October 18, 2011 > Why You Should Know About Atrial Fibrillation
Why You Should Know About Atrial Fibrillation
Irregular Heartbeat Is Dangerous and Difficult to Diagnose
Medical conditions and terminology can take on an almost fictional quality after we've heard them on our favorite medical drama too often, making them feel worlds away.
But when it comes to atrial fibrillation, also known as A fib or AF, this condition is anything but fiction. It is not only the most common type of irregular heartbeat, but also one of the main risk factors for stroke, the No. 4 killer of Americans. In fact, AF accounts for between 15 percent and 20 percent of strokes in the U.S., according to American Heart Association (AHA) data.
"It is important to identify these patients and treat them so that they don't go on to have strokes," according to Ash Jain, M.D., cardiologist and Medical Director of Washington Hospital's Stroke Program, a comprehensive Primary Stroke Center, certified by the Joint Commission in collaboration with the American Stroke Association.
Unfortunately, both diagnosis and treatment of AF pose unique challenges. First and foremost, simply identifying patients with AF can be difficult, mostly due to the fact that signs of AF may - or may not - show up, even after extensive monitoring, Dr. Jain explains.
"When someone has an irregular heart beat all the time, it is easiest to diagnose," Dr. Jain says. "However, if it comes and goes, it is more difficult to diagnose. And it is important to note that even if the irregular heartbeat comes and goes - known as paroxymal AF - it is equally dangerous as one that persists all the time.
"This is why a lot of patients with an irregular heart beat that comes and goes end up having strokes."
When patients are identified as having AF, Dr. Jain says the treatment process becomes a delicate balancing act between addressing the symptoms and preventing complications due to medications.
"The problem is that when you treat patients, you have to treat them with blood-thinning medications, and there is a risk of bleeding," he says. "You have to carefully measure the risk of stroke versus the risk of bleeding."
Despite these challenges, Dr. Jain urges people not to ignore any sign of AF.
"Irregular heartbeat causes heart function to decrease by as much as 30 percent," he says. "This decrease in function makes people tired, short of breath and they experience less energy and weakness and tiredness because of this. They definitely need to get a complete checkup if they are experiencing these symptoms."
The good news, according to Dr. Jain, is that treatment is possible. Treating physicians might employ a variety of options to achieve goals cited by the National Heart Lung and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), including:
* Preventing blood clots from forming, thus lowering the risk of stroke.
* Controlling how many times a minute the ventricles contract.
* Restoring a normal heart rhythm, referred to as rhythm control, which allows the atria and ventricles to work together to efficiently pump blood to the body.
* Treating any underlying disorder causing or raising the risk of AF.
"You can control the heart's rhythm, but you don't know how long a patient will stay in sinus rhythm - which is the normal beating of the heart - so they need to be on blood thinners," Dr. Jain notes. "Because it is so difficult to make the diagnosis, you don't want to take a chance."
While blood thinners carry the risk of bleeding, preventing stroke far outweighs the risk associated with using these medications, he says.
"The risk of bleeding from blood thinners is much less than the risk of stroke from uncontrolled atrial fibrillation - 0.5 percent versus at least 6 percent. Treating these patients with radio frequency ablation is an option."
Ablation is a procedure that typically employs catheters to correct structural problems in the heart causing the arrhythmia. The long, flexible tubes are inserted through a vein in the groin and threaded to the heart. Ablation helps the heart maintain a regular rhythm, thereby helping to avoid negative effects of AF, such as a weakening of the heart muscle and a loss of synchronous function, according to Dr. Jain.
"In these cases patients are still on blood thinners and may require a pacemaker, so patients still are not back to normal."
Ultimately, Dr. Jain wants the people to understand the risk of AF so that they can talk to their physician about their risk factors for stroke.
"It is difficult to diagnose and treat, but community members have to be aware of the symptoms of atrial fibrillation-like palpitation, irregular heartbeat and feeling tired and short of breath - because it can cause stroke and heart failure, and we can control it and make things better if we know about it," Dr. Jain concludes.
Are you at risk?
According to the NHLBI, risk factors for AF include:
* High blood pressure (hypertension)
* Coronary heart disease (CHD)
* Heart failure
* Rheumatic heart disease
* Structural heart defects, including mitral valve prolapse
* Pericarditis, an inflammation of the fibrous sac surrounding the heart
* Congenital heart defects
* Sick sinus syndrome, which happens when the heart's electrical signals don't fire properly and the heart rate slows down, sometimes switching back and forth between a slow rate and a fast rate
Other conditions that raise the risk for AF include hyperthyroidism (too much thyroid hormone), obesity, diabetes, and lung disease.
Washington Hospital is currently developing a program specifically for the treatment of atrial fibrillation, bringing in physicians who specialize in this area of treatment. Dr. Sanjay Bindra, who was formerly an assistant professor at the University of California, Los Angeles (UCLA) recently joined the Washington Hospital medical staff for this purpose, according to Dr. Jain.
The heart (and brain) of things
To find a physician who specializes in atrial fibrillation, visit www.whhs.com/physicians and search by name, specialty, zip code or medical group.
For information about cardiac care at Washington Hospital, visit www.whhs.com/heart.