications like strokes or heart failure.

1. Stroke
   
   
   Atrial fibrillation increases the risk of stroke by five times.

   For patients with AF, the upper chambers of their heart are not pumping effectively. As such, blood flow is slow or stagnant which may cause blood clots to form. If these blood clots travel through the blood stream and block the arteries in the brain, a stroke can happen.

2. Heart Failure
   AF can weaken the heart by making the heart work harder and reducing its ability to pump blood around the body efficiently. As the heart beats rapidly, it is unable to completely fill up with oxygen-rich blood to transport to the brain and other parts of the body, leading to fatigue, shortness of breath, and even causes fluid to build up in the lungs, legs, ankles and feet.
   

Some common symptoms of atrial fibrillation (AF) are:

• Palpitations or heart flutters
• Shortness of breath
  
• Chest discomfort
• Fainting spells
• Dizziness
• Fatigue and exercise intolerance

It is important to note that some people with AF, especially those who are older, might not experience symptoms. Please visit a doctor if you have occasional chest pains or have an abnormally high or low heart rate.

Treatment and control of underlying medical or cardiac problems may help one reduce the risk of developing atrial fibrillation (AF). This includes:

• Managing high blood pressure (hypertension): Taking medication and making lifestyle changes to manage hypertension reduces the risk of AF.
  Exercising regularly: Moderate-intensity exercise lowers blood pressure and reduces the risk of coronary artery disease that could lead to development AF.
  
• Eating a heart healthy diet: Eat more whole grains, vegetables and fruits and cut down on salt and solid fats. This reduces one’s risk of medical conditions such as coronary artery disease which are associated with higher risks of experiencing AF.
  
  
  Eating a heart healthy diet can reduce the risk of many conditions associated with higher risks of experiencing atrial fibrillation

• Maintaining a healthy weight: One should aim to maintain a healthy Body Mass Index (BMI) under 27 kg/m2. This will help to reduce the effects or complications associated with AF.
• Smoking cessation: Quitting smoking reduces the risks of AF.
• Managing stress: This reduces one’s risk of experiencing an abnormal heart rhythm like AF.
• Reducing alcohol or caffeine consumption: Drinking too much caffeine or alcohol, especially binge drinking, can trigger incidences of AF.
  

There are many diagnostic tests available for the diagnosis of atrial fibrillation (AF) such as:

• Checking pulse: This is a simple test that can help with the detection of AF and can be done by the doctor as part of a physical examination or by yourself. If you are checking your own pulse, make sure you do not smoke or consume caffeine before taking the measurement. 
• Electrocardiogram (ECG): This is the main diagnostic test for AF. It measures your heart rhythm and electrical activity, which shows if the heart is beating too quickly. If you have AF, the ECG should show absent P waves and rapid disorganised electrical activity.
• Holter: A Holter monitor is a portable ECG recorder which measures your heart rhythm for 24 to 48 hours. This is used because a typical ECG is rather short and may not be able to capture a moment of AF.
• Blood tests: Help check for possible conditions that might lead to AF.
• Echocardiogram: An ultrasound of the heart allows doctors to look at the functions and structures of the heart and valves to detect any structural abnormalities.
  

Aside from these tests, a thorough medical history will be obtained from patients with suspected or known AF.

A) Heart Rate or Heart Rhythm Control 

1) Medications 

Medical therapy with drugs can be given to slow down the heart rate or convert AF back to the normal sinus rhythm.

 

2) Procedures 

• Electrical cardioversion: An electric shock will be delivered to the heart to convert an irregular or rapid heart rhythm (arrhythmia) back to a normal heart rhythm.  
• Catheter ablation: A thin tube called an electrode catheter is used to conduct an electrophysiology study (EPS) which locates the site causing the abnormal heart rhythm. A radiofrequency energy is then delivered to ablate (or destroy) areas of abnormal electrical activity. 

B) Stroke Prevention

​Watch our videos on Atrial Fibrillation:

理解心房颤动 / Understanding Atrial Fibrillation (Chinese version)

Memahami Fibrilasi Atrium Bersama / Understanding Atrial Fibrillation (Malay version)