Atrial fibrillation – Diagnosis and treatment – About Your Online Magazine


Diagnosis

To diagnose atrial fibrillation, your doctor can review your signs and symptoms, review your medical history and conduct a physical exam. Your doctor may order several tests to diagnose your condition, including:

  • Electrocardiogram (ECG). An ECG uses small sensors (electrodes) attached to the chest and arms to detect and record electrical signals as they travel through the heart. This test is the main tool for the diagnosis of atrial fibrillation.
  • Holter Monitor. This portable ECG device is carried in your pocket or placed on a belt or shoulder strap. It records your heart activity for 24 hours or more, which provides your doctor with an extended assessment of your heart rate.
  • Event recorder. This portable ECG device is intended to monitor your cardiac activity for a few weeks to a few months. When you experience symptoms of a fast heart rate, you press a button and an ECG strip from the previous and following minutes is recorded. This allows your doctor to determine your heart rate at the time of symptoms.
  • Echocardiogram. This test uses sound waves to create moving images of your heart. Usually, a wand-shaped device (transducer) is held on your chest. Sometimes, a flexible tube with the transducer is conducted through the throat to the esophagus. Your doctor may use an echocardiogram to diagnose structural heart disease or blood clots in the heart.
  • Bloodtests. This helps the doctor to rule out thyroid problems or other substances in the blood that can lead to atrial fibrillation.
  • Stress test. Also called an exercise test, stress testing involves running tests on the heart during exercise.
  • Chest X-ray. X-ray images help the doctor to see the condition of your lungs and heart. Your doctor may also use an X-ray to diagnose conditions other than atrial fibrillation that can explain your signs and symptoms.

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Treatment

The most appropriate atrial fibrillation treatment for you will depend on how long you’ve had atrial fibrillation, how uncomfortable your symptoms are, and the underlying cause of your atrial fibrillation. Generally, the treatment goals for atrial fibrillation are:

  • Restart the pace or control the rate
  • Prevents blood clots, which can decrease the risk of stroke

The strategy you and your doctor choose depends on many factors, including whether you have other heart problems and whether you are able to take medications that can control your heart rate. In some cases, more invasive treatment, such as catheter medical procedures or surgery, may be required.

In some people, a specific event or an underlying condition, such as a thyroid disorder, can trigger atrial fibrillation. Treating the disease that causes atrial fibrillation can help relieve your heart rate problems. If your symptoms are uncomfortable or if this is your first episode of atrial fibrillation, your doctor may try to reset the pace.

Restarting your heart rate

Ideally, to treat atrial fibrillation, heart rate and rhythm return to normal. To correct your condition, doctors can reset your heart to its normal rhythm (sinus rhythm) using a procedure called cardioversion, depending on the underlying cause of atrial fibrillation and how long ago.

Cardioversion can be done in two ways:

  • Electrical cardioversion. In this brief procedure, an electric shock is administered to the heart through paddles or patches placed on the chest. The shock interrupts the electrical activity of the heart for a brief moment. The goal is to redefine your heart’s normal rhythm.

    You will receive a sedative before the procedure, so you should not feel the electric shock. You can also receive medications to help restore your normal (anti-arrhythmic) heartbeat before the procedure.

  • Cardioversion with drugs. This form of cardioversion uses drugs called antiarrhythmic drugs to help restore normal sinus rhythm. Depending on your heart condition, you may be given medications intravenously or orally to help get your heart back to normal.

    This is usually done in the hospital with continuous monitoring of your heart rate. If your heart rate returns to normal, your doctor will often prescribe the same or similar antiarrhythmic medication to try to prevent further episodes of atrial fibrillation.

Before cardioversion, you can receive warfarin or another blood-thinning medication for several weeks to reduce the risk of blood clots and strokes. If your episode of atrial fibrillation lasted more than 48 hours, you may need to take this type of medication for at least a month after the procedure to prevent blood clots in the heart.

Maintain a normal heart rate

After electrical cardioversion, your doctor may prescribe antiarrhythmic drugs to help prevent future episodes of atrial fibrillation. Medicines can include:

  • Dofetilide
  • Flecainide
  • Propafenone
  • Amiodarone
  • Sotalol

While these drugs can help maintain a normal heart rate, they can cause side effects, including:

Rarely, they can cause ventricular arrhythmias – life-threatening rhythm disturbances originating in the lower chambers of the heart. These drugs may be needed indefinitely. Even with medication, there is a chance of another episode of atrial fibrillation.

Heart rate control

Medications may be prescribed to control the speed of your heartbeat and restore it to a normal pace.

  • Digoxin. This medicine can control your heart rate at rest, but not as well during activity. Most people need additional or alternative medications, such as calcium channel blockers or beta-blockers.
  • Beta blockers. These medications can help lower your heart rate at rest and during activity. They can cause side effects, such as low blood pressure (hypotension).
  • Calcium channel blockers. These medications can also control your heart rate, but they may need to be avoided if you have heart failure or low blood pressure.

Catheter and surgical procedures

Sometimes medications or cardioversion to control atrial fibrillation do not work. In such cases, the doctor may recommend a procedure to destroy the area of ​​cardiac tissue that is causing erratic electrical signals and restore the heart to its normal rhythm. These options may include:

  • Catheter ablation. During this procedure, the doctor inserts long, thin tubes (catheters) into your groin and guides them through the blood vessels to the heart. The tip of the catheter produces radiofrequency energy, extreme cold (cryotherapy) or heat to destroy areas of the heart tissue that are causing rapid and irregular heartbeats. Scar tissue forms, which helps signaling to return to normal. Cardiac ablation can correct arrhythmia without the need for drugs or implantable devices.

    Your doctor may recommend this procedure if you have atrial fibrillation and a normal heart and the medication does not improve your symptoms. It can also be useful for heart failure patients who have an implanted device and cannot take or tolerate antiarrhythmic drugs.

  • Maze procedure. There are several variations of the maze procedure. The doctor may use a scalpel, radiofrequency, or extreme cold (cryotherapy) to create a pattern of scar tissue that interferes with the lost electrical impulses that cause atrial fibrillation.

    Labyrinth procedures have a high success rate, but atrial fibrillation can return. If this happens, you may need another cardiac ablation or another cardiac treatment.

    Because the surgical labyrinth procedure (using a scalpel) requires open heart surgery, it is usually reserved for people who do not improve with other treatments or when it can be done during a necessary cardiac surgery, such as coronary artery bypass surgery or heart valve repair .

  • Ablation of the atrioventricular (AV) node. If medications or other forms of catheter ablation do not work or cause side effects, or if you are not a good candidate for these therapies, AV node ablation may be an option. The procedure involves using a catheter to deliver radiofrequency energy to the path (AV node) that connects the upper and lower cardiac chambers.

    The procedure destroys a small area of ​​cardiac tissue, preventing abnormal signaling. However, the upper chambers of the heart (atria) still tremble. It will be necessary to implant a pacemaker to keep the lower chambers (ventricles) beating correctly. You will need to take anticoagulants after this procedure to reduce the risk of a stroke due to atrial fibrillation.

Prevention of blood clots

Many people with atrial fibrillation or those undergoing certain treatments for atrial fibrillation are at an especially high risk of blood clots that can lead to stroke. The risk is even greater if other heart diseases are present along with atrial fibrillation.

Anticoagulants

Your doctor may prescribe blood thinning medications (anticoagulants), such as:

  • Warfarin. Warfarin can be prescribed to prevent blood clots. If warfarin is prescribed, carefully follow your doctor’s instructions. Warfarin is a powerful medication that can cause dangerous bleeding. You will need to have regular blood tests to monitor the effects of warfarin.
  • Newer anticoagulants. Several newer blood thinning medications (anticoagulants) are available to prevent strokes in people with atrial fibrillation. These medicines include dabigatran, rivaroxaban, apixaban and edoxaban. They have a shorter action than warfarin and generally do not require regular blood tests or monitoring by your doctor. These drugs are not approved for people who have mechanical heart valves.

Many people have episodes of atrial fibrillation and don’t even know it – so you may need anticoagulants for the rest of your life, even after your rhythm has returned to normal.

Left atrial appendage closure

Your doctor may also consider a procedure called closing the left atrial appendage.

In this procedure, doctors insert a catheter through a vein in the leg and, eventually, lead it to the upper left cardiac chamber (left atrium). A device called the left atrial appendage closure device is then inserted through the catheter to close a small sac (appendix) in the left atrium.

This can reduce the risk of blood clots in certain people with atrial fibrillation, since many blood clots that occur in atrial fibrillation form in the left atrial appendage. Candidates for this procedure may include those who have no heart valve problems, who are at increased risk of blood clots and bleeding and who cannot take anticoagulants. Your doctor will evaluate you and determine if you are a candidate for the procedure.

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Clinical tests

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means of preventing, detecting, treating or controlling this disease.

Lifestyle and home remedies

It may be necessary to make lifestyle changes that improve the overall health of the heart, especially to prevent or treat conditions such as hypertension and heart disease. Your doctor may suggest several lifestyle changes, including:

  • Eat heart-healthy foods. Eat a healthy diet low in salt and solid fats and rich in fruits, vegetables and whole grains.
  • Exercise regularly. Exercise daily and increase your physical activity.
  • Quit smoking. If you smoke and can’t stop on your own, talk to your doctor about strategies or programs to help you break your smoking habit.
  • Maintain a healthy weight. Excess weight increases the risk of developing heart disease. Healthy weight loss can help control the symptoms of atrial fibrillation and can improve the results of catheter ablation.
  • Keep your blood pressure and cholesterol levels in check. Make lifestyle changes and take prescription drugs to correct high blood pressure (hypertension) or high cholesterol.
  • Drink alcohol in moderation. Excessive alcohol consumption (drinking five drinks in two hours for men or four drinks for women) can increase your chances of atrial fibrillation. In some people, even modest amounts of alcohol can trigger atrial fibrillation.
  • Keep follow-up care. Take your medications as prescribed and have regular follow-up visits with your doctor. Tell your doctor if your symptoms get worse.

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Preparing for your appointment

If you think you may have atrial fibrillation, it is essential that you make an appointment with your family doctor. If atrial fibrillation is detected early, its treatment may be easier and more effective. However, you can be referred to a doctor trained in heart disease (cardiologist).

Since commitments can be brief and there is usually a lot to discuss, it is a good idea to be prepared for them. Here is some information to help you prepare for your appointment and what to expect from your doctor.

What can you do

  • Be aware of any pre-booking restrictions. When making an appointment, ask if there is anything you need to do in advance, such as restricting your diet. You may need to do this if your doctor orders blood tests.
  • Write down any symptoms you are experiencing, including anyone who may appear unrelated to atrial fibrillation.
  • Write down the main personal information, including any family history of heart disease, stroke, high blood pressure or diabetes and any major stress or recent changes in life.
  • Make a list of all medications, vitamins or supplements you are taking.
  • Take a family member or friend along, if possible. It can sometimes be difficult to understand and remember all the information provided to you during an appointment. Someone accompanying you may remember something you missed or forgot.
  • Write questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important, if time runs out. For atrial fibrillation, some basic questions to ask your doctor include:

  • What is probably causing my symptoms or condition?
  • What are the other possible causes for my symptoms or condition?
  • What kind of tests do I need?
  • What is the most appropriate treatment?
  • What foods should I eat or avoid?
  • What is the appropriate level of physical activity?
  • How often should I be screened for heart disease or other complications of atrial fibrillation?
  • What are the alternatives to the main approach you are suggesting?
  • I have other health problems. How can I better manage them together?
  • Are there any restrictions that I need to follow?
  • Should I consult an expert? How much will it cost and will my insurance cover an appointment with a specialist? (You may need to ask your insurance company directly for coverage information.)
  • Is there a generic alternative to the drug you are prescribing?
  • Are there brochures or other printed material that I can take home? Which sites do you recommend visiting?

In addition to the questions you have prepared to ask your doctor, do not hesitate to ask questions during your consultation.

What to expect from your doctor

Your doctor is likely to ask you a series of questions. Being ready to answer them can save time to review any points on which you want to spend more time. Your doctor may ask:

  • When did you start feeling the symptoms?
  • Are your symptoms continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, seems to make your symptoms worse?

Paula Fonseca