Atrial fibrillation and atrial flutter
Symptoms, types, causes, diagnosis, treatment and prevention
Things you need to know about Atrial fibrillation
What is atrial fibrillation?
The heart is made up of four chambers, two upper “atria” and the two lower “ventricles”. The heart beats in a rhythmic pattern due to triggering of electrical impulses generated in a bunch of nerve cells called sinoartial (SA) node located in the atrium. These impulses travel to the atrioventricular (AV) node located in the ventricle. An irregular and frequently rapid heart rate is called atrial fibrillation. It occurs due to chaotic electrical signals in the atria, so they quiver. Thus impulses are bombarded to the ventricles and they also may start to beat rapidly, a sign that differentiates atrial fibrillation from flutter. As a result, the heart rhythm becomes fast and irregular. In atrial fibrillation, the heart beat may range from 100 to 175 beats a minute as compared to the normal 60 to 100 beats a minute.
What are the symptoms of atrial fibrillation?
Atrial fibrillation at times may not have any symptoms but sometimes the following may be observed:
- Chest pain
- Confusion
- Decreased ability to exercise
- Dizziness
- Fatigue
- Lightheadedness
- Racing heartbeat or heart palpitations
- Shortness of breath
- Weakness
Such symptoms with chest pain should be immediately reported in hospital emergency.
What are the types of atrial fibrillation?
Depending on the frequency of the symptoms, it can be:
- Occasional orparoxysmal atrial fibrillation, that may stop on its own.
- Persistent atrial fibrillation, that may requiretreatment like medication or electrical shock.
- Long-standing persistentatrial fibrillation, which is continuous, sometimes persisting for >12 months.
- Permanentatrial fibrillation, which requires medications continuously.
What causes atrial fibrillation?
Atrial fibrillation occurs most commonly due to abnormalities or damage within the structure of heart. Some common causes of atrial fibrillation are:
- Conditions like Atrial septal defects, Sick sinus syndrome
- Defects of valves like mitral stenosis
- Heart attacks and congestive heart failure, coronary artery disease
- High blood pressure
- Hyperthyroid
- Lung diseases
- Previous heart surgery
- Sleep apnoea
- Stimulants like caffeine, tobacco or alcohol
- Stressful conditions
- Viral infections
What is atrial flutter?
Atrial flutter is a condition that is similar to atrial fibrillation, but with a more synchronized rhythm. It is an abnormal or chaotic atrial contraction without involvement of ventricles.
What are the symptoms and causes of atrial flutter?
Atrial fibrillation and flutter have same causes and risk factor. However, atrial flutter is usually not life-threatening if promptly treated.
Some of the common symptoms of atrial flutter are:
- Chest pain
- Dizziness
- Person can feel his own heart as pounding or racing
- Shortness of breath
- Sometime fainting or passing out
- Weakness or tiredness
Like, atrial fibrillation, atrial flutter is caused due to similar triggers. However, abnormal rhythm of heart is presented differently. Atrial flutter occurs from disturbed electrical impulses at right atrium. Thus, the atria beat at a faster rate 250 – 300 beats per minute. These rapid contraction impulses slow down by the time they reach ventricles through AV node. Ventricles beat at 150 beats per minute, relatively slower than atria. This causes flutter or tremor, as felt by the patient.
Atrial fibrillation and flutter belong to a larger group of conditions called Supra Ventricular Tachycardia. They may present as alternate episodes in some patients.
How is atrial fibrillation and atrial flutter diagnosed?
If you experience any symptom of atrial fibrillation or flutter, you must seek immediate medical attention at a hospital. Check for the availability of a cardiologist and related infrastructure like catheterization lab, ICCU (intensive cardiac care unit), and tests etc. The cardiologist will be able to diagnose it by:
- Medical History
- Physical examination
- Tests:
- Electrocardiogram (ECG)
- Holter monitor
- Event recorder
- Echocardiogram/Transesophageal echocardiography (TEE)
- Blood tests
- Stress test
- Chest X-ray
What is the treatment of atrial fibrillation and atrial flutter?
Treatment of atrial fibrillation is governed by frequency and type of fibrillation with underlying causes.
Cardioversion-resetting the heart’s rhythm can be conducted in two ways:
- Electrical cardioversion with electric shocks
- Cardioversion with drugs called anti-arrhythmic medications
Catheter and surgical procedures
Sometimes invasive procedures may be resorted to when the conservative approach doesn’t work.
- Catheter ablation:Long, thin tubes known as catheters with electrodes at the catheter tips are used to destroy the spots generating abnormal impulses.
- Surgical maze procedure:This is done using open-heart surgery, where a cardiac surgeon creates incisions in the atria to create scar tissue which interferes with stray electrical impulses that cause atrial fibrillation.
- Atrioventricular (AV) node ablation:Radiofrequency energy is used through area of AV node to destroy area causing abnormal impulses.
- Left atrial appendage (LAA) closure:After creating a hole in the left atrium, a device known as left atrial appendage closure device is inserted through a catheter which closes an appendage i.e a sac in the left atrium.
What are the risks of ablation and surgical procedures? What is its recovery time?
- Blood clot formation at the site of catheter insertion.
- Rapid abnormal heart rhythm.
- Perforation or damage in the surrounding areas of heart.
- Temporary heart block.
- Life threatening complications are rare.
Although the time of recovery may vary from person, but generally 6-8 weeks may be required for observation.
Atrial flutter ablation complications:
- After AV node ablation, blood-thinning medications may continuously be required to prevent strokes
- Although these procedures have a high success rate up to 90%, atrial fibrillation may recur
How can atrial flutter and fibrillation be prevented?
Lifestyle changes that improve the overall health of the heart can help like:
- Healthy nutritious diet
- Regular exercise
- Cessation of smoking and excess alcohol
- Maintain a healthy weight
- Control your blood pressure and cholesterol levels
- Maintain follow-up care with your cardiologist
To know more about atrial fibrillation, you can request for a call back and our atrial fibrillation and atrial flutter specialist will call you and answer all your queries
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References:
- Mayo Clinic. Atrial fibrillation. Available at: https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624 Accessed on March 3, 2018.
- American Heart Association. Atrial fibrillation. Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300294.pdf Accessed on March 3, 2018.
- US National Library of Medicine. Atrial fibrillation. Available at:https://medlineplus.gov/atrialfibrillation.html Accessed on March 3, 2018.
