Atrial Fibrillation Overview

Atrial fibrillation is the most common heart rhythm disorder.  In atrial fibrillation, abnormal signals from the left atrium completely disrupt the normal rhythm, which becomes irregular and fast. Most often these abnormal signals come from the pulmonary veins. 

Under these conditions, the heart contracts in a disordered manner and does not pump blood efficiently. This results in palpitations, shortness of breath, or severe fatigue. This rhythm disorder is easily diagnosed on an electrocardiogram or ECG.

This disease can have many causes. The most known risk factors are: cardiovascular diseases, diabetes, high blood pressure, being overweight, age, sleep apnea, genetic predisposition, and intensive sports practice.

In atrial fibrillation, the left atrium does not contract properly, causing pooling of blood in this cavity.  This pooling can cause clot formation that can travel into the arteries of the brain and cause a stroke and brain damage.

In long-term atrial fibrillation, the heart becomes permanently weakened, resulting in heart failure. The heart can no longer provide all the oxygen the body needs which increases fatigue, shortness of breath, and risk of pulmonary edema. This is why it’s important to maintain the normal rhythm as long as possible.

In treating atrial fibrillation, it is most important to prevent a stroke and to stop abnormal electrical activity. Conventional anticoagulants such as vitamin K antagonists or, more recently, direct oral anticoagulants thin the blood and prevent clot formation. Alternatively, antiarrhythmic medications can stop the abnormal electrical activity from the pulmonary veins and prevent palpitations.

If antiarrhythmics are ineffective or poorly tolerated, radiofrequency ablation can target the source of atrial fibrillation. The procedure typically lasts about 2 hours, uses general anesthesia, and requires a hospital stay of a few nights. 

A small puncture in the vein of the groin allows the catheter to access the heart.  Then a thin needle allows the catheter to pass from the right to the left side of the heart. The catheter is equipped with an electrode that visually records the electrical activity of heart cells. 

This is called an electrical map of the heart and allows the electrophysiologist to target the exact origin of the abnormal electrical activity. The origins are often near the pulmonary veins.

 Next, the abnormal electrical sources are scarred with heat or cold, and the heart returns to its normal function. This procedure can let the patient discontinue medications.

Atrial fibrillation is a common disorder which can be serious if under treated. Many treatments are possible and effective. Ask your doctor or your cardiologist for details.

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