Atrial Fibrillation (AF) is a common condition affecting the elderly. The prevalence of AF increases with age. It is estimated that 1% of individuals above the age of 60 and 8% of individuals above the age of 80 years must be suffering from AF
AF means fast beating of the upper chambers (atria) of the heart. The atrial rate is expected around 400-600 beats per minute. At this rate there is no effective contraction of the upper chambers and this causes blood to stagnate. This can cause small clots which can then migrate to the brain causing stroke. The other symptoms of this condition may be palpitations and breathlessness. A fast heart rate for a long time may also cause the heart pumping to go down and cause a condition called heart failure.
AF increases stroke risk!
The most devastating consequence of this heart beat disorder is stroke. The elderly (aged > 65 years) are at high risk of stroke. The other risk factors for stroke are blood pressure, heart failure, diabetes and patients who have had strokes in the past.
Treatment of AF:
Treatment of AF is two-fold.
1. The primary goal is to prevent strokes.
Patients with the highest risk should receive blood thinners. Warfarin and Dabigatran are the commonest drugs used. Individuals at lower risk can be treated with Aspirin.
2. The second goal of treatment is to control or prevent AF.
Patients who have had AF for a long duration are on drugs which slow down the heart rate and thereby reduce palpitations. In the initial stages of the disease, the recurrence of the condition (AF) can be prevented by medications. There are multiple drugs available and should be taken in consultation with physicians.
The main goal of treatment still remains Stroke Prevention.
Do you experience Fast heart rates (Tachycardias)?
What do the patients complain of?
The patients tend to complain of episodes of palpitations due to fast heart rates. Some patients may feel giddy or have episodes of fainting if the heart rates are too fast.
How is this condition diagnosed?
The condition can be diagnosed by a electrocardiogram (ECG) which reveals the fast heart rate. Some patients may need to undergo EP study to diagnose this condition.
What are the causes of Fast heart rates?
These can be due to various causes, however, the common one seen are SVT (supra-ventricular tachycardia), AF (atrial fibrillation) and VT/VF (ventricular tachycardia/ fibrillation).
- SVT (Supra-Ventricular Tachycardia): These are caused by the presence of an extra electrical connection between the upper and lower chambers. These patients experience intermittent fast heart rates associated with palpitations and lightheadness. The episodes can be highly distressing and limit one’s activities. They can be easily controlled with medications. However, with the advent of new technology, it has become easier to get rid of them and cure the patient of the fast heart rates. The procedure is called EP (electrophysiology) study and is carried out by inserting small catheters via one’s groin upto the heart. The heart is then stimulated to start the fast heart rate and the location of the extra connection is studied. The pathway can be burnt (ablated) by radiofrequency energy in a controlled manner with the help of catheters. These procedures have a good success rate (> 90%) and take around 2-3 hours. The patient can be mobilized after few hours and discharged the next day.
- Atrial fibrillation: This is a disease of the elderly in which the upper chambers (atria) beat at extremely fast rates (400-750 beats/minute). Thus there is no effective pumping of the upper chamber, causing blood to stagnate and form clots which can cause strokes in high risk individuals. These patients need to be treated with drugs called blood thinners to reduce the risk of stroke. In addition, drug therapy is required to prevent the lower chambers from going fast which can be very distressing to the patient or life threatening. Ablation therapy can be offered in some patients in the early form of the disease. The procedure lasts 4-6 hours and are done through the groin. The chances of recurrence are high (around 30%)
- VT (ventricular tachycardia): These are life threatening and are responsible for sudden cardiac deaths. Most of the patients who suffer from these either have blocks in their blood supply to the heart (have suffered heart attacks before) or have low pumping function of the heart. These patients can be controlled by oral medications. However, devices called Defibrillators are implanted to treat future episodes and to reduce the death rate in patients with heart attacks and poor heart function. These are implanted just like pacemakers except that they have the additional function to detect and shock these dangerous rhythms. In patients with poor heart functions, an extra wire (lead) is placed on the left side of the heart to improve the heart function.
More than 10 million people in India have atrial fibrillation, making it a very common heart rhythm disorder. In AF, the heartbeat is irregular and rapid, sometimes beating as often as 300 times a minute, about four times faster than normal. Although it isn’t life threatening, A Fib can lead to other rhythm problems, chronic fatigue and congestive heart failure. Chances of having a stroke are five times higher for those with A Fib. There are a number of effective treatments to control A Fib (for consistency) and/or reduce the risk that it will cause serious health problems.
What’s is AF?
AF is nothing but fast beating of the upper chambers of the heart (atria).
What does AF cause?
Patients with AF feel severe palpitations, uneasiness in the chest and sometimes breathlessness.
What harm can AF cause?
The greatest harm that AF causes is Stroke or Paralytic attacks. These are due to blood clots occluding the arteries in the brain circulation. Also if the individual has a persistently high heart rate, it can cause weakness of the heart muscle.
Where do these blood clots come from?
These blood clots are formed in the upper chambers of the heart. Due to
AF, there is stasis of blood in the upper chambers/ atria and this causes blood clots to form. These blood clots can then migrate to the brain causing strokes.
How do I prevent strokes if I have AF?
One needs to take tablets called blood thinners to prevent clot formation. Elderly patients and patients with diabetes, high blood pressure and weak hearts are more likely to have strokes and so need to be on blood thinners.
How can AF be treated?
AF can be treated by medications prescribed by your cardiologist. Some of the patients can be cured by a procedure called Ablation in the early stages.