Atrial fibrillation, also known as AF, is one of the most common heart arrhythmias affecting many Australians today. We spoke with Cardiac Electrophysiologist Dr Wai Kah Choo to better understand this serious heart condition, its symptoms, causes, long-term impacts if left undetected, and available treatment options.
What is Atrial Fibrillation (AF)?
Atrial Fibrillation occurs when the electrical impulses that regulate the upper chambers of the heart, known as the atria, become chaotic and disorganised in rhythm, disrupting its normal coordination. This chaotic activity in the atria results in patients who may present with symptoms, or in approximately 30% of cases, have no symptoms at all.
In the video below, Dr Choo explains what AF is using a simple metaphor:
What are the symptoms of AF and how is it diagnosed?
Recognising the potential symptoms associated with AF is critical when it comes to early detection, and ultimately long-term management of this common condition. Symptoms of AF can include:
- Shortness of breath,
- Palpitations, racing, or a fluttering feeling in the chest,
- Decreased exercise tolerance,
- Fatigue,
- Lightheadedness,
- Chest pain, and
- Signs of heart failure (swollen feet, breathlessness and decreased exercise tolerance).
Experiencing these symptoms can significantly impact daily activities and quality of life, emphasising the urgency of seeking prompt medical evaluation to properly diagnose and manage potential cases of AF.
The diagnosis of Atrial Fibrillation often begins with simple assessments, such as taking the patient’s radial pulse and detecting an irregular pattern in the heart rate through palpation. However, for a more definitive diagnosis, healthcare professionals rely on Electrocardiographs (ECG) to illustrate the irregular heart rhythm.
In some cases, particularly for persistent or intermittent atrial fibrillation, additional diagnostic measures may be necessary. This can involve the use of ambulatory ECG monitors, which are worn by the patient for various time periods, with the data collected then analysed by a cardiology team to confirm the presence of AF.
Dr Choo explains how patients might suspect they have atrial fibrillation and how AF is diagnosed in the video below:
What causes Atrial Fibrillation, and what are the possible risk factors?
Understanding the risk factors that can contribute to atrial fibrillation (AF) is crucial for managing and preventing this condition. While the exact causes of AF remain unknown, certain predisposing heart conditions can elevate the risk, including:
- Hypertension,
- Atherosclerosis,
- Heart valve disease,
- Cardiomyopathy,
- Some congenital heart conditions.
Furthermore, the development of AF often coincides with other health issues and comorbidities, such as diabetes, obesity, chronic obstructive pulmonary disease, sleep apnea, pulmonary embolism, and endocrine disorders such as an overactive thyroid gland.
Moreover, lifestyle factors have been identified as potential triggers for AF episodes:
- Binge drinking alcohol,
- High intake of caffeine, tea, and energy drinks,
- Smoking,
- Consumption of methamphetamines and cocaine.
Being aware of these risk factors can help patients and healthcare professionals better manage AF and minimise its impact on overall health.
Dr Choo further explains some of the risk factors associated with atrial fibrillation in the video below:
What are the treatment options for Atrial Fibrillation?
Atrial fibrillation treatment aims to regulate the heartbeat and prevent blood clots, which can lead to complications such as stroke. The treatment will also vary based on factors such as the duration of AF, symptoms, and underlying causes.
Management options can include:
- Lifestyle changes,
- Medication,
- Cardioversion therapy,
- Surgical procedures.
Surgical intervention can include catheter ablation, a procedure performed in a cardiac catheter lab, typically by a Cardiologist with sub-speciality training. These Cardiologists, also known as Electrophysiologists (EP), aim to stop the irregular stimulus from within the upper chambers and reduce the likelihood of a recurrence of AF. This procedure may also be referred to as Pulmonary Vein Isolation (PVI).
There are several types of technologies used to perform PVI to treat Atrial Fibrillation. These include:
- Radiofrequency Ablation (RFA) – Where a catheter with a tip that generates heat is applied to the area of concern inside the atrium to create a scar to the abnormal electrical tissue/pathway, which isolates the electrical stimulus that may cause AF.
- Pulsed-field ablation (PFA) – Uses high-energy electrical pulses to disrupt the tissue that may cause AF.
- Cryoablation – Uses a similar style of catheter to RFA/PFA, but instead of using heat or energy sources to disrupt the electrical pathway, the catheter uses a gas to freeze the tissue that may be the cause of the AF.
All of the above AF surgical procedures can vary in procedure length, success rates, and complication rates. Therefore, these considerations are discussed between a Cardiologist Electrophysiologist and the patient to determine the most appropriate option on an individual basis.
In the below video, learn more about the ablation procedure and how it’s evolved with Dr Choo:
Atrial Fibrillation presents complex challenges for both patients and healthcare professionals. Its prevalence is often underestimated, highlighting the importance of identifying its symptoms, and being aware of the causes and risk factors.
Early detection through symptom recognition and medical evaluation is crucial for effective management. Through collaborative efforts between patients and healthcare providers, tailored treatment plans can be developed to address individual patient needs and minimise the risk of long-term complications.
Dr Wai Kah Choo is a Cardiac Electrophysiologist who specialises in the management and treatment of arrhymias such as Atrial Fibrillation.
He currently treats patients at both the Gold Coast Private Hospital and John Flynn Private Hospital. Click here to learn more about Dr Choo.
This article has been reviewed for accuracy by Shane Bassett (RN/BN/CCRN), a Registered Nurse and Clinical Content Director at Connect The Docs.