Atrial Fibrillation
Description: In normal heart rhythm (called sinus rhythm), a pacemaker called the sinus node fires off about once a second initiating a heart beat. Th
ere are other tissues in the atria which can act as pacemakers if the sinus node fails, and also the atrial tissues can conduct electricity. In atrial fibrillation pacemakers are firing off all over the atria creating chaotic electric circuits. This means the heart beats irregularly, usually too fast, the atrial do not contract normally but just fibrillate. This means they do not empty all the blood out of the atria and its appendages, clots can form and these can break off and go anywhere in the circulation causing a blocked artery anywhere in the body – leading to a stroke, heart attack, gangrene in leg etc.
Atrial fibrillation can be intermittent or continuous. The patient usually feels a change in heart rhythm, may feel faint as the rhythm changes and short of breath.
The cause of fibrillation is usually enlargement and stretching of the atria (the top chambers of the heart). This can happen with heart valve disease, high blood pressure or heart failure, however often no obvious cause can be found. Sometimes conditions like hyperthyroidism (excess thyroid hormone), diabetes, obesity, smoking, some drugs (asthma drugs, NSAIDs, steroids and drinking excess alcohol. Occasionally excess physical activity can precipitate an attack.
What your doctor can do
Investigations.
- Confirm what the abnormal rhythm is with an ECG, or a Holter monitor which is an ECG recorder worn for 24 hours to see what the rhythm is.
- To identify any possible cause for the fibrillation: an echocardiogram, blood tests or stress ECG.
Treatment –
- Sudden onset of atrial fibrillation – if possible go to hospital straight away, not that it is dangerous, but if caught in the first 12 – 24 hours the heart can be ‘shocked’ back into the normal rhythm under a general anaesthetic – cardioversion (click here).
Also, the hospital will use drugs to slow the heart rate, often intravenously – amiodarone, beta blockers, diltiazem or verapamil, magnesium.
If the fibrillation does not stop within 24 hours the patient is started on anticoagulants (sometimes heparin or clexane then warfarin or dabigatran.
The patient is then discharged and usually returns after 6 weeks to consider cardioverting now that there is no risk of any clots being present. - Intermittent attacks of atrial fibrillation – see if there is any obvious cause, if so avoid it – hard physical exercise, smoking, excess alcohol. Even drinking a very cold drink (the oesophagus runs beside the atria and the cold liquid can irritate the atria). Often patients are given a tablet – flecainide, beta blocker to take to stop the attack. Often the attacks just peter out, usually while resting or sleeping, and if they do not, then go to hospital as above.
- Persistent atrial fibrillation – three things need to be considered:
- Rate control – drugs such as diltiazem, verapamil or beta blockers (metoprolol) are usually used. Occasionally digoxin, which has been used for centuries, is used but rarely these days. If amiodarone is used to control rhythm and bring it back to normal, this should NOT be used long term as it has severe long-term side effects.
- Treating the underlying cause – high blood pressure, heart failure, hyperthyroidism etc.
- Anticoagulants to prevent clots forming in the atrial and then breaking off into the circulation (emboli). The decision on whether anticoagulation is needed is made using a number of factors – the CHADS2 score (high blood, pressure, heart failure, diabetes, previous stroke, age over 75). If none of these are present than maybe anticoagulation is not necessary, if one or more then anticoagulate. Drugs that can be used include aspirin – this is very weak and only stops 20% of clots and shouldn’t be used. Warfarin and dabigatran are the drugs currently recommended – the latter being easier to use as it does not require regular blood tests, and there is less risk of bleeding.
Procedures
- Electrophysiological therapy: electrophysiology catheters are placed in the atria, and can destroy pathways that are causing the fibrillation. This can be very successful, in the hands of a skilled operator.
What you can do :
Lifestyle
- First make sure you understand what atrial fibrillation means and if they are serious or just a nuisance. Reassurance can often make them disappear
- Then relax and stop worrying, because stress creates adrenaline which makes palpitations much worse.
- Study to see if anything precipitates them such as vigorous exercise, some foods, coffee, cigarettes, severe stress. If you can find a cause, try to avoid it.
- Routinely it is best to try stopping alcohol and caffeine ( coffee, tea, sports drinks etc) for a while. Do not drink very cold drinks, especially if you are hot.
Nutritional supplements –
- A good multivitamin/multimineral will make sure that the heart has all the nutrients and minerals it requires.
- Omega 3 fish oils,1–2 grams daily, can have a rhythm-controlling effect.
- Magnesium (and calcium). Magnesium is essential to keep the heart rhythm regular, therefore we use 800–1,000mg daily in all our patients with palpitations.
- CoEnzyme Q10 can improve the energy supply to the heart and may help some people with palpitations – try 100mg/day for a few weeks and see if it helps.
- Hawthorne has been used for heart disease for many centuries, and in many countries of Europe is part pf conventional medical therapy. It has a number of confirmed actions including stabilise heart rhythm, helps open arteries, improved heart function and has a mild sedative action. For people with intermittent atrial fibrillation, this may be very helpful. (Note it can interact with digoxin, and because it lowers the blood pressure any drugs which also lower BP may be enhanced).
- Some people ask if taking fish oils or vitamin E both of which have a mild anticoagulant action, can be used instead of warfarin or dabigitran. The answer is NO! A stroke or heart attack due to a clot in atrial fibrillation is usually major because the clots are so large. These supplements are just to weak to prevent these clots from forming.
The Nutritional supplements I use and recommend to my patients
For my patients with atrial fibrillation I recommend – USANA – Essentials, Biomega, Active Calcium plus, Coquinone –