Atrial fibrillation (AF) is one of the most common heart rhythm problems. In AF the electrical activity in the upper chambers of the heart (atria) become chaotic leading to an irregular heartbeat which is often rapid.
In the UK, AF affects up to 800,000 people, and is most common in those over 55 years of age and in those patients with high blood pressure or other types of heart problems.
Despite this, in some patients the cause of AF is not clear. When atrial activity is chaotic, blood flow through the heart can be reduced leading to stagnation and clot formation and as a result, patients with AF are at increased of risk of stroke. The risk of stroke can be reduced with blood thinning drugs (anticoagulants).
Atrial fibrillation presents itself in many different ways. The commonest symptoms are palpitations which are often rapid and irregular.
Patients may also feel:
In some patients, there are no symptoms and the discovery of AF is usually an incidental finding.
Atrial fibrillation is not usually life threatening, but can be uncomfortable and often needs treatment.
There are a number of different approaches to the treatment of atrial fibrillation which can to be tailored to your individual circumstances. All patients need an assessment of their stroke risk and placed on appropriate treatment as needed.
There are essentially three strategies to treat AF:
Medication to control the heart rate or rhythm may be the most suitable treatment for some patients. This may be in the form of regular, daily medication to prevent episodes or single doses to take when you have an attack to try and stop it.
In patients who are in AF all the time, a cardioversion, which is a small electrical shock across the heart under light general anesthesia, can restore the heart to a normal rhythm.
This can be quite a successful treatment in selected patients and restore patients to a better quality of life.
However, as it does not deal with the underlying cause, AF can return and although success rates can be good in the short to medium term, in the long term there is a chance that the AF may return.
Catheter ablation is a treatment option for patients who continue to have symptoms of atrial fibrillation despite medication or for those patients who do not wish to take regular medication or where the cardioversion has not been successful. Catheter ablation offers the prospect to improve quality of life and is potentially curative.
The procedure is invasive and involves the insertion of catheters, or fine wires, to the heart through the veins at the top of the leg. There are electrodes at the tip of the wires which detect electrical signals from different parts of the heart. Radio waves are used to create heat which destroys (ablates) the electrical signals that are responsible for triggering AF. These signals are usually located inside the pulmonary veins in the majority of patients and this technique is called pulmonary vein isolation.
Patients who have been in AF for a long time may need a more extensive ablation procedure to restore normal rhythm. Success rates of catheter ablation for paroxysmal AF are approximately 70-80% and often more than one procedure is required to achieve success. The success rates are less if you have been in atrial fibrillation for a long time. The procedure is associated with a low rate of risks but some of these can be serious, although these are very rare, so it is important that you are assessed by an atrial fibrillation specialist in this field.
The atrial fibrillation specialist here at the London Cardiac group are experts in the treatment of heart rhythm disorders and are highly trained to assess and treat all patients with atrial fibrillation.