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Atrial fibrillation

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	- Introduction - Causes - Diagnosis - Treatment
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Treatment goals

Left untreated, the overactive heart muscle can weaken and stretch out. This makes it harder for the atria to contract properly, so blood backs up even more. This problem not only increases the risk of stroke, but it can also lead to congestive heart failure. Treating AF correctly is the best way to reduce stroke risk. The goals of treatment plans for AF are:

• Prevent blood clots from forming
• Heart rate control within a relatively normal range
• Restore a normal heart rhythm, if possible

Treating atrial fibrillation is an important way to help prevent stroke. That's why the American Heart Association recommends aggressive treatment of this heart arrhythmia, following these guidelines:

• Atrial fibrillation should be treated with some form of preventive medication prescribed and monitored by a physician.
• Aspirin and Warfarin, the currently used medications, can have a major beneficial effect on public health in the United States.
• Physicians differ on the choice of drugs to prevent embolic stroke — stroke caused by an embolus (blood clot). It's clear that Warfarin is more effective against this type of stroke than aspirin. However, Warfarin has side effects, such as abnormal bleeding, especially in older patients.
• Warfarin in well-regulated doses that lead to a moderate interference with clotting is effective and appears safe in many patients.
• Patients at high risk for stroke should probably be treated with Warfarin rather than aspirin unless there are contraindications. Examples include potential bleeding problems or ulcer.
• Patients over 75 should be followed especially carefully.

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Treatment

The treatment will vary from case to case and requires expert attention from a heart specialist (cardiologist). There are a number of treatment options for AF. The first line of treatment usually involves medications, but there are other treatments that may be appropriate in other cases:

Ablation

Cardiac ablation is a medical procedure performed to prevent abnormal electrical impulses from ever beginning in the first place. In an ablation procedure, the electrophysiologist first does mapping, which means the precise area in the heart at which the abnormal signals start are pin-pointed. The electrophysiologist then eliminates the small area of tissue that is causing the arrhythmia.

There is also a procedure called AV nodal ablation. This involves ablating the AV node, keeping the abnormal impulses from traveling to the heart’s lower chambers. A pacemaker is used to regulate the heartbeat after this therapy.

AF Suppression

AF Suppression is designed to suppress atrial fibrillation (AF). An implanted pacemaker stimulates the heart in a way that preempts any irregular rhythms.

A clinical study has found that a software-based AF Suppression algorithm can suppress symptomatic paroxysmal and persistent AF better than standard pacing. The AF Suppression algorithm is available in certain ICDs and pacemakers manufactured by St. Jude Medical.

Cardioversion

Cardioversion changes an abnormal heart rate back to a normal one. Cardioversion can be done through medication or through electricity. Electrical cardioversion is typically used to treat cases of persistent or permanent AF, and it is often used with medication.

There are two types of electrical cardioversion: external and internal. For external cardioversion, two external paddles are placed on the patient’s chest or on the chest and back. A high-energy electrical shock is sent through the patches, through the body to the heart. The energy shocks the heart out of AF and back into normal rhythm.

Internal cardioversion uses a similar approach, but instead of using paddles on the outside of the body, a catheter is inserted through a vein to the heart. The electrical energy is delivered through the catheter to the inside of the heart to stop the AF. Internal cardioversion has met with high success and provides an alternative to external cardioversion.

Medication

In about half of all atrial fibrillation (AF) cases, medication can be effective in controlling the rate at which the upper and lower chambers of the heart beat. Standard medications used for AF include:

• Beta-blockers (like carvedilol or propanolol) and calcium-channel blockers (like verapamil or diltiazem), which slow the heart rate;
• Digoxin, which slows the heart rate through the AV node, therefore decreasing the rate at which the electrical impulses conduct from the upper to the lower chambers; and
• Other medications (such as amiodarone, dofetilide, disopyramide, flecainide, procainamide and sotalol) which try to chemically convert AF back to normal rhythm (cardioversion).

Medication to prevent clots

To lower the risk of stroke either aspirin or Warfarin are generally prescribed. Aspirin has an antiplatelet effect and is less likely to cause abnormal bleeding, but Warfarin seems to be more effective at preventing clot-caused strokes. Regular INR tests are carried out to monitor the dose of Warfarin. INR should usually test between 2.0 and 3.0.

Prognosis and survival

Prognosis is related to the underlying cause; it is excellent when due to idiopathic atrial fibrillation and relatively poor when due to ischemic cardiomyopathy. Healthy life style, regular checks on blood pressure and treatment for raised blood pressure can reduce the chances of developing the heart problems that cause atrial fibrillation.

Some study results

Among people with atrial fibrillation who not are taking the anticoagulant drug Warfarin, women are more likely to form dangerous blood clots than men, according to a study.
Men who explode with anger or expect the worst from people are more likely to develop an irregular heart rhythm called atrial fibrillation, according to another study report.

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