Your GP should be the first point of contact when it comes to your general health. However, if your symptoms centre around your heart health, they are likely to refer you to a heart specialist, also known as a cardiologist. You may also be referred to an electrophysiologist – a cardiologist who specialises in the specific management of heart rhythm problems.
The first step is to find if there is a cause of the atrial fibrillation. This is be done through a series of tests, depending on your physical condition.
An Electrocardiogram, or ECG, is a test that records the electrical activity of your heart as well as its rhythm. ECG tests are non-invasive, painless, can be carried out in the hospital or by your GP and typically take around five minutes to complete. Small stickers, or electrodes, are placed on your arms, chest and legs and the ECG records your heart’s rhythm and displays it as waves on a monitor or on paper.
Heart monitoring is usually conducted if atrial fibrillation is suspected but only lasts for a short period of time. Four stickers are placed on your chest and connected by wires to a small portable monitoring device that is clipped on to a belt or worn from a neck strap It monitors your heart over a period of 24 to 48 hours. More recently, some hospitals use an ECG patch with waterproof glue that can be worn for 7-14 days
Cardiac ultrasound (a transthoracic echocardiogram) can be used to take moving pictures of your heart, looking at the size and strength of the muscle chambers and how well the valves work. It is painless and take 15-20 minutes.
Alternatively, a doctor may need a more unique perspective of your heart by using a transoesophageal echocardiogram, or ”TOE”. This device takes the form of a flexible tube that is inserted through the mouth and oesophagus by swallowing it and uses ultrasound to produce detailed pictures of the heart.
If your doctor suspects diabetes you may have a blood tests to look for this. You may need close monitoring of your blood pressure. If you snore heavily, stop breathing for short periods during the night and fall asleep during the day you doctor may refer you for a sleep study to look for obstructive sleep apnoea. If you are overweight your doctor can advise on exercise, diet and weight loss regimens.
To control atrial fibrillation, medicines, called antiarrhythmics, are used to restore the heart’s natural heart rhythm and control the rate at which the heart beats. The type of anti-arrhythmic medication that’s recommended depends on the type of atrial fibrillation you have, how healthy your heart is, what other prescribed medication you have and any side effects of these medications.
Cardioversion, also known as electrical cardioversion, is a treatment conducted to reset an abnormal heart rhythm back to normal. It is only done on people who are in atrial fibrillation and either need their rhythm returning to normal very quickly because it is extremely uncomfortable, or they have been in atrial fibrillation for many days and it won’t return to normal on it’s own. An electric shock is delivered by a defibrillator through two patches, one on the front and one on the side or back of the chest. Before the shock is delivered the patient is given either a general anaesthetic or heavy sedation so they do not feel the shock.
Ablation is a treatment of atrial fibrillation that uses carefully directed burning or freezing to deliberately create scars in the atriums that act as insulation and prevent the spread of the abnormal electrical impulses that cause the abnormal rhythm. Atrial fibrillation ablation is commonly used when medicines or other treatments prove ineffective, however, depending on the patient, it can also be used as the first treatment. The procedure is conducted by inserting thin wires, also known as catheters, into a vein at the top of the leg and feeding them up to the inside of the heart. It takes a few hours to do and can be done with local anaesthetic and sedation or with general anaesthetic. Ablations are done at specialist hospitals by cardiac electrophysiologists.
A stroke occurs when the blood supply to the brain is either interrupted or cut off and the brain cells are damaged or die. In order to maintain good brain health, the brain requires a continuous flow of blood which carries oxygen and vital nutrients.
To avoid the chances of a stroke, a combination of regular exercise, a healthy diet, avoiding smoking and alcohol and managing underlying conditions such as blood pressure and diabetes are recommended.
Atrial fibrillation can cause strokes directly. AF can the flow of blood in the left atrium to slow down so much it may start to clot. If a clot forms and is then dislodged and pumped out of the heart, it commonly goes through the circulation up to the brain, where it will block an artery and cause a stroke. In people with AF who are at high risk of a stroke, medication commonly called “blood thinners” are used to lower the risk by preventing clots. This can be warfarin (a vitamin K antagonist) or Direct Oral AntiCoagulants (DOACs, also known as NOACs) such as Apixaban, Dabigatran, Rivaroxaban and Edoxaban. Your doctor will help you decide if you are high risk and need protection by using the CHADS-VASc score and will advise you on the best anticoagulant to try.
In people who are in atrial fibrillation all the time (persistent or permanent AF) it is important to make sure the heart rate is not fast all of the time. You doctor will test your resting heart rate and if necessary prescribe medication to slow it down.