What is Atrial Fibrillation (AF)?
This is a common abnormality of the heart rhythm and occurs with increasing frequency with age. It is due to the normal synchronised beating of the heart becoming disorganised.
The pacemaker can no longer run the heartbeat as a faster chaotic beat takes over. This can lead to palpitations, breathlessness, chest pain and rarely blackouts. In addition, the chaotic rhythm can lead to a risk of blood clots in the heart, leading on to a risk of stroke. For this reason, treatment of atrial fibrillation (AF) is directed firstly at reducing stroke risk, and secondly at treating the symptoms by controlling the heart rhythm.
Symptoms of Atrial Fibrillation
The AF is initially suspected by feeling your pulse. The diagnosis needs confirmation with an electrocardiogram (ECG ). Often blood tests will be taken to look for possible causes of AF , and an echocardiogram (TTE) will be needed to ensure you do not have a structural heart problem. A 24-hour ECG monitor may be needed to see how fast you are going at other times.
Atrial Fibrillation Treatment
The cardiologist will prescribe either warfarin, aspirin or one of the newer blood-thinning drugs (DOAC), to reduce the stroke risk (see below). In addition, he/she may give you drugs to slow the heart rate down, such as betablockers or digoxin. He/she may suggest trying to get the heart beat regular again – cardioversion . This can be done with drugs or with the application of an electrical treatment whilst you are sedated. You may need ablation therapy, if you are very symptomatic.
The CHA2DVAS2 Score to predict stroke risk in AF
|C||Congestive heart failure||1|
|H||Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)||1|
|A||Age > 75 years||2|
|S2||Prior Stroke or TIA||2|
We can advise on whether you need warfarin or other blood thinning therapy based on the best available evidence. For example, if your CHADVAS score (see table above) is 1 or more, these type of drugs are usually the best option to reduce the risk of stroke.