What is atrial fibrillation and how is it treated?
If someone you know has been diagnosed with atrial fibrillation (AF), he's not alone: According to the American Heart Association, 2.2 million Americans live with this heart rhythm abnormality.
Atrial fibrillation means that the atria (the upper chambers of the heart) are beating very rapidly and irregularly, "quivering" instead of contracting normally. In itself, AF isn't life threatening, but it can cause uncomfortable symptoms like palpitations, fatigue, dizziness, and nausea. It can also lead to other rhythm problems and congestive heart failure.
But the most serious complication is stroke: AF increases a person's risk of having a stroke by fivefold because his quivering atria can't efficiently pump blood into his ventricles (the lower chambers of the heart). When leftover blood pools in one or both atria, blood clots may form and break loose from the heart.
AF isn't a cause for panic, nor is it a death sentence: The person you're caring for can live a reasonably active life for many years. What you need to know is how he will be treated, what to do to help him prevent a stroke, and what warning signs you should look out for.
AF treatment is designed to help prevent a stroke and normalize heart rate and rhythm as much as possible. The patient's doctor may prescribe a number of different medications:
To thin his blood and slow clotting , he should take aspirin (considered an antiplatelet drug) or warfarin (an anticoagulant). Warfarin is more effective against embolic strokes (caused by blood clots), but it also has more side effects. If he has an ulcer or other bleeding problems, his doctor will probably recommend aspirin instead.
The doctor will most likely prescribe medication to slow the patient's heart rate as well. Some of the most commonly prescribed drugs are beta blockers, calcium channel blockers, digoxin, and amiodarone.
His doctor may also prescribe medication to normalize his heart rhythm . One such drug, ibutilide, is given intravenously under close medical supervision. Other medications come in pill form.
When does more aggressive treatment make sense for atrial fibrillation?
If a patient's atrial fibrillation doesn't respond to medication, the doctor may recommend a more aggressive approach. Even if he isn't at high risk for stroke, with prolonged AF, the atria may begin to enlarge. Enlarged atria pump blood even less efficiently, which can lead to congestive heart failure.
Electrical cardioversion may be recommended to reset the heart to a normal rhythm. This noninvasive procedure is performed in a hospital, and he'll be given sedation through an IV. Once he falls asleep, two electrode pads or paddles will be applied to his skin: one near the breastbone, and the other on the lower left chest or back. A burst of electrical current is sent through them, shocking the heart. If the procedure is successful, his heart rhythm will be restored to normal -- at least temporarily -- and he'll probably be able to return home that day and resume normal activities in a day or two.
Radiofrequency catheter ablation is another procedure that may help. The person you're caring for will be given a local anesthetic to numb the points where the catheter is inserted (usually the groin, neck, or elbow). The cardiologist will thread thin flexible tubes (catheters) through one or more blood vessels until they reach the heart. Once the cardiologist determines exactly which heart cells are causing the abnormal rhythm, she'll deliver a burst of radiofrequency energy to destroy those cells. He should be able to go home that day and will probably be able to resume normal activities in a few days.
An implantable pacemaker to keep his heart beating at a normal rate may help if the AF occurs only when the person's heart rate is very slow. The procedure takes place in a hospital, with light sedation and local anesthetic. The cardiologist will implant the pacemaker wires directly into his heart, while the battery and other components are inserted just under the skin of the chest or abdomen. The procedure takes about an hour, but he'll spend the night in the hospital. His pacemaker will need to be checked in four to eight weeks.
An implantable atrial defibrillator may help in rare cases. Like an electrical cardioversion, this device delivers an electrical shock to the heart to restore its rhythm to normal. Implantable defibrillators aren't typically used for AF, but it might be necessary if the person you're caring for also has a ventricular arrhythmia.
Surgery may be needed if other treatments fail to correct the patient's AF or if he has one or more strokes. Unlike cardioversion or catheter ablation, surgery requires six to eight weeks of recovery. The surgeon may perform a maze procedure (the name refers to the complex series of incisions required). If the person you're caring for is und ergoing surgery for another problem, the surgeon may perform a modified maze procedure instead. The Cleveland Clinic's website offers detailed descriptions of these surgical techniques.
How can I help someone with atrial fibrillation avoid a stroke or heart failure?
Atrial fibrillation dramatically increases the risk of stroke -- approximately 15 percent of strokes happen in people with AF. That's why it's vitally important that the person you're caring for do everything he can to reduce his risk.
Unless he has a serious bleeding problem, he needs to take aspirin or warfarin to make his blood less likely to clot. But he also needs to make important lifestyle changes and control other medical conditions like high blood pressure, coronary artery disease, and diabetes.
For more detailed information about preventing stroke , see 10 Ways You Can Help Your Parents Prevent a Stroke .
What are the warning signs of stroke ?
Because the risk of stroke is so much higher with AF, you should familiarize yourself with the warnin g signs:
Sudden numbness or weakness of the face, arm, or leg -- especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden difficulty walking, loss of balance or coordination, dizziness
Although a sudden severe headache may occur in someone having a "red" stroke (in which bleeding occurs), it's not a symptom of a stroke caused by a blood clot.
For more information, see How to Tell if Your Parent Is Having a Stroke .
What should I do if I think he's having a stroke?
Call 911 at the first sign of stroke . Don't wait to see if the symptoms go away, and don't let the person you're caring for talk you out of calling.
Should we worry about heart failure?
Prolonged AF can weaken the heart, ultimately resulting in congestive heart failure. But as long as your friend or relative's AF is being treated, this is one complication you shouldn't worry about. And even if he does develop heart failure, he may still live well for many years.