ATRIAL FIBRILLATION (A-FIB)

To my children, who are very worried and concerned about their father, and who have asked me many questions about A-Fib. I am sorry that I am unable to answer all your questions, so I began a search on the computer to find as much information as I could to pass on to you. I have tried to condense the information so it isn’t overwhelming but I also didn’t want to change the context of the information. That being said, please read all of the following, I know it is a lot but it is informative. I have placed two asterisks (**) on a part about hypoglycemia (which my two dear sons both suffer from) and three asterisks (***) regarding Mike and his job, and four asterisks (****) regarding Debi and her exhaustive timetable, so please pay close attention and all of you know the areas that you need to address in your own lives (smoking, etc.). This is a Familial disease (so it runs in the family).  Also, please keep in mind that when dad has the Cardioversion he is no longer in A-Fib, so some of these problems are when he is in A-Fib. But when he falls back into A-Fib, we go back to the ultimate risks.  Love you all, Mom.

In Atrial Fibrillation (A-Fib) the upper part of your heart beats faster than the rest of your heart. If you could look inside your chest, the top part of your heart would be shaking like Jell-O or beating more rapidly than the lower section of your heart. You feel an uncomfortable flutter in your chest or like your heart is going to jump out of your ribs or that your heart is "flip-flopping around." Your pulse is irregular and/or more rapid than normal. You may feel lightheaded (fainting), very tired, have shortness of breath, sweating and chest pain, swelling in your legs, and sometimes a distressing need for frequent urination.

Somewhere in your heart extra electrical signals are being generated which cause the top part of your heart (the atria) to contract and quiver rapidly and irregularly (fibrillate) like a bag of worms. The atria can contract as many as 300-600 times a minute. Your whole heart, however, does not beat 300-600 times per minute.

Your heart is a muscular pump divided into four chambers---two atria located on the top and two ventricles on the bottom. Normally each heart beat starts in the right atrium where a group of cells called the Sinus Node generates an electrical signal that travels down an electrical road (the AV Node) that connects the atria to the ventricles. This electrical signal causes the heart to beat. First, the atria contract, pumping blood into the ventricles. Then, a fraction of a second later the ventricles contract sending blood throughout the body. Normally the heart beats at 60-80 times per minute. 

In A-Fib, electrical signals from other parts of the heart disrupt your heart's normal rhythm and cause the atria to beat or quiver rapidly on their own. However, only a small number of these atrial beats make it through the AV Node (which acts like a gate) to the ventricles. This is fortunate, because you couldn't live with a heart beat that rapid. But some A-Fib beats do make it through the AV Node and make your whole heart beat irregularly and/or faster than normal.

HOW SERIOUS AN ILLNESS IS A-FIB?

VERY RAPID, IRREGULAR HEART RATE
An A-Fib patient may develop an extremely rapid, irregular heart rate which can be life threatening. A very rapid, irregular heart rate can strain your heart, reduce your circulation to dangerous levels, and make you feel like you're going to faint from lack of oxygen.

STROKE RISK
The biggest danger from A-Fib is stroke. Because your heart isn't pumping out properly, blood can pool in your atria. Blood clots can form and travel to the brain causing stroke. An A-Fib stroke is worse than other causes of stroke. Half of all strokes associated with atrial fibrillation are major and disabling. Strokes in women are more disabling than in men.

There is also a danger of "silent" A-Fib strokes where stroke effects aren't evident but may appear like attention deficit, forgetfulness, and senile dementia. Silent A-Fib is very common.

BLOOD THINNERS
Warfarin reduces the risk of stroke by 60% to 70% in A-Fib patients but is not an absolute guarantee one will never have an A-Fib stroke. Be aware that warfarin has a risk of life-threatening bleeding. Warfarin may prevent an A-Fib (ischemic) stroke while somewhat increasing one's chances of a bleeding (hemorrhagic) stroke, particularly among the elderly.

A-FIB DAMAGES YOUR HEART, BRAIN & OTHER ORGANS
The upper parts of your heart (the atria) aren't pumping enough blood into the lower chambers of your heart (the ventricles). It's estimated that this reduces the amount of blood flowing to the rest of your body by about 15%-30%. You may not be getting enough blood to your brain and other organs which may cause weakness, fatigue, dizziness, fainting spells, swelling of the legs, and shortness of breath.

Recent studies indicate that A-Fib reduces mental abilities and may lead to dementia. Patients with A-Fib are 44% more likely to develop dementia.

A-Fib untreated can also lead to more serious heart rhythm problems, to symptoms of congestive heart failure, and to heart failure.  20-50% of patients suffering from A-Fib develop heart failure.

Very fast heart rates over time can strain the heart and cause a heart attack. Prolonged A-Fib episodes may stretch and weaken the heart muscle. A-Fib with a persistent rapid rate can cause a form of heart failure called tachycardia induced Cardiomyopathy, which can significantly increase mortality and morbidity. If you have A-Fib, you're more likely to die than someone in normal heart rhythm. A-Fib nearly doubles your chances of death.

A-FIB REMODELS YOUR HEART & IS A PROGRESSIVE DISEASE

In a process called "remodeling," your heart actually changes if you have A-Fib long enough. The fast, abnormal rhythm in your atria causes electrical changes and enlarges your atria. Your heart develops fibrosis, the formation of fibrous tissue in the heart. Your A-Fib episodes become more frequent and longer, often leading to continuous or Chronic A-Fib.

HOW DO YOU GET A-FIB (CAUSES)?

HEART PROBLEMS
If you've had other heart problems, this could lead to diseased heart tissue which generates the extra A-Fib pulses. Hypertension (high blood pressure), Mitral Valve disease, and Congestive Heart Failure seem to be related to A-Fib, possibly because they stretch and put pressure on the pulmonary veins where most A-Fib originates. 

HEAVY DRINKING
Heavy drinking may trigger A-Fib, what hospitals call "holiday heart"---the majority of A-Fib admissions occur over weekends or holidays when more alcohol is consumed. No association was found between moderate alcohol use and A-Fib. Healthy middle-aged women who consumed more than 2 drinks daily were 60% more likely to develop A-Fib.

SEVERE BODY & MIND STRESS
Extreme fatigue****, emotional stress, severe infections, severe pain, traumatic injury, and illegal drug use can trigger A-Fib. Low or high blood and tissue concentrations of minerals (electrolytes) such as potassium, magnesium and calcium can trigger A-Fib. Thyroid problems (hyperthyroidism), lung disease, reactive hypoglycemia**, viral infections, diabetes, and smoking can trigger A-Fib. Smoking cigarettes raises the risk of developing A-Fib even if one stops smoking, possibly because past smoking leaves behind permanent fibrotic damage to the atrium which makes later A-Fib more likely.
   
BEING OVERWEIGHT
As we put on pounds, our risk of developing A-Fib increases. Health problems linked to obesity, like high blood pressure and diabetes, can contribute to A-Fib. And obesity may put extra pressure on the pulmonary veins and induce A-Fib.

GENETICS
Some research has identified a Familial A-Fib where A-Fib is passed on genetically. A-Fib can run in families. The presence of a first-degree relative with A-Fib results in a doubling of the likelihood that other members of the family will develop A-Fib.

A-FIB TRIGGERS
Some cases have been reported where antihistamines, bronchial inhalants, local anesthetics, medications such as sumatriptan (a headache drug), tobacco use, MSG, cold beverages, high altitude, and even sleeping on one's left side or stomach are said to have triggered A-Fib. Chocolate in large amounts may trigger attacks. Chocolate contains a little caffeine, but also contains a milder cardiac stimulant. GERD (heartburn) and other stomach problems may be related to or trigger A-Fib. If so, antacids may help your A-Fib. Coffee may be antiarrhythmic and may reduce propensity and inducibility of A-Fib both in normal hearts and in those with focal forms of A-Fib.

SLEEP APNEA
Recent research indicates sleep apnea (where your breathing stops while you are sleeping) may contribute to A-Fib, probably by causing stress to the Pulmonary Vein openings. Many people have sleep apnea and don't know it. Your significant other can tell you if you snore a lot, which is often a sign of sleep apnea. If you have A-Fib, it might be wise to have yourself checked for sleep apnea.

MECHANICALLY INDUCED
Be careful if you work around equipment that vibrates. Certain frequencies and/or vibrations may possibly trigger or induce A-Fib.

VAGAL
If your A-Fib episodes occur usually at night, after a meal, when resting after exercising, or when you have digestive problems (because of the connection between the vagus nerve and the stomach, vagal afib can often follow stomach symptoms such as gas or stomach pains) you may have Vagal A-Fib.

ADRENERGIC
If your A-Fib is normally triggered by exercise, stress, stimulants, exertion***, etc., then you may have Adrenergically-Mediated A-Fib.

PHYSICAL AND GENDER CHARACTERISTICS
Endurance athletes have "enhanced Vagal tone" and are more prone to develop Vagal A-Fib.

A-Fib is often found in tall people, particularly basketball players. Being big and tall as a youth puts men at higher risk of developing A-Fib in older age. The risk of A-Fib was double for men in the highest quartile of body surface area at age 20. Men get A-Fib more than women.

AGING
A-Fib is associated with aging of the heart. As patients get older, the prevalence of A-Fib increases, roughly doubling with each decade. It's estimated that 70% of all A-Fib patients are between the ages of 65 and 85.This suggests that A-Fib may be related to degenerative, age-related changes in the heart. Inflammation may contribute to the structural remodeling associated with A-Fib.

TREATING A-FIB

The key to stopping A-Fib is to eliminate the extra electrical pulses A-Fib generates. Medications in general aren't very effective or have serious side effects.  Sometimes an electrical shock (Cardioversion) can return your heart beat to normal. 

Atrial Fibrillation is curable. An effective treatment to eliminate these extra electrical pulses is Pulmonary Vein Ablation. Under conscious sedation anesthetic (you aren't knocked out) or general anesthesia a soft, flexible tube (a catheter) with an electrode at the tip is inserted into a vein in your groin and moved into your heart. This catheter is directed to the precise location(s) in your heart that produce these extra signals. Using radiofrequency, laser, cryo or ultrasound energy these area(s) are burned off or isolated from your heart. All you feel is a little warmth or tingling. After the procedure you may feel a little tenderness or have some bruising in your groin where the catheter was inserted.  Otherwise the procedure is usually painless, because there are no nerve endings inside the heart or blood vessels.

Catheter ablation for A-Fib is one of the great medical breakthroughs of our time. Unfortunately with the current number of A-Fib doctors (and surgeons), they can take care of only a fraction of those developing A-Fib each year. Catheter and Surgical PVI ablations combined take care of less than 1% of the A-Fib population annually.

Please weigh the above statements carefully (the author is concerned that they may create unwarranted fear). How do you feel? If you don't feel any symptoms and your doctor says your heart isn't enlarging and/or developing poor ejection fraction, etc., then there's no need to rush out to get a Pulmonary Vein Ablation which does involve comparatively low but nevertheless real risk. Many people decide to simply live with A-Fib rather than undergo treatments to make them A-Fib free.

(The information above was taken (in part) from: Atrial-Fibrillation, Resources for Patients, written and published by Steve S. Ryan, Ph.D.) (http://www.a-fib.com/)