An in-depth discussion on atrial fibrillation

Esteemed consultant interventional and general cardiologist Dr Dwayne Conway provides an in-depth discussion on atrial fibrillation, explaining causes, treatment and if it can be reversed naturally. 

What is the main cause of atrial fibrillation?

Atrial fibrillation is an extremely common condition as people get older. In fact, it is so common that it can almost be considered a normal part of ageing for people who are around the age of 80.

Around one in five people over the age of 80 suffer from atrial fibrillation, indicating that the most important cause of atrial fibrillation is the natural ageing process, while the most common medical condition linked to atrial fibrillation is high blood pressure, because of the effect that high blood pressure has on the heart and because it is a commonly occurring condition. Similar to the way getting old is something that happens to everybody, high blood pressure happens to a very large number of people, therefore making it a frequent cause of atrial fibrillation.

It is rare for younger people to get atrial fibrillation but for those in whom it does occur, causes can differ. In younger people, it's more likely to be an inherited tendency which might come on spontaneously, or be triggered by a stimulant such as caffeine or alcohol. Furthermore, it may occur due to an acute illness like pneumonia, severe burns or due to having an operation.

What's the first line treatment for atrial fibrillation? Can it be stopped immediately?

When we treat atrial fibrillation we have to think about three aspects:

• The symptoms caused by atrial fibrillation and how can we relieve the symptoms that the patient is feeling.
• The atrial fibrillation itself and if we make it that go away, restoring a normal heart rhythm.
• What risk is the atrial fibrillation posing to patients and how can we lower that risk.

Restoring normal heart rhythm is not always the best way to lower the risk of problems because one of the most common consequences of atrial fibrillation, particularly in older people, is stroke. A stroke happens due to blood clots that form in in the left atrium of the heart and then travel through the bloodstream up to the brain. The most effective way of preventing stroke is with anticoagulation drugs. They don't do anything for the atrial fibrillation but make a big difference in reducing the risk of stroke.

In terms of treatments to improve the symptoms of atrial fibrillation, symptoms are often largely driven by the speed of the heart rate. In atrial fibrillation it tends to go quite fast, therefore medications that help to slow the heart rate down such as beta blockers, digoxin or diltiazem can be useful symptom relievers.

We don’t always try to restore normal heart rhythm, but there are medications available which can do this. However, they're not suitable for everyone. In addition, there is procedure available named cardioversion DC, which is extremely efficient and effective. However, unfortunately, people often relapse into atrial fibrillation meaning that it's not a strong long-term treatment.

Furthermore, another invasive procedure is atrial fibrillation ablation, which is designed to change the electrical structure within the atrium of the heart, to try to prevent the atrial fibrillation from reappearing.

It is typically used for people who've had episodes on and off of atrial fibrillation or where cardioversion has been used to eliminate atrial fibrillation. We will often use this procedure to stop a recurrence. However, it is a large procedure which is only used for a minority of cases. Anticoagulation drugs are much more commonly used.

What is the most common treatment for atrial fibrillation?

Anti-coagulation is the most commonly used treatment for atrial fibrillation, because the biggest problem for people with atrial fibrillation is the risk of stroke, and anticoagulation is the best way to prevent stroke.

However, it doesn’t treat the atrial fibrillation itself. The most commonly used medication for heart rhythm is beta blockers. They don't make a huge difference to the occurrence of atrial fibrillation but they do help to stop the atrial fibrillation from being quite so fast, helping people live with atrial fibrillation symptoms when it is present. They tend to not notice the palpitations and distressing symptoms but there are such a number of different drugs and treatments available, meaning that they're very long to list and have to be tailored to the individual patient.

Can atrial fibrillation go away?

This depends on the underlying cause. Again much of this relates to ageing process. For the majority of people with atrial fibrillation, it occurs because of an ageing process that is takes place within the left atrium of the heart.

There are several factors related to this, including a stretch in the size of the left atrium. This develops as a response to conditions such as high blood pressure or heart failure, where the atrium stretches up due to increased pressure.

Other factors include fibrosis in the atrium. A change in the actual structure within the atrial wall can happen with the stretching process, as well as with inflammatory problems, such as diabetes and ageing. If somebody is elderly with high blood pressure, heart failure and diabetes and they have atrial fibrillation, it's highly unlikely that the atrial fibrillation will go away or that it will go away for very long, meaning that they will probably live with atrial fibrillation for the rest of their life.

On the other hand, the majority of people under the age of 60 with healthy hearts have atrial fibrillation, or paroxysmal atrial fibrillation, which means that they have atrial fibrillation for periods of time and periods of normal heart rhythm; it comes and goes. As mentioned, treatments such as ablation and cardioversion can be used to encourage the heart to stay in its normal rhythm.

Cardioversion is successful as a short-term treatment but not long-term. Ablation works well but often requires one or two long procedures. However, it can help to prevent atrial fibrillation from recurring, sometimes even in people who have structurally abnormal hearts.

Can atrial fibrillation be reversed naturally?

Atrial fibrillation can be reversed naturally in some cases, but not in all. If the condition has been caused by irreversible problems, such as the effect of ageing or heart failure or permanent problems, it is unlikely to go away. If it's caused by something like a chest infection that puts a stress on the body or drinking too much alcohol, a change in the underlying condition can help the atrial fibrillation to go away naturally. Reducing alcohol intake, exercise and weight loss can all help.

Keeping fit will help to reduce the chance of atrial fibrillation and may promote normal rhythm in someone who's had an episode of atrial fibrillation, provided that they don't have other permanent problems that have triggered the atrial fibrillation.

If you have atrial fibrillation and would like to discuss this wirh Dr Conway, simply visit his Top Doctors profile today.