What You Need to Know
There are excellent resources online that cover the basic concepts of AFIB so I will not repeat them here. I would like to summarize what I want my patients to know about Atrial Fibrillation (AFIB). When you see ads on prime time television advertising blood thinners such as Eliquis, Xarelto, and Pradaxa...you can be certain that millions of people have atrial fibrillation.
What is AFIB?
Atrial fibrillation is one of the most common cardiac rhythm disturbances (dysrhythmias). Rather than beating uniformly, the top chambers (atria) are ‘quivering’ or fibrillating. Blood cannot circulate properly, and clots may form in an area of the heart known as the atrial appendage. Patients who have a history of Congestive heart failure, Hypertension, Age of 75, Diabetes or blood vessel disease, or women—will have a higher risk of blood clots causing stroke. This CHADS-VASC2 score In patients with risk factors for stroke: HTN, age over 75, a weak heart, DM or a previous stroke, determines which patients require blood thinners.
What Causes AFIB?
High blood pressure.
CAD
Thyroid disease.
Stimulants: Alcohol. Medications. Possibly Caffeine.
Lung disease.
Infection.
Sleep Apnea.
Valvular heart disease.
More common with Obesity, Diabetes, Kidney disease.
What are the Three Goals of Therapy for AFIB?
1. Blood thinners to prevent stroke
2. Medications to control heart rate
3. Procedures and Medications to Re-establish normal (sinus) rhythm.
How Do You Treat AFIB?
1. Blood thinners:
a. Eliquis, Xarelto, Pradaxa.
b. Warfarin
2. Medications to control heart rate.
a. Beta blockers
b. Calcium channel blockers
3. Converting the heart back to normal rhythm.
a. Electrical Cardioversion.
b. Antiarrhythmic Medications
c. Atrial fibrillation ablation
Blood thinners:
Those with a CHADS-VASC2 score of >2, a blood thinner is required. There are two types of blood thinners: warfarin/coumadin vs. newer medications known as DOAC (Eliquis, Pradaxa, Xarelto, etc.). If you have AFIB all the time, known as chronic AFIB, then aspirin has no role. There may be a role for aspirin (asa) in patients who have AFIB once in a while (paroxysmal AFIB).
Medications to Control Heart Rate:
Medications to slow your heart rate down, such as Beta Blockers or Calcium Channel Blockers are prescribed. An older medication, digoxin may be used, if blood pressure is too low.
Converting Your Heart Back to Normal Rhythm:
This is known as Cardioversion. Cardioversion may be electrical or chemical. Most commonly, we refer to electrical cardioversion. i.e. using an electrical shock to convert your heart back to normal rhythm.
Antiarrhythmic Medications: More powerful, highly effective medications which maintain a normal rhythm. They do have a chance of causing irritable and potentially dangerous arrhythmias and careful monitoring is required.
AFIB ablation. A more complex procedure to ‘ablate’ or destroy the area of the heart (near the pulmonary veins) where AFIB occurs.
Prognosis?
AFIB is a ‘bothersome’ but a benign (safe) condition so long as you are protected from stroke (blood thinners) and your heart rate is controlled (beta or calcium channel blockers). But be aware...
AFIB is often difficult to ‘cure’.
Because there are so many options of therapy available (which are not all that successful in restoring/maintaining normal rhythm)—it becomes both time consuming, confusing and frustrating for many patients.
Back to Normal Rhythm
Once you are back in normal (sinus) rhythm after cardioversion there will be a monitoring period where you will continue blood thinners for 3-6 months. It’s a good idea to monitor your heart rhythm with a device known as Kardia or, if you have an iphone--an Apple Watch.
There are 2 week external heart monitors that are used and also implantable loop recorders.
Note: Understanding your heart condition is not difficult. Patients become frustrated and confused when doctors don’t explain things clearly. If you don’t understand what your doctor is talking about, then you won’t be able to ask meaningful questions. I hope that my posts provide you with a framework that you can build upon to become an active participant in your healthcare.
Stay Healthy!
Gregg Yamada MD FACC
Disclaimer: I hope you find my posts to be educational, pertinent, interesting, and thought provoking. The information provided is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Please schedule an appointment with your doctor to discuss these issues and to determine what is right for you.
© 2020. Gregg M. Yamada, MD FACC. All rights reserved
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