September is a month to bring awareness to several common medical maladies, not the least of which is atrial fibrillation, also known as Afib. Atrial fibrillation is simply when the atrium, the top portion of the heart, quivers, instead of effectively transmitting your normal heartbeat from the SA node to the ventricle via the AV node. The result of Afib is weak and ineffective blood pumping from the heart to the rest of the body, leading to symptoms of lightheadedness, overall weakness, chest pain, shortness of breath, fatigue, and perhaps palpitations or feeling like the heart is racing.
Afib can be diagnosed fairly easily by an ECG/EKG in your doctor’s office. However, this 10-second test cannot always catch Afib that comes and goes. For these patients, a Holtor monitor for 24-48 hours will be ordered, or even an event monitor can be implanted just under the skin for several years to help catch cases of Afib that would otherwise go undiagnosed if there is a high suspicion that the arrhythmia may be present.
Afib is the most common heart arrhythmia, and your risk increases with age. Afib affects 10% of those over the age of 80. While the prevalence of Afib is more common in older men, an equal number of women are diagnosed with Afib due to their longer lifespan. Afib in women tends to be more deadly. Women typically only get Afib at older ages unless there is a genetic risk linked through other female family members previously diagnosed at an age younger than 75. Younger people at an elevated risk of Afib are those who have engaged in high level endurance and even intense strength training over several or more years. Even at middle age and without any typical cardiovascular risk factors (hypertension, diabetes, obesity, high cholesterol, heavy alcohol use), patients can be diagnosed with lone atrial fibrillation. Lone Afib is rare, diagnosed only in 2% of patients younger than age 65, and is diagnosed when there is no apparent reason causative factor for Afib at the time of diagnosis (sports activity not included).
For patients diagnosed with Afib, the risk of stroke is increased by 5x the normal risk of stroke- that's an increase of 500%! In fact, 15-25% of ischemic strokes, in which a blood clot blocks an important vessel in the brain leading to brain cell death due to a lack of blood flow, are due to Afib. Worse yet, when patients with Afib have a stroke, it tends to be severe or even deadly compared to strokes from other causes, meaning that any loss of function, whether seeing, speaking, sensation, or motor difficulties are extremely difficult if not impossible to recover, deeply impacting quality of life for patients who are fortunate enough to survive the stroke. Patients who have been diagnosed with Afib are also at a high risk of dementia and heart failure as Afib persists and becomes more permanent through the years.
There are effective treatments for atrial fibrillation. For those who have been recently diagnosed, first it is critical to be placed on a blood thinner called an anti-coagulant. This drug thins the blood, reducing stroke risk by 65%. With the advent of new blood thinners other than warfarin (Coumadin), taking a blood thinner has never been easier and safer, without the need for frequent blood testing and with no need to alter your diet. In addition to the ability of an anti-coagulant to reduce stroke risk, recent research confirms that it reduces the risk of incident dementia caused by Afib by 60% compared to Afib patients who are not on blood thinners. For patients who are at a high risk of bleeding, anti-coagulants may not be an option. For these patients, there are implanted devices such as the Watchman device and a surgical procedure called a left atrial appendage ligation or closure that might help reduce the risk of stroke.
Next, to reduce the symptoms caused by Afib and to reduce the risk of heart failure, medications are prescribed to control the heart rate and/or rhythm. If bouts of Afib come and go infrequently (known as paroxysmal Afib), radiofrequency ablation is an excellent, minimally invasive procedure that targets the precise areas of the atrium instigating the arrhythmia. With this treatment, Afib can be effectively eliminated (although research is unable to tell us for how long at this point). If the Afib is persistent (lasts longer than a week), your doctor may recommend cardioversion, a treatment in which a patient is sedated and a shock is applied to the heart, which encourages the heart to return to its normal rhythm. Ablation is still an excellent option for this patient group as well to reduce the need for future cardioversions. Once Afib has been persistent for more than a year (called long-term, persistent Afib), the effectiveness of ablation is more uncertain; this is being actively researched at this time, but ablation may be an option. For patients with permanent Afib (their heart is in Afib all the time, despite other treatments), the patient and his or her doctor may decide to allow the arrhythmia to continue, utilizing medications to help control the accelerated heart rate and attempt to reduce any accompanying symptoms.
Finally, lifestyle changes are very effective along with the other strategies listed above in reducing Afib frequency and progression to a more persistent form of Afib. One of the best things an Afib patient can do is to change their diet and exercise to reduce any excess weight. Also treating sleep apnea, which is found in nearly 50% of patients with Afib, is a big help as well. Controlling excess stress, reducing alcohol intake, stopping smoking, and reigning in high blood pressure are also helpful in reducing Afib frequency and progression.
Many people with Afib never know they have it until they have their first stroke. By then it is critically too late. This is why it is so important to be screened for Afib at every doctor’s appointment including at your annual physical. To effectively screen for Afib, your pulse should be monitored for a full 60 seconds to be certain that you are not in Afib. If you are having symptoms of lightheadedness, dizziness, shortness of breath, weakness or fatigue, chest pain, and/or heart palpitations or feeling that your heart is racing or your heartbeat is irregular, please call your doctor immediately, go the Emergency Room, or call 911 if your symptoms are significant and/or worsening.
Signs of a stroke are a sudden change in vision, inability to speak or change in ability to speak, loss of sensation on one side of your body, weakness or inability to move one side of your body, and/or drooping of the face. Call 911 immediately if you are having symptoms of a stroke, as allowing time to pass significantly reduces your treatment options and the ability to save brain cells that are in the process of dying.
While being diagnosed with Afib can feel overwhelming, going undiagnosed is a serious risk to your health, quality of life, and longetivity. Nine percent of people age 65 and older have Afib. In the US, this number is only expected to grow as the overall population ages in the next 20 years. The costs related to the treatment of Afib and associated strokes and heart failure are staggering, since patients with Afib tend to require frequent hospitalizations and have a higher mortality rate. Annually in the US, 130,000 patients die from complications due to Afib. Please take the opportunity this fall to talk to your doctor, or talk to your loved ones at risk of Afib and stroke about scheduling their annual physical and asking for Afib screening. Taking a few preventative steps today can really help save a life!