About Atrial Fibrillation
Atrial fibrillation is a condition where the atrium beats in an uncoordinated fashion. This can be of variable speed and generally results in palpitations, tiredness, fatigue and lightheadedness. Because of the contractions being uncoordinated it can result in a clot formation within the heart which can then cause a stroke by embolisation to the brain.
Atrial fibrillation is been associated with significant consequences viz strokes, deterioration in heart muscle function and a shortened lifespan.
There are several approaches to the treatment of atrial fibrillation. However, the one therapy which is used in all arms of treatment is anticoagulation. This is been shown to prevent stroke.
The risk of stroke can be estimated by using a scoring system called the Chads²vasc system which uses various criteria to predict the stroke risk. The higher the score the higher the risk. It’s generally accepted that achieved a score of one or more would indicate that anticoagulation should be started.
Treatment
Dealing with atrial fibrillation itself can be difficult and generally would start with medical treatment i.e. medication would be used to slow the heart rate or attempt to get it back to normal rhythm. This can be variably successful. Broadly speaking rate control can be an effective treatment but does not return the rhythm to normal. Should the heart rate be difficult to control with medication, then an ablation of the AV node and Pacemaker can be done for rate control.
In very symptomatic people it is advisable to undergo pulmonary vein isolation. This is a procedure where an attempt is made to return the person to sinus rhythm. Is generally done under anaesthesia and requires the insertion of catheters into the heart which is used to measure the activation of the heart and ablation is performed to isolate the trigger areas which in the majority of people are the pulmonary veins. This is done with either radiofrequency (heat) or cryo- energy (freezing). The success of both these procedures is approximately 70%. Generally speaking one has to consider anticoagulation for at least three months after the procedure if the CHAD score is low and often for life if the CHAD score is high.
In the approximately 30% of patients who have a recurrence of atrial fibrillation after the procedure, either medical treatment is sufficient to control the arrhythmia or a repeat ablation is necessary where alternate triggers are sought.
All procedures have some risk, these include perforation of the heart, formation of clot in the heart while be working inside the heart, atrial oesophageal fistula and in rare cases even death.
Overall this is a very successful treatment.
Contact
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- Suite 30, Netcare Sunninghill Hospital, Sandton, Gauteng, South Africa, 2191