Atrial Fibrillation

Atrial Fibrillation

Introduction

Atrial Fibrillation means the upper chambers of the heart. These upper chambers of the heart start  beating chaotically quiet irregularly that is what is called as Atrial Fibrillation. Normally a heart beats  around 60-100 times per minute so the number of beats a heart should beat is determined by the  sinus node and its function but at times when there is an enlargement of atria or sometimes there is  an infection or inflammation of the atria what happens is these atria start beating chaotically so this  chaotic beating of the atria is called Atrial Fibrillation. In this video Dr. C Raghu TAVR expert in India explains  to  you all about Atrial Fibrillation, What are  the  types in Atrial Fibrillation? What are  the  complications of Atrial Fibrillation? How to detect Atrial Fibrillation?

Atrial Fibrillation means the upper chambers of the heart. These upper chambers of the heart start  beating chaotically quiet irregularly that is what is called as Atrial Fibrillation. Normally a heart beats  around 60-100 times per minute so the number of beats a heart should beat is determined by the  sinus node and its function but at times when there is an enlargement of atria or sometimes there is  an infection or inflammation of the atria what happens is these atria start beating chaotically so this  chaotic beating of the atria is called Atrial Fibrillation. In this Atrial Fibrillation in contrast to the 60- 100 beats per minute of the atrial contraction here the atrial rate is between 400-600 per minute so  the atria start beating very fast and quiet irregularly.

 

So if the atria beat very fast and irregularly what does it mean? 

It means that if a structure is beating at 400-600 per minute the beating is quiet ineffective so that is  what we call as atrial paralysis or the atria is not effectively functioning so atrial fibrillation leads to  dysfunction of the atrium

This atrium contributes to about 20% of heart output so when the atrium is dysfunctional the heart  pumping is reduced by around 20%.

 

Onset of Atrial Fibrillation

Atrial Fibrillation can be either

  • sudden onset
  • chronic
  • paroxysmal.

Acute Atrial Fibrillation: Atrial Fibrillation sometimes it happens suddenly like in the scenario of an  acute heart attack or in a scenario of an inflammation of pericardium or sometimes when there is a  sudden pulmonary embolism that means there is a blood clot within the blood vessels supplying the  lungs. In  those circumstances  there can be a  sudden onset of Atrial Fibrillation  so  this is called an  acute Atrial Fibrillation so once after the cause for the Atrial Fibrillation has been reversed there is a strong  chance  that  this  Atrial  Fibrillation  can  revert  back  to  normal  sinus  so  the  atrium  will  start  contracting at a much lower rate.

Chronic  Atrial  Fibrillation: The  other  type  of  Atrial  Fibrillation  is  a  Chronic  Atrial  Fibrillation  or  a  Chronic Persistent Atrial Fibrillation where the Atrial Fibrillation is present for more than a week in  duration and continues to persist. So that means that the Atrial Fibrillation does not come back to  sinus rhythm but in fact is present for beyond a week and continue to remain so for rest of the life so  that is what we call as Chronic Atrial Fibrillation or a long standing Atrial Fibrillation.

Paroxysmal  Atrial  Fibrillation: There  is  another  type  of  Atrial  Fibrillation  called  Paroxysmal  Atrial  Fibrillation that means Atrial Fibrillation is present for certain duration of time and then reverts back  to  sinus  rhythm  and  once  again  might  come  up again.  It  comes  and  goes  that  is  what  we  call  as  Paroxysmal Atrial Fibrillation.

 

Which type of Atrial Fibrillation is dangerous? 

All types of Atrial Fibrillation are dangerous.

 

Why they are dangerous?  

Atrial Fibrillation as we  understood  reduces  the  pumping ability  of  the  heart  by  20% in addition a  prolonged and fast rate of the heart fatigues the heart and reduces the heart pumping ability again  that is called left ventricular dysfunction

The most dreaded complication of Atrial Fibrillation is brain stroke because the atria are chaotically  contracting  or  they  are  inefficiently  contracting  there  is  pooling  of  blood  within  atrium  and  this  pooling of blood or stasis or stagnation of blood in the atrium leads to promotion of blood clots in  the atrial chambers. These blood clots which are present in  the atrial chambers because  the heart  continues to beat every minute every second so what happens is these small clots which are present  in  the atrial chambers get dislodged and potentially lead  to a brain stroke  these dislodge and  they  gets lodged in the brain vessels so that is called a brain stroke. So a patient with Atrial Fibrillation can  develop a heart dysfunction they can develop a brain stroke they can develop a sudden reduction in  the cardiac output so these are the various complications of Atrial Fibrillation.

 

How can we detect Atrial Fibrillation? 

We have seen that if the Atrial Fibrillation is chronic and persistent that can be easily detected by an  ECG or an Electrocardiogram. This is  the simplest inexpensive  test  to detect  the presence of Atrial  Fibrillation.

But if it is a Paroxysmal Atrial Fibrillation that means it comes and goes then we might have to use a  long  term  ECG  recording  technology  to  identify  or  diagnose  or  detect  the  presence  of  Atrial  Fibrillation.  So  there  are  numerous  technologies  to  identify  Atrial  Fibrillation  on  a  long  standing  basis. Some of them are external that means we put as a patch ECG outside or we connect multiple  electrodes  as  in  the  form  of a  Holter  monitoring  or  we  have  got  a  lot  of  novel  devices  like  the  Alivecor where you can just touch with the fingertips of the thumb to identify Atrial Fibrillation. So  number of technological advances have appeared to detect the presence of Atrial Fibrillation. Even  our Apple watch also  has got an Atrial Fibrillation  detection algorithm so an apple watch also  can

detect the  presence  of  Atrial  Fibrillation.  Quite  a  few  of  my  patients  tend  to  identify  their  Atrial  Fibrillation  from  their  apple  watch  so  you  have  got  simple  technologies  you  have  got  complex  technologies

The most complex technologies like where you can put an implantable loop recorder.  A small device  is implanted into the subcutaneous tissue that means beneath the skin and the muscle or the fat and  then this recorder will continue to record the heartbeat.

So you have got the simple technology like the ECG and a moderately complex technology like the  ECG  patch  or  the  Holter  recording  or  a  14  day  ECG  patch  is  also  available  and  finally  for  those  patients where the Atrial Fibrillation is very rare you can put an implantable loop recorder that can  last for about 2 years of the time.

So what happens is if these patients tend to have one episode of Atrial Fibrillation which is persistent  for more than 30 seconds then we can say that this patient has got an Atrial Fibrillation which could  be Paroxysmal in nature.

In  conclusion  lot  of  new  technologies  are  there  one  of  the  easiest  technology  is  the  apple  watch  somebody who is a patient you can use a Alivecor type of monitor. If the patient is newly diagnosed  or you want to confirm or make a diagnosis of Atrial Fibrillation you can use a Holter monitoring, a  patch ECG  for atleast 14 days. For one to diagnose Atrial Fibrillation atleast 14 days of recording is  required before we can say that this patient does not have Atrial Fibrillation.


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