When the heart is functioning normally, it beats to a regular rhythm and the 2 upper and 2 lower chambers pump blood in a regular manner and flow. However, if the 2 upper chambers of the heart, known as the atria, beat in an irregular rhythm, and are not pumping in coordination with the 2 lower chambers, known as the ventricles, the flow of blood is disrupted and this can cause palpitations and shortness of breath. This condition, known as Atrial Fibrillation (AF) can be a recurring temporary condition or it may be chronic which means that it becomes permanent. Recurring episodes of AF are serious but not usually life-threatening but there is a serious risk that the disruption in the pumping rhythm can cause stasis of blood in upper chambers of the heart which could lead to the formation of blood clots.
There are several reasons why AF may occur. The most common include:
The most common symptoms of AF include:
These and other less common symptoms may be occasional, recur at frequent intervals or may be permanent.
A detailed medical history, physical examination, echocardiography (ECG), and thyroid function tests are conducted to ensure the treatment plan has no side effects due to underlying heart conditions. Doctors may treat underlying risk factors or causes, such as obesity, high blood pressure, overactive thyroid, high cholesterol, diabetes, or smoking.
Medications are the first course of action for AF treatment to prevent blood clot formation and reduce the heart rate, thereby restoring normal heart rhythm. Anti-arrhythmic medications are effective in restoring normal heart rhythm when administered immediately after AF onset at a suitably high dosage. Medications are recommended for patients who do not immediately require therapy. Beta-blockers, such as metoprolol or esmolol, and calcium channel blockers, such as diltiazem and verapamil, are commonly used for AF treatment.
Anti-coagulant therapy is essential before cardioversion (explained below) or when the onset of AF cannot be elucidated. It is vital for patients with AF as they are highly susceptible to blood clot formation in the atria (upper chambers of the heart), increasing stroke risk.
This procedure uses a mild electrical shock to restore normal heart rhythm. Although the method is of short duration, patient preparation takes a few hours. Preparation includes administering general anesthesia and placing electrodes on the chest and back, which are connected to the cardioversion machine. The machine records the heart’s electrical activity and sends mild electrical shocks to the heart to restore normal rhythm. After the procedure, the heart rhythm and blood pressure are monitored.
This procedure may dislodge blood clots, increasing stroke risk. Therefore, anti-clotting medications are recommended before or after the procedure. Electrical cardioversion is frequently coupled with anti-arrhythmic drugs to increase the chances of restoring normal heart rhythm.
A catheter (a thin, flexible wire) with a sensor at its tip is inserted into the neck or groin vein. The sensor applies heat energy (radio waves) to create scars in a specific area of the heart causing an irregular heartbeat. The scar neutralizes or re-routes the abnormal electrical signals causing the irregular heartbeat. This procedure is being successfully performed at Kauvery Hospital.
This safe and minimally invasive procedure is useful for paroxysmal atrial fibrillation treatment. It targets the tissue responsible for abnormal electrical signalling between the pulmonary vein and atria. A catheter is inserted into the vein in the groin area and guided to the heart. Once the pulmonary vein is accessed, the balloon is inflated and filled with a gas coolant. The cold temperature creates a scar and stops the abnormal transmission of electrical signals. This method reduces the risk of stroke or heart failure. Large areas of tissue can be treated, increasing the effectiveness of the process.
The Maze procedure is considered the best surgical treatment for AF. In Cox-Maze III, the surgeon makes multiple small incisions in a maze-like pattern to create scars in both atria. The scars block the abnormal electrical signals, ensuring the atria and ventricles (lower chambers of the heart) expand and contract in a timely fashion and in the correct order. The procedure involves transmural incisions (penetrating all the tissue layers) that permanently block abnormal electrical signals. Additionally, the removal of the left atrial appendage (a small tongue-shaped sac attached to the left atrium) reduces stroke risk, as blood trapped in the left atrial appendage can form clots.
The Cox-Maze IV procedure uses ablation techniques (heating or freezing heart tissue), rather than incisions, to create the scars.
A single ablation catheter is inserted into the vein near the groin area to deliver radio waves and knock out the AV node (involved in sending electrical signals from the atria to the ventricles). A pacemaker is implanted before or during the procedure to transmit electrical signals, resulting in a coordinated heartbeat. As this procedure involves a pacemaker, it is usually the last option for AF treatment.
When AF causes blood flow to slow down in the heart, this stagnant blood can form clots. These clots may become dislodged from the heart and travel to the brain or to any other part of the body. When this happens the supply of blood to the organ is reduced or may even be blocked. Without proper blood supply, the brain cells begin to die and this may result in, among other complications, paralysis, reduced mental ability and even death. This is known as an Embolic Stroke. An embolus is a clot that traveled from one part of the body to the other, usually from the heart.
It is estimated that about 1 in every 6 strokes is caused by AF and that those suffering from AF are 5 times more likely to suffer from a stroke as compared to those without this condition. Studies also show that a stroke caused by AF is twice as likely to be fatal or result in permanent disability as compared to strokes from other causes.
Atrial Fibrillation has become the commonest cause of a stroke in the elderly, of unknown cause, the so-called Cryptogenic stroke. On the brighter side, Atrial Fibrillation is now being detected efficiently by smartwatches and ELRs (external loop recorders) These are wearable devices which are the new age highly useful medical devices.
A healthy lifestyle can reduce the risk of AF and a resulting Embolic Stroke. A heart-healthy life will include:
Living in Salem? If you suspect you suffer from AF or any other heart condition, consult a doctor without delay. The earlier the condition is diagnosed and treatment begun, the greater the chances of recovery. Even if you do not have any symptoms of AF regular medical check-ups that include the heart will help to minimize the risk of AF or other cardiac conditions developing.
A full and thorough cardiac examination to determine the presence of a medical condition or the likelihood of one developing requires both a highly qualified and experienced cardiologist and a hospital with state-of-the-art medical equipment. A clean bill of health is the best outcome, but if that does not happen, in a hospital with a world-class Center of Excellence in Cardiology and Cardiac Surgery, you can be sure of receiving the best possible treatment and care.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
