Last week, Dr. Anthony Navone began a discussion on atrial fibrillation, also known as A-fib. The condition is the most common type of arrhythmia that doctors address. An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Dr. Navone’s column concludes today.

Atrial fibrillation also is more common in people who are having heart attacks or who have just had heart surgery.

Certain factors also can raise your risk for A-fib. For example, drinking large amounts of alcohol, especially binge drinking, raises your risk. Even modest amounts of alcohol can trigger A-fib in some people. Caffeine or psychological stress also may trigger A-fib in some people.

Data suggest that people who have obstructive sleep apnea are at greater risk for a-fib. Sleep apnea is a common disorder that causes one or more pauses in breathing or shallow breaths while you sleep.

Research suggests that people who receive high-dose steroid therapy are at increased risk for atrial fibrillation. Genetic factors also may play a role in causing A-fib.

Signs, Symptoms, and Complications

• Palpitations

• Shortness of breath

• Weakness or problems exercising

• Chest pain

• Dizziness or fainting

• Fatigue (tiredness)

Atrial fibrillation Complications

AF has two major complications, STROKE and HEART FAILURE

Treatment of atrial fibrillation

Treatment for atrial fibrillation depends on how often you have symptoms, how severe they are, and whether you already have heart disease. General treatment options include medicines, medical procedures, and lifestyle changes.

The goals of treating A-fib include:

Preventing blood clots from forming, thus lowering the risk of stroke.

Controlling how many times a minute the ventricles contract. This is called rate control. Rate control is important because it allows the ventricles enough time to completely fill with blood. With this approach, the abnormal heart rhythm continues, but you feel better and have fewer symptoms.

Restoring a normal heart rhythm. This is called rhythm control. Rhythm control allows the atria and ventricles to work together to efficiently pump blood to the body.

Treating any underlying disorder that's causing or raising the risk of A-fib—for example, hyperthyroidism (too much thyroid hormone).

People who have a-fib but don't have symptoms or related heart problems may not need treatment. A-fib may even go back to a normal heart rhythm on its own.

In some people who have A-fib for the first time, doctors may choose to use an electrical procedure or medicine to restore a normal heart rhythm.

Repeat episodes of A-fib tend to cause changes to the heart's electrical system, leading to persistent or permanent A-fib. Most people who have persistent or permanent AF need treatment to control their heart rate and prevent complications.

Blood clot prevention

People who have A-fib are at increased risk for stroke. This is because blood can pool in the heart's upper chambers (the atria), causing a blood clot to form. If the clot breaks off and travels to the brain, it can cause a stroke.

Preventing blood clots from forming is probably the most important part of treating A-fib. The benefits of this type of treatment have been proven in multiple studies.

Doctors prescribe blood-thinning medicines to prevent blood clots. There are many different types of blood thinners available to prevent stroke in atrial fibrillation.

Rate control

Doctors can prescribe medicines to slow down the rate at which the ventricles are beating. These medicines help bring the heart rate to a normal level.

Rate control is the recommended treatment for most patients who have A-fib, even though an abnormal heart rhythm continues and the heart doesn't work as well as it should. Most people feel better and can function well if their heart rates are well-controlled.

Rhythm control

Restoring and maintaining a normal heart rhythm is a treatment approach recommended for people who aren't doing well with rate control treatment. This treatment also may be used for people who have only recently started having A-fib. The long-term benefits of rhythm control have not been proven conclusively yet.

Restoring a normal rhythm also becomes less likely if the atria are enlarged or if any underlying heart disease worsens. In these cases, the chance that A-fib will recur is high, even if you're taking medicine to help convert A-fib to a normal rhythm.

There are many other options beyond medications for controlling atrial fibrillation. Some of these options include cardioversions, atrial fibrillation ablation, pacemakers, and a new procedure called the Watchman. A new FDA-approved procedure called “Watchman” is available to reduce the risk of stroke in people who have atrial fibrillation and are unable to take long-term blood thinners. This procedure, as well as many others are available at St. Patrick’s Hospital in Missoula. For more information about atrial fibrillation or if you would like to be evaluated for heart symptoms, please call Marcus Daly Cardiology Services to set up an appointment. 406-375-4665.

Questions and or comments regarding this week’s health column please contact, Anthony Navone, MD at Marcus Daly Cardiology Center, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840, Working together to build a healthier community!