Atrial Fibrillation

How is atrial fibrillation treated?

Some patients require no treatment.  The atrial fibrillation goes away by itself and the normal heart rhythm is restored.  This is often the cause for people who have one episode of atrial fibrillation.  Most people however require treatment with tablets.

The tablets are used for the following reasons:

Slow the heart rate — this usually relieves most of the symptoms of palpitations and breathlessness.  Most people with chronic AF are on these tablets.  These drugs are Digoxin (Lanoxin), Atenolol (Tenormin, Noten), Verapamil (Isopten, Vercaps) or Diltiazem (Cardizem).

Restore and maintain normal heart rhythm — these drugs are useful in people who have episodic (paroxysmal) atrial fibrillation to reduce the frequency of recurrences and sometimes prevent episodes altogether.  These drugs include Sotalol (Sotacor), Flecainide (Tambocor) and Amiodarone (Cordarone).

Reduce risk of blood clots — anticoagulation.  These drugs are used to prevent blood clots forming in the heart.  Some patients only need Aspirin but others require Warfarin (Coumadin), an anticoagulant drug which requires regular blood tests to maintain careful control.

In some patients who have had an episode of AF, the tablets do not restore normal rhythm.  In these cases, an electric shock is required to reset the heart rhythm (this is called a ‘cardioversion’).  It is performed under a brief general anaesthetic and requires coming into hospital for a day.

What is the normal rhythm of the heart?

The heart has four chambers: the left and right atrial which set the heart rhythm and the left and right ventricles which pump blood around the body.

The heart beat is triggered by an electrical signal which starts in the top of the heart (the sinus node in the right atrium) and spreads through the atrial.  It then travels through a narrow zone in the middle of the heart, the atrio-ventricular node (AV node), to reach the ventricles where it triggers the pumping action.  This rhythm is called “sinus” rhythm.  The normal pulse rate varies between 40—60 per minute during sleep, 60—80 per minute at rest and 80—150 per minute during exercise.

What causes atrial fibrillation?

Atrial fibrillation may occur without any underlying heart disease.  It is more common in older people but can occur at any age. 

The most common conditions are:

  • High blood pressure (hypertension)
  • Coronary artery disease (angina and heart attacks)
  • Heart valve disorders
  • Chronic lung diseases
  • Heart failure
  • Thyroid gland overactivity

Atrial fibrillation commonly occurs in the week following open heart surgery. It may occur shortly after other surgery.  Heavy alcohol use (binge drinking) can bring on an episode of atrial fibrillation.

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