Atrial fibrillation



Patient Perspective Paper 9

These notes are a patient’s view on atrial fibrillation following a most interesting and enlightening talk given to the Oxford ICD Group by Elaine Watson of JRH. You might like to refer to the various booklets on the subject and these are amongst the stock of information, which I bring to every meeting of the Group.

I must emphasise once again that notes such as these are very much my personal interpretation and I apologise but take no responsibility for any inaccuracy. If you are worried in any way concerning your own position, please consult your own doctor or consultant.



Introduction.

A normal heart beat is regular. Depending on the individual and the circumstances (eg exercise), it will beat at various speeds on what is called a “sinus rhythm”. Sometimes however a person may have a normal variance of this – it is then called “ectopic”. Atrial fibrillation (often called “AF”) is an abnormality in the rhythm of the heart (ie an arrhythmia) involving the two upper chambers of the heart. The pulse therefore shows an irregularity and this may well be a sign that someone has atrial fibrillation and therefore should be investigated. Because this test is so simple, it is strongly promoted by the Arrhythmia Association. (“Know your pulse”).

AF is the most common form of arrhythmia, affecting 4 out of every 100 people over the age of 65. It is estimated that there are 600,000 patients with AF in England. In essence the electrical impulses become disorganised within the atria, causing a range of symptoms. In itself it is not life-threatening. However, because it decreases the flow of blood, causing it to pool, there is therefore an increased possibility of the formation of a clot so possibly resulting in a stroke, which can of course be dangerous.

It is important to realise that ICDs are not implanted for AF and they have discriminators to prevent an inappropriate shock being administered to the patient as a result of AF. However they are useful in that they detect AF and this can be picked up when the history of the ICD is checked.

Some AF comes and goes and it usually stops within 48 hours (Paroxysmal). Other types of AF can be persistent: in this case medical advice is needed to find to a way bring the heart back to a normal rhythm (cardioversion). Cardioversion is accomplished by either medication or electrical pulse or a combination of both. Some AF is however permanent and the heart cannot be brought back to a pure sinus rhythm: in this case the AF is treated in an appropriate way, depending on its severity, to mollify its effects.



Causes and symptoms

It is important to state that with some patients the causes may not be obvious even after investigation but the following might well not help the situation:


Often some patients experience no symptoms at all and are therefore surprised to be told that they have AF. Common symptoms are :
  • Palpitations
  • Chest pain or discomfort
  • Shortness of breath
  • Dizziness and fainting



    • Treatment

    Clinical diagnosis is evaluated using a mixture of an ECG machine, blood tests, physical examination, echocardiography and symptoms relating to the medical history of the patient.

    Rate control (how fast the heart beats) can be altered using drugs or AV node ablation combined with a pacemaker.
    Rhythm control can also be modified using drugs or direct AF ablation. Often a suitable combination of drugs is chosen to help the patient’s rate and rhythm. Cardioverson can be achieved with medication or electrical shock. Often anticoagulation drugs such as warfarin or aspirin are prescribed to reduce the risk of blood clots and stroke.



    The Atrial Fibrillation Association is a useful source of information. Their website is www.atrialfibrillation.org.uk.

    GCS/08.02.10

    Geoff Shaw